Skip to main content
Log in

Effect of tonsillectomy on humeral and cellular immunity: a systematic review of published studies from 2009 to 2019

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Although tonsillectomy is the most commonly performed surgical operation for children, its postoperative effect on the immune response was a source of debate among physicians.

Purpose

The aim of this systemic review was study the effect of tonsillectomy on children immune response.

Data sources

PubMed, Medline, Embase and Cochrane Library.

Review methods

All relevant articles published English language addressing the effect of tonsillectomy on the immune system were included. One investigators extracted data regarding: year of the study, sample size, study design, sample size, timing of analysis, studied immune factors, result and conclusion were identified. Another investigator independently reviewed data accuracy.

Results

Ten articles published between from January 2009 to January 2019 in about this issue that included 404 children were reviewed. All reviewed studies showed a non-significant difference between levels of indicators of the humeral immunity (IgA, IgG, IgM, C3 and C4) pre- and postoperatively. Studies that measured these indicators only after surgery, showed a non-significant difference in their levels between patients and healthy controls. Levels of indicators of cellular immunity (CD4+ , CD3+ , CD8+ , CD19+ , CD25+ , CD16+ , CD+ 56) showed slight reduction or increase in some studies but without a significant difference compared to their levels preoperatively, postoperatively at different intervals or with healthy controls. Other studies found no changes in these indicators postoperatively.

Conclusion

There was enough evidence to conclude that tonsillectomy has no negative affect on both humeral and cellular immunity of children

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Brandtzaeg P (2011) Potential of nasopharynx-associated lymphoid tissue for vaccine responses in the airways. Am J Respir Crit Care Med 183(12):1595–1604

    Article  Google Scholar 

  2. Kato A, Hulse KE, Tan BK, Schleimer RP (2013) B-lymphocyte lineage cells and the respiratory system. J Allergy Clin Immunol 131(4):933–957

    Article  CAS  Google Scholar 

  3. Menche N (2012) Biologie anatomie physiologie. Urban and Fischer, Munich.

  4. Jović M, Avramović V, Vlahović P, Savić V, Veličkov A, Petrović V (2015) Ultrastructure of the human palatine tonsil and its functional significance. Rom J Morphol Embryo 56(2):371–377

    Google Scholar 

  5. Poholek AC, Craft J (2009) Competing for help: new insights into the function of follicular helper T cells. Immunol Cell Biol 87(6):438–439

    Article  CAS  Google Scholar 

  6. Palomares O, Ruckert B, Jartti T, Kucuksezer UC, Puhakka T, Gomez E et al (2012) Induction and maintenance of allergen-specific FOXP3+ Treg cells in human tonsils as potential first-line organs of oral tolerance. J Allergy Clin Immunol 129(2):510–520

    Article  CAS  Google Scholar 

  7. McClory S, Hughes T, Freud AG, Briercheck EL, Martin C, Trimboli AJ et al (2012) Evidence for a stepwise program of extrathymic T cell development within the human tonsil. J Clin Invest 122:1403–1415

    Article  CAS  Google Scholar 

  8. Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C, Crameri R et al (2004) Immune responses in healthy and allergic individuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med 199:1567–1575

    Article  CAS  Google Scholar 

  9. Santos FP, Weber R, Fortes BC, Pignatari SS (2013) Short and long term impact of adenotonsillectomy on the immune system. Braz J Otorhinolaryngol 79(1):28–34

    Article  Google Scholar 

  10. Isaacson G, Parikh T (2008) Developmental anatomy of the tonsil and its implications for intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol 72(1):89–96

    Article  Google Scholar 

  11. Piessens P, Hens G, Lemkens N, Schrooten W, Debruyne F, Lemkens P (2012) Effect of adenotonsillectomy on the use of respiratory medication. Int J Pediatr Otorhinolaryngol 76(6):906–910

    Article  CAS  Google Scholar 

  12. Faramarzi A, Shamsdin AA, Ghaderi A (2006) IgM, IgG, IgA serum levels and lymphocytes count before and after adenotonsillectomy. Iran J Immunol 3(4):187–191

    CAS  PubMed  Google Scholar 

  13. Bitar MA, Dowli A, Mourad M (2015) The effect of tonsillectomy on the immune system: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 79(8):1184–1191

    Article  Google Scholar 

  14. Tanaka T, Couser WG, Nangaku M (2011) The role of humoral and cell-mediated adaptive immune response, an update on glomerulopathies - etiology and pathogenesis. Prof. Sharma Prabhakar (Ed.), ISBN: 978-953-307-388-0, InTech https://www.intechopen.com/books/anupdate-on-glomerulopathies-etiology-and-pathogenesis/the-role-of-humoral-and-cell-mediated-adaptiveimmune-response. Accessed 14 July 2018

  15. Byars SG, Stearns SC, Boomsma JJ (2017) Increased risk of many early-life diseases after surgical removal of adenoids and tonsils in childhood. https://www.biorxiv.org/content/biorxiv/early/2017/07/05/158691.full.pdf. Accessed 14 July 2018

  16. Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters M, Santaguida PL, Shamliyan T, Singh K, Tsertsvadze A, Treadwell JR (2008) Assessing the risk of bias of individual studies in systematicreviews of health care interventions. In: Methods guide for effectiveness and comparative effectiveness reviews. US Department of Health and Human Services, Rockville.

  17. Kaygusuz I, Cengiz H, Godekmerdan A et al (2009) Evaluation of longterm impacts of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol 73(3):445–449

    Article  Google Scholar 

  18. Hessan HS, Abbas AM (2012) Determination of serum immunological parameters in children with recurrent acute tonsillitis after tonsillectomy. Med J Babylon 9(3):563–569

    Google Scholar 

  19. Amintehran E, Kamrava SK, Ghalebaghi B, Behzadi AH, Sobhkhiz A, Javadinia S (2012) Serum immunologbulin values and lymphocytes phenotypes in children undergoing adneotonsillectomy. Int J Clin Pediatr 1(1):25–29

    Google Scholar 

  20. Nasrin M, Miah MRA, Datta PG, Saleh AA, Anwar S, Saha KL (2012) Effect of tonsillectomy on humoral immunity. Bangladesh Med Res Counc Bull 38:59–61

    Article  CAS  Google Scholar 

  21. Zhou C, Dai Z (2011) Postoperative changes of immunity in children undergoing adenoidectomy with tonsil ablation or with partial tonsillectomy. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zh 25(21):990–992

    CAS  Google Scholar 

  22. Elmagd EA, Meguid MM, Ali SS, Ahmed SS, Ismail AM (2013) Effect of tonsillectomy on cellular and humoral immunity in children in qena governorate. Life Sci J 10(4):3426–3441

    Google Scholar 

  23. Dai ZY, Huang DY, Zhou CY (2014) Effects of partial tonsillectomy on the immune functions of children with obstructive sleep apneahypopnea syndrome at early stage. Genet Mol Res 13:3895–3902

    Article  CAS  Google Scholar 

  24. Pidelaserra Martí G, Isdahl Mohn KG, Cox RJ, Brokstad KA (2014) The influence of tonsillectomy on total serum antibody levels. Scand J Immunol 80(5):377–379

    Article  Google Scholar 

  25. Cassano M, Russo G, Granieri C, Ciavarella D (2018) Modification of growth, immunologic and feeding parameters in children with OSAS after adenotonsillectomy. Acta Otorhinolaryngol Ital 38(2):124–130

    CAS  PubMed  Google Scholar 

  26. Zielnik-Jurkiewicz B, Jurkiewicz D (2002) Implication of immunological abnormalities after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 64(2):127–132

    Article  Google Scholar 

  27. Kaygusuz I, Godekmerdan A, Karlidag T, Keles E, Yalcin S, Aral I, Yildiz M (2003) Early stage impacts of tonsillectomy on immune functions of children. Int J Pediatr Otorhinolaryngol 67:1311–1315

    Article  Google Scholar 

  28. Ikinciogullari A, Dogu F, Ikinciogullari A, Egin YE, Babacan E (2002) Is immune system influenced by adenotonsillectomy in children? Int J Pediatr Otorhinolaryngol 66:251–257

    Article  Google Scholar 

  29. Ventura EV, Guerrero DG, Reina PG, Lopez DA (2000) Serum immunoglobuline levels in tonsillectomized patients: an unsolved mystery. Acta Otorhinolaryngol Esp 51:403–440

    Google Scholar 

  30. El-Ashmawy S, Taha A, Fatt-hi A, Basyouni A, Zaher S (1980) Serum immunoglobulins in patients with chronic tonsillitis. J Laryngol Otol 94(9):1037–1045

    Article  CAS  Google Scholar 

  31. López-González MA, Sánchez B, Mata F, Delgado F (1998) Tonsillar lymphocyte subsets in recurrent acute tonsillitis and tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 43(1):33–39

    Article  Google Scholar 

  32. Moreno PM, Sanchez M, Sainz M, Gutierrez F (1992) Changes in immunological response in tonsillectomized children. II. Decreased cellular response. Clin Otolaryngol Allied Sci 17(5):380–382

    Article  CAS  Google Scholar 

  33. Lesinskas E, Drigotas M (2009) The incidence of adenoidal regrowth after adenoidectomy and its effect on persistent nasal symptoms. Eur Arch Otorhinolaryngol 266:469–473

    Article  Google Scholar 

  34. Kim SY, Lee WH, Rhee CS, Lee CH, Kim JW (2013) Regrowth of the adenoids after coblation adenoidectomy: cephalometric analysis. Laryngoscope 123:2567–2572

    PubMed  Google Scholar 

  35. Van Kempen MJ, Rijkers GT, Van Cauwenberge PB (2000) The immune response in adenoids and tonsils. Int Arch Allergy Immunol 122:8–19

    Article  Google Scholar 

  36. Lenander-Lumikari M, Tenovuo J, Puhakka HJ et al (1992) Salivary antimicrobial proteins and mutans streptococci in tonsillectomized children. Pediatr Dent 14:86–91

    CAS  PubMed  Google Scholar 

  37. Emerick KS, Cunningham MJ (2006) Tubal tonsil hypertrophy: a cause of recurrent symptoms after adenoidectomy. Arch Otolaryngol Head Neck Surg 132(2):153–156

    Article  Google Scholar 

  38. Yamauchi S, Ikeda M, Yoshida A, Okamoto K (1981) Immunological considerations in patients with tonsillar lesions, Tokai. J Exp Clin Med 6:181–192

    CAS  Google Scholar 

  39. Sennaroglu L, Onerci M, Hascelik G (1993) The effect of tonsillectomy and adenoidectomy on neutrophil chemotaxis. Laryngoscope 103(12):1349–1351

    CAS  PubMed  Google Scholar 

Download references

Funding

No funding and financial relationships to disclose.

Author information

Authors and Affiliations

Authors

Contributions

RGA had the idea for the article, RGA performed the literature search and data analysis, SA drafted and critically revised the work.

Corresponding author

Correspondence to R. G. Altwairqi.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Altwairqi, R.G., Aljuaid, S.M. & Alqahtani, A.S. Effect of tonsillectomy on humeral and cellular immunity: a systematic review of published studies from 2009 to 2019. Eur Arch Otorhinolaryngol 277, 1–7 (2020). https://doi.org/10.1007/s00405-019-05672-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05672-6

Keywords

Navigation