(Adeno)tonsillectomy: what is the impact on the immune system?

Objectives: The effect of (adeno)tonsillectomy (ATE) on the immune system is still a point of discussion. In this study, we investigate the local and systemic immunological consequences of removing (adeno)tonsillar tissue, based on changes in immunoglobulin (Ig) levels, T and B lymphocyte counts, and frequency of pre- and post-operative upper airway infections. Methodology: We performed a literature review and included six studies examining short-term effects (≤1 year postoperative) and six studies examining long-term effects (≥1 year post-operative) of ATE on humoral and cellular immunity. The use of medication, frequency of visits to the doctor, cost-effectiveness of the procedure, and quality of life pre- and post-operatively were also used as outcome parameters for long-term effects. Results: In the short term, only one study showed a significant post-operative decrease in IgA, IgM, and IgG levels, as well as cytotoxic T-lymphocyte count. Two studies noted both a significant decrease in IgG levels and a significant increase in T helper cells. No significant change in Ig levels or lymphocyte counts were observed after ATE in the long term. Conclusion: There is no evidence that ATE compromises the immune system in either the short or long term. Physicians and researchers agree that ATE is an effective treatment for recurrent adenotonsillitis that improves quality of life and reduces the frequency of upper airway infections. However, additional long-term and large-scale studies are needed.