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Kim JY, Ko I, Kim DK, Yu MS. Adenotonsillectomy Does not Alter the Risk of Upper Airway Infections in Children. Laryngoscope 2021; 131:2376-2383. [PMID: 33720418 DOI: 10.1002/lary.29506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/29/2021] [Accepted: 02/19/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Given the conflicting evidence regarding adenotonsillectomy and the risk of upper airway infections (UAIs), including acute pharyngitis (APT), rhinosinusitis (ARS), and otitis media (AOM), we evaluated the risk of developing UAIs following adenotonsillectomy in a childhood population. METHODS In this population-based follow-up study, we used data from the National Health Insurance Service-National Sample Cohort. The adenotonsillectomy group (n = 2,377) included patients aged <10 years who underwent an adenotonsillectomy. For every patient with APT (n = 2,309), ARS (n = 2,308), and AOM (n = 2,207) who had an adenotonsillectomy, four participants were randomly selected for the control groups (n = 9,204, n = 9,196, and n = 8,788, respectively) using propensity score matching. The number of postoperative hospital visits for UAIs was recorded for 1 to 9 years, and the equivalence test was used to compare the number of visits between the adenotonsillectomy and control groups. RESULTS There were no significant differences in the incidence of APT, ARS, or AOM at the margin of equivalence of difference (-0.5 < 95% confidence interval of difference < 0.5) between the two groups from postoperative year 1 to year 9. The hospital visits for these diseases gradually decreased over time in both groups. There was a significant decrease in the number of visits for APT, ARS, and AOM in the 5-9 years age group when compared with those in the <4 years age group (P < .01). CONCLUSION Our results suggest that adenotonsillectomy does not alter the frequency of UAIs in children. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea.,Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Radman M, Ferdousi A, Khorramdelazad H, Jalali P. Long-term impacts of tonsillectomy on children's immune functions. J Family Med Prim Care 2020; 9:1483-1487. [PMID: 32509637 PMCID: PMC7266207 DOI: 10.4103/jfmpc.jfmpc_935_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/20/2023] Open
Abstract
Background There exist a wide level of discrepancy regarding the role of tonsils and its indication among pediatricians and ENT specialists. This fact sometimes causes confusion and delay in making the right decisions by parents and specialists for appropriate treatment of patients. Objectives Thus, the aim of this study was to investigate the effects of long-term tonsillectomy on the immune system of patients. Methods In this case-control study we measured the status of immune system in 34 children (aged 9-15 years) following 4 to 6 years of tonsillectomy. We have also enrolled 30 healthy children with similar age group. Venous blood samples were taken and the serum levels of IgG, IgA, and IgM were detected along with expression of CD4, CD8, CD10 and CD56. Data were analyzed by SPSS version 18 software and a P < 0.05 was considered as significant. Results We found that the mean serum levels IgM, IgA, and IgG in the case group was significantly (P < 0.0001) lower than the control group. Whereby, the CD4, CD8 and CD56 expressions was examined, there was no significant difference in both groups while only CD10 expression was lower in tonssiloctomized patients (P = 0.108). Conclusion Overall, according to these findings, CD10 as a marker of B lymphocytes in children undergoing tonsillectomy was significantly less than those healthy children. This may indicate a decrease in B cells and further reduced antibody production in these patients.
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Affiliation(s)
- Masoud Radman
- Clinical Research Development Unit (CRDU), Moradi Hospital, Rafsanjan, Iran
| | - Asiyeh Ferdousi
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Khorramdelazad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan, Iran
| | - Pooneh Jalali
- Family Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Cassano M, Russo G, Granieri C, Ciavarella D. Modification of growth, immunologic and feeding parameters in children with OSAS after adenotonsillectomy. ACTA ACUST UNITED AC 2019; 38:124-130. [PMID: 29967551 DOI: 10.14639/0392-100x-1380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 03/11/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY Obstructive sleep apnoea syndrome can cause growth delay in children. Adeno-tonsillectomy can resolve the syndrome in most cases. The aim of our study is to examine modifications in clinical and laboratory growth and immunological parameters and food intake changes in OSAS children after surgery. Twenty-eight children with severe OSAS associated with adeno-tonsillar hypertrophy were submitted to paediatric evaluation to calculate auxologic parameters (weight, height, BMI and standard deviation scores), a blood draw to evaluate growth (GH; IGF-1) and immunological parameters (IgG; IgA; IgM) and a dietitian evaluation to calculate caloric intake before and after 3 months following adeno-tonsillectomy. Mean height and weight values in the study group were slightly inferior to same-age children mean according to the percentile values. After surgery, both height and BMI increased significantly at 3-months follow-up: mean height increased 2.93 cm (p = 0.0001); BMI values greatly increased by 0.72 kg/m2 (p = 0.009). Standard deviation scores increased significantly for height (p = 0.03), weight (p = 0.001) and BMI (p = 0.001). These values significantly increased, despite almost unchanged caloric intake between the pre- and post-surgery period (90 ± 24 vs 91 ± 27 kcal/kg/day; p > 0.05). In all children, age-related GH values were normal and did not show any significant increase, while IGF-1 values significantly increased during the study period (p = 0.01). Regarding immunological parameters, only IgA levels decreased after surgery and maintained a value that was higher than normal (> 70 mg/dL). In conclusion, children affected by adenotonsillar hypertrophy and OSAS do not show significant growth delay, but they do experience a slowdown in growth rate. After adeno-tonsillectomy, the speed of growth soon increases, as weight and growth increase notwithstanding an unchanged food intake. Moreover, surgery does not cause reduction in the efficiency of the immune system.
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Affiliation(s)
- M Cassano
- Department of Clinical and Experimental Medicine, Section of Otorhinolaryngology, University of Foggia, Italy
| | - G Russo
- Department of Clinical and Experimental Medicine, Section of Otorhinolaryngology, University of Foggia, Italy
| | - C Granieri
- Department of Clinical and Experimental Medicine, Section of Otorhinolaryngology, University of Foggia, Italy
| | - D Ciavarella
- Department of Clinical and Experimental Medicine, Dental School, University of Foggia, Italy
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Long-term effects of adenotonsillectomy on serum-specific immunoglobulin E. Pediatr Res 2017; 82:801-805. [PMID: 28700564 DOI: 10.1038/pr.2017.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/12/2017] [Indexed: 11/08/2022]
Abstract
BackgroundThe biased immune reactions of the adenotonsillar tissues are not always reflected by the serum immunoglobulin E (IgE); thus, we hypothesize that the systemic atopic status may not be changed after the adenotonsillectomy (AT) in children.MethodsTwenty-five children with AT and 23 age-matched healthy children were enrolled into this study, and followed up for ~4 years. Nasal Symptoms Scores (NSS), Quality of Life Scores (QOLS), specific IgE (sIgE), cytokines, and inflammatory cell were documented in all the subjects before and after study.ResultsFourteen patients and three healthy controls had positive serum sIgE levels (>0.35 kU/l) at the study-start that was not changed by the study-end. Two patients and two sIgE-negative healthy controls showed the Dermatophagoidespteronyssinus sensitization at the study-end. NSS and QOLS showed significant improvement after the surgery in the sIgE-positive patients (P<0.05), whereas no significant changes were found in the sIgE-negative patients (P=1.00). In addition, the serum sIgE-negative patients showed significant increases in interleukin (IL)-4, IL-5, and IL-10 levels in the serum (P<0.001), although no significant differences were found post surgery (P=0.667, 0.408, and 0.714, respectively).ConclusionsOur study showed that AT did not affect the pediatric atopic status. The systemic atopy may be independent of the tonsillar and adenoid tissues in children.
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Bitar MA, Rameh C, Ataya NF, Najarian A, Chakhtoura M, Abdelnoor A. Alterations in Humoral Immunity After Partial Versus Total Tonsillectomy: A Pilot Study and Systematic Review of Literature. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-6214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bitar MA, Dowli A, Mourad M. The effect of tonsillectomy on the immune system: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2015; 79:1184-91. [PMID: 26055199 DOI: 10.1016/j.ijporl.2015.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/12/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Abstract
IMPORTANCE The immunological sequelae of tonsillectomy in children have been a source of debate among physicians and a continuous concern for parents. Contradictory pertinent results exist in the literature. OBJECTIVE To understand the real effect of tonsillectomy on the immune system. DATA SOURCES MEDLINE, EMBASE and COCHRANE. STUDY SELECTION Articles addressing the effect of tonsillectomy on the immune system, up to Dec 2014. Related keywords and medical subject headings were used during the search. The abstracts were reviewed to determine suitability for inclusion based on a set of criteria. Manual crosscheck of references was performed. DATA EXTRACTION We checked the tests results and the conclusion of each study to classify it as supporting or refuting the hypothesis of a negative effect of tonsillectomy on the immune system. RESULTS We reviewed 35 articles, published between 1971 and 2014, including 1997 patients. Only Four studies (11.4%), including 406 patients (20.3%) found that tonsillectomy negatively affects the immune system. We performed a separate meta-analysis on various reviewed humoral and cellular immunological parameters (e.g. total and specific serum Ig's, SecIgA, cellular immunity, and Ag specific Ig). There is more evidence to suggest that tonsillectomy has no negative clinical or immunological sequalae on the immune system. Study limitations included heterogeneity in the diagnostic tools, timing of testing, indication for tonsillectomy and patients' age. CONCLUSION It is reasonable to say that there is enough evidence to conclude that tonsillectomy has no clinically significant negative effect on the immune system. It will be important for future studies to uniformly use both preoperative and control laboratory tests' levels to compare the postoperative levels with, to have short and long term follow-up levels, and to include both humoral and cellular immunity in their measurements. RELEVANCE The results should reassure both surgeons and parents that tonsillectomy has no proven clinical sequalae. If more research is to be done in the future, it should be performed in a standardized way to avoid the heterogeneity seen in the literature.
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Affiliation(s)
- Mohamad A Bitar
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Department of Pediatrics & Adolescent Medicine, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Department of ENT Surgery, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Alexander Dowli
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Maine Medical Center, Portland, ME, USA
| | - Marc Mourad
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon
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Wang YP, Wang MC, Lin HC, Lee KS, Chou P. Tonsillectomy and the risk for deep neck infection-a nationwide cohort study. PLoS One 2015; 10:e0117535. [PMID: 25849535 PMCID: PMC4388732 DOI: 10.1371/journal.pone.0117535] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/26/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although the tonsils contribute to first line immunity against foreign pathogens in the upper aero-digestive tract, the association of tonsillectomy with the risk of deep neck infection remains unclear. The aim of this study was to assess the incidence rate and risk of deep neck infection among patients who had undergone a tonsillectomy. METHODS This retrospective cohort study evaluated all patients who had undergone tonsillectomy between 2001 and 2009 as identified from the Taiwan National Health Insurance Research Database. For each post-tonsillectomy patient, 10 age-, sex-, and index date-matched controls without a history of tonsillectomy were randomly selected. Cox Proportional hazard model and propensity score model were performed to evaluate the association between tonsillectomy and deep neck infection after adjusting for demographic and clinical data. RESULTS There were 34 (71.6 cases per 100,000 person-years) and 174 (36.6 cases per 100,000 person-years) patients that developed deep neck infection in the tonsillectomized and comparison cohorts, respectively. After adjusting for covariates, patients who had undergone a tonsillectomy had a 1.71-fold greater risk of deep neck infection by both Cox proportional hazard model (95% confidence interval, 1.13-2.59) and propensity score model (95% confidence interval, 1.10-2.66). This association was not altered regardless of the indication for tonsillectomy (i.e. chronic/recurrent tonsillitis or sleep apnea/hypertrophy of tonsil) (p = 0.9797). CONCLUSIONS Based on our review of a nationwide cohort study we identified that the risk of deep neck infection is significantly increased among patients who have undergone a tonsillectomy. Additional research is needed to explore the possible mechanisms behind these findings.
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Affiliation(s)
- Ying-Piao Wang
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Mao-Che Wang
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, #201, Sec. 2 and School of Medicine, National Yang-Ming University, #155, Sec.2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
| | - Hung-Ching Lin
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Kuo-Sheng Lee
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
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Pidelaserra Martí G, Isdahl Mohn KG, Cox RJ, Brokstad KA. The Influence of Tonsillectomy on Total Serum Antibody Levels. Scand J Immunol 2014; 80:377-9. [DOI: 10.1111/sji.12213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Pidelaserra Martí
- Broegelmann Research Laboratory; Department of Clinical Sciences; University of Bergen; Bergen Norway
| | - K. G. Isdahl Mohn
- The Influenza Centre; Department of Clinical Sciences; University of Bergen; Bergen Norway
| | - R. J. Cox
- The Influenza Centre; Department of Clinical Sciences; University of Bergen; Bergen Norway
- Department of Research and Development; Haukeland University Hospital; Bergen Norway
- Jebsen Centre for Influenza Vaccine Research; University of Bergen; Bergen Norway
| | - K. A. Brokstad
- Broegelmann Research Laboratory; Department of Clinical Sciences; University of Bergen; Bergen Norway
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Santos FP, Weber R, Fortes BC, Pignatari SSN. Short and long term impact of adenotonsillectomy on the immune system. Braz J Otorhinolaryngol 2013; 79:28-34. [PMID: 23503904 PMCID: PMC9450877 DOI: 10.5935/1808-8694.20130006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 10/13/2012] [Indexed: 11/29/2022] Open
Abstract
Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. Objective To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. Method This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). Results TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. Conclusion This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.
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Kaygusuz I, Alpay HC, Gödekmerdan A, Karlidag T, Keles E, Yalcin S, Demir N. Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol 2009; 73:445-9. [PMID: 19150575 DOI: 10.1016/j.ijporl.2008.11.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/26/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this follow-up study was to investigate the long-term effects of tonsillectomy in comparison with their short-term results. PATIENTS AND METHODS We successfully retrieved 20 out of our previously reported 37 patients who underwent tonsillectomy in our clinic 54 months ago. The blood levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16++56+ (cellular immunity), and IgG, IgA, IgM, C3 and C4 (humoral immunity) were determined and compared with their previously reported short-term respective values. RESULTS There were no statistically significant differences between the short-term (1 month) and long-term (54 months) values of IgA, IgG, IgM and C4 levels of the patients (P>0.05). There was a slight but statistically significant decrease in complement factor C3 value compared to its the early-stage value (P<0.05) but this was not significantly different from age-matched healthy controls (P>0.05). The levels of CD4+ and CD19+ were higher and the levels of CD16++56+ and CD25+ were lower in the late-stage (54 months) compared to their early-stage values (P<0.05). When the long-term immune parameters of the tonsillectomized patients were compared with aged-match healthy controls, there were no significant differences between the levels of immunoglobulins, complements and lymphocytes (IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD19+, CD25+, CD16++56+) (P>0.05). CONCLUSION The results of this long-term follow-up study indicate that tonsillectomy do not compromise the immune functions of children as humoral and cellular immunity of patients recovered compared to their early-stage immune status (1 month), as they have similar immune capacity compared to their age-matched healthy controls at both early- and late-stages. Although a small sample of patients enrolled, our results are of importance with respect to the reassuring in settling the widely held urban myth that tonsillectomy compromises life long immunity.
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Affiliation(s)
- Irfan Kaygusuz
- Department of Otorhinolaryngology, Firat University Medical Faculty, 23119 Elazig, Turkey
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van den Akker EH, Sanders EAM, van Staaij BK, Rijkers GT, Rovers MM, Hoes AW, Schilder AGM. Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial. Ann Allergy Asthma Immunol 2006; 97:251-6. [PMID: 16937760 DOI: 10.1016/s1081-1206(10)60022-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It remains controversial whether pediatric adenotonsillectomy ultimately results in decreased serum immunoglobulin levels and if so whether such a decrease is associated with increased susceptibility to upper respiratory tract infections (URIs). OBJECTIVE To evaluate changes in serum immunoglobulin levels in relation to occurrence of URIs in children participating in a randomized controlled trial on the effectiveness of adenotonsillectomy. METHODS A total of 300 children aged 2 to 8 years, with symptoms of recurrent throat infections or tonsillar hypertrophy, were randomly assigned to either adenotonsillectomy or watchful waiting (WW). Serum samples were collected at baseline and at 1-year follow-up. Occurrence of throat infections and other URIs during first-year follow-up was recorded in a diary by the child's parents. RESULTS Paired serum samples were available for 123 children (63 in the adenotonsillectomy group and 60 in the WW group). IgG1 and IgG2 levels decreased but remained within the reference range for age in both study arms. IgM and IgA levels decreased as well but remained elevated. The IgA level in the adenotonsillectomy group decreased in significantly greater degree compared with the WW group, but this difference disappeared in cases where children experienced frequent URIs. In general, no relation between immunoglobulin levels and the number of throat infections or URIs at 1-year follow-up was found. CONCLUSIONS Immunoglobulin levels of children undergoing adenotonsillectomy decreased from elevated to slightly elevated or reference values for age during 1-year follow-up irrespective of treatment (adenotonsillectomy or WW). IgA showed a greater decrease in the adenotonsillectomy group but rose to levels comparable with the WW group in cases of frequent URIs. This finding indicates that the remaining mucosa-associated lymphoid tissue can compensate for the loss of tonsil and adenoid tissue.
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Affiliation(s)
- Emma H van den Akker
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
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Xie Y, Chen X, Nishi S, Narita I, Gejyo F. Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy. Kidney Int 2004; 65:1135-44. [PMID: 15086452 DOI: 10.1111/j.1523-1755.2004.00486.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although there are many papers about IgA nephropathy (IgAN) and tonsils, respectively, reviews about the relationship between tonsils, tonsillitis, tonsillectomy, and IgAN are limited. In this review, we introduced the structure, development, and function of tonsils, difference of tonsils with and without IgAN, consistency of both tonsillar IgA and glomerular IgA, the effect of tonsil stimulation, tonsil infection, and tonsillectomy on IgAN showed some evidences in which tonsils were closely related to IgAN and polymeric IgA1 deposited in glomerular mesangium were at least in part of tonsillar origin. Tonsillectomy can improve the urinary findings, keep stable renal function, improve mesangial proliferation and IgA deposit, have a favorable effect on long-tern renal survival in some IgAN patients, and do not cause significant immune deficiency and do not increase incidence of the upper respiratory tract infections, and can be used as a potentially effective treatment. The indications of tonsillectomy in patients with IgAN include mainly the deterioration of urinary findings after tonsillar infection, mild or moderate renal damage. However, tonsillectomy may not be enough and may not change the prognosis in IgAN patients with marked renal damage.
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Affiliation(s)
- Yuansheng Xie
- Kidney Center of PLA, Department of Nephrology, Chinese General Hospital of PLA, Beijing, China
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Amorós Sebastiá LI, Ferrer Ramírez MJ, López Mollá C, Carrasco Llatas M, Plá Mochilí A, Díaz Ruiz M, Estellés Ferriol JE, López Martínez R. Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2004; 55:404-8. [PMID: 15605804 DOI: 10.1016/s0001-6519(04)78544-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.
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Kaygusuz I, Gödekmerdan A, Karlidag T, Keleş E, Yalçin S, Aral I, Yildiz M. Early stage impacts of tonsillectomy on immune functions of children. Int J Pediatr Otorhinolaryngol 2003; 67:1311-5. [PMID: 14643474 DOI: 10.1016/j.ijporl.2003.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the changes in the humoral and cellular immunity of patients with chronic tonsillitis before and 1 month after tonsillectomy. PATIENTS AND METHODS 37 patients scheduled for tonsillectomy were enrolled in this study. The levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16+ + 56+ were measured for cellular immunity, and levels of IgG, IgA, IgM, C3 and C4 were measured for humoral immunity in blood samples taken from these patients before and 1 month after the operation. RESULTS The levels of CD3+, CD8+ and CD19+ were reduced in post-operative period as compared to pre-operative period but this was not statistically significant (P > 0.05). However it was found that the level of CD4+ was significantly increased while the level of CD25+ was reduced (P < 0.05) in the post-operative period. There were statistically significant differences between pre- and post-operative levels of immunoglobulins, C3 and C4, which were decreased after tonsillectomy (P < 0.05), but these levels were comparable with those of the control group. CONCLUSION The results from the present study indicate that humoral and cellular immunity of patients undergoing tonsillectomy were decreased in the early period and came to normal later. The cellular and humoral immune responses are stimulated in patients with tonsillitis, and tonsillectomy removes this stimulus without negatively affecting the patient's immune functions.
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Affiliation(s)
- Irfan Kaygusuz
- Department of Otorhinolaryngology, Firat University Medical Faculty, Firat Universitesi Firat, Tip Merkezi KBB Klinigi, 23200 Elazig, Turkey.
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15
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Abstract
Tonsillectomy (T) is one of the most common surgical procedures performed on children. Long-term follow-up studies concerning its consequences are lacking. This study is the first study done on a group of patients that underwent T in their childhood, about 20 years ago. The investigation is a cohort study, which followed-up 18 patients who were tonsillectomized 20 years ago. It was to be determined whether these subjects suffer from more respiratory tract infections (or other infections) today, than people who are not tonsillectomized. A group of 54 age-matched subjects were selected for comparison. A questionnaire was mailed to the study population. No significant differences were found between the groups in the frequency of upper respiratory tract infection (URI). The mean number of URI's was approximately [MSOffice1]2.5 per year in both groups. The duration of the URI's was identical in each group. A high temperature was present to the same extent in each group. Absence from work, number of visits to physicians and the use of antibiotics were the same in each group. However, the prevalence of chronic disease was greater in the T-group than in the comparison group. The difference was significant with a Relative Risk of 9.41 and a Confidence Interval differing from 1 (1.13<RR<78.14) for the T-population to develop chronic disease. Because of the small number of the present study population, the results must be validated by further immunological and epidemiological studies on long-term effects of tonsillectomy.
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Affiliation(s)
- Ewa Johansson
- Department of Neuroscience and Locomotion, Division of Otorhinolaryngology, Linköpings Universitet, SE 58185 Linköping, Sweden
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Childers NK, Powell WD, Tong G, Kirk K, Wiatrak B, Michalek SM. Human salivary immunoglobulin and antigen-specific antibody activity after tonsillectomy. ORAL MICROBIOLOGY AND IMMUNOLOGY 2001; 16:265-9. [PMID: 11555302 DOI: 10.1034/j.1399-302x.2001.016005265.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The importance of the lymphoid tissue collectively known as Waldeyer's ring, which includes the palatine, lingual and nasopharyngeal tonsils, in the induction and contribution of specific antibody responses in human saliva is not clear. The purpose of this study was to determine whether salivary immunoglobulin A (IgA) levels differ in quantity and quality between subjects who have had a tonsillectomy and age, sex and race-matched controls. Parotid saliva, whole saliva, and blood serum samples were collected from 25 volunteer children who had undergone tonsillectomy (T-) within 6-14 months of sampling and from 25 age, sex and race-matched controls. The levels of total IgA (and subclasses) in saliva, and of antigen-specific salivary IgA and serum IgA and IgG antibodies to 4-9 relevant antigens were analyzed by ELISA. No significant difference was observed in the mean total IgA and IgA subclass levels in parotid and whole saliva, although the mean levels for children with a T- were slightly lower. Children with a T- had significantly higher parotid salivary IgA and IgA1 specific/total activity than controls. The total and specific whole saliva IgA and the specific serum IgA or IgG activities were not significantly different from controls. These results indicate an association between the removal of tonsils and increased levels of specific IgA activity in parotid saliva within the first year after a T-.
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Affiliation(s)
- N K Childers
- Department of Pediatric Dentistry, School of Dentistry, University of Alabama at Birmingham, 35294-0007, USA
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Bussi M, Carlevato MT, Panizzut B, Majore L, Giaretta F, Omedé P. Expression of antigens associated with the individual stages of the inflammatory response in child and adult as a possible distinctive method for recurrent and chronic tonsillitis. Int J Pediatr Otorhinolaryngol 1996; 35:243-50. [PMID: 8762597 DOI: 10.1016/0165-5876(95)01316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Monoclonal antibodies (MoAbs) specific for the antigens associated with each stage of an inflammatory response were assayed with tonsillar mononuclear cells (TMNG). MoAbs BMA 27 E 10 and BMA 4 D 10 were used as markers for the early stages, BMA RM 3/1 for the intermediate stage, BMA 25 F 9 for the late stage, and BMA G 16/1 for the chronic stage. TMNC were obtained from patients operated for (1) recurrent tonsillitis with hypertrophy caused by common flora (children); (2) an indication for surgery for chronic tonsillitis in adults; (3) patients who were 'warm' tonsillectomized for a second peri-tonsillar phlegmon. Our results are presented and discussed in the light of their possible clinical significance. Our findings indicate that clinical chronic tonsillitis in the adult really is such. In the adults studied there was a high expression of antigens which is associated with the chronic stages, while the low expression of antigens is associated with the intermediate stage and an even lower antigen expression indicates the acute stage. In children what is considered to be chronic tonsillitis may perhaps be more correctly regarded as an expression of recurrent inflammation.
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Affiliation(s)
- M Bussi
- II ENT Department, University of Turin, Italy
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