The Effect of Tonsillectomy on the Immune System

Abstract

Objective: Parents of children undergoing tonsillectomy often ask about its effect on their child’s immunity. To answer this question, we conducted a thorough review of the literature, including an unpublished study we previously conducted.

Method: A Medline search was conducted. All articles up to January 2012 addressing the effect of tonsillectomy on the immune system were included. No exclusion criteria were used. We previously studied 19 patients undergoing total or partial tonsillectomy. Preoperative and postoperative serum and saliva immunoglobulin levels were taken.

Results: We reviewed 27 articles, published between 1971 and 2010, including 1665 patients (aged 1.5 to 45 years). The studies looked at different parameters, for example, serum immunoglobulins, salivary immunoglobulins, and delayed hypersensitivity test. The lack of standardization of diagnostic tools, follow-up duration, indication for tonsillectomy, and patients’ ages precluded a meta-analysis. Six studies (722 patients) found that tonsillectomy negatively affects the immune system, while 21 studies (943 patients) showed no effect. In our study, there was statistically nonsignificant decrease in secretory IgA level after both total (178.02 to 95.01 µg/mL) and partial (197.24 to 111.34 µg/mL) tonsillectomy.

Conclusion: Though the reviewed studies had variability in many aspects, one is more likely to believe that tonsillectomy has no significant effect on the immune system. Articles supporting this conclusion were more recent and had a more comprehensive assessment of the immune system.