The Effect of Tonsillectomy on the Salivary Immune Factors: A Systematic Review and Meta-Analysis
Mohamad A. Bitar*
Department of ENT Surgery, The Children’s Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
- Corresponding Author:
- Mohamad A. Bitar
Department of ENT Surgery
The Children’s Hospital at Westmead
Locked Bag 4001, Westmead, NSW 2560, Australia
E-mail: [email protected]
Received date: January 21, 2015; Accepted date: February 16, 2015; Published date: February 25, 2015
Citation: Bitar MA (2015) The Effect of Tonsillectomy on the Salivary Immune Factors: A Systematic Review and Meta-Analysis. Otolaryngology 5:187. doi:10.4172/2161-119X.1000187
Copyright: © 2015 Bitar MA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Background & objectives: The effect of tonsillectomy on the immune system is a controversial issue. The debate is largely based on contradictory findings in the literature. However, it is unlikely for tonsils to produce a negative systemic effect and it is more logical to think about a local effect that can be transient or long lasting. The aim of this systematic review is to analyze the observed changes in salivary immune factors following tonsillectomy and understand their clinical significance.
Materials & methods: Systematic review of the English literature was performed using Medline, Embase and Cochrane. We used the terms tonsillectomy, adenotonsillectomy, humoral immunity, immune system, saliva in various combination to look for pertinent studies. We excluded duplicate publications, reviews and studies that did not analyze salivary immune factors.
Results: Thirty four manuscripts studied the effect of tonsillectomy on the immune system. Only 9 of them (including 585 patients) looked at the effect on salivary immune factors. All studies analyzed the effect on salivary Immunoglobulin (Ig) A, four of them studied additional factors such as other salivary Ig’s, anti-microbial proteins (lactoferrin, peroxidases, lysozyme), anti-viral and anti-bacterial Ig’s. One study showed a significant decrease in salivary IgA, another showed a decrease in salivary IgG and a third showed a decrease in salivary IgM, lactoferrin and antimicrobial salivary IgG. Two studies had non-conclusive concerns regarding the observed changes in salivary immune factors, the third study recommended measuring salivary IgA pre and postoperatively. Only 11.1% of the studied patients had on the short term, a significant decrease in SecIgA level that can be attributed to tonsillectomy.
Conclusion: Tonsillectomy does not seem in general to negatively affect the host’s salivary immune defenses. The concerns raised are based on a partial apparent down-regulation of the some of the salivary immune components. More longitudinal studies are needed to really understand the clinical effect of any observed change in the salivary immune system.