Alterations in Humoral Immunity After Partial Versus Total Tonsillectomy: A Pilot Study and Systematic Review of Literature

Background: The palatine tonsils are secondary lymphoid organs, important in sampling antigens directly from the epithelial surfaces. They produce antibodies locally and distally through their migrating B cells. Objectives: The aim of this study was to compare the changes in serum and saliva immunoglobulin (Ig) levels after total vs. partial tonsillectomy and also to systematically review the literature regarding the changes in humoral immunity following tonsillar surgery. Patients and Methods: Children with obstructive tonsils were recruited in a pilot study and randomized to undergo total or partial tonsillectomy. Blood and saliva samples were obtained immediately preoperatively and within 3 months postoperatively, to measure serum Ig (G, M and A) and saliva secretory IgA concentrations. Patients’ clinical history was reviewed at one year postoperatively. Systematic literature review regarding the effects of tonsillar surgery on humoral immunity was performed, using Medline, Embase and Cochrane. Results: Nineteen patients completed the study (11 partial, 8 total). No statistically significant changes noted in the serum Ig’s level in both groups, except for IgM which increased (P = 0.018) after partial tonsillectomy, mainly in males (P = 0.04), and in those aged 5 years and older (P = 0.02). There was noticeable decrease in susceptibility to infections. Four out of 30 studies (406 out of 1796 patients) showed decrease in some elements of the humoral immunity or suspected a negative impact of tonsillectomy on the immune system. Conclusions: Partial tonsillectomy does not seem to offer an immunological advantage over total tonsillectomy. The literature does not imply a significant negative impact of tonsillectomy on the humoral immune system