A tonsillectomy is a surgical procedure involving the removal of the palatine tonsils, which are lymphoid tissues located at the back of the throat. This procedure is commonly performed in children but can also be indicated in adults.

The primary indications for tonsillectomy include obstructive sleep apnea (OSA) due to tonsillar hypertrophy and recurrent or chronic tonsillitis. For OSA, tonsillectomy is often performed in conjunction with adenoidectomy and has been shown to improve sleep outcomes, quality of life, and behavior in children.[1][2][3] The American Academy of Otolaryngology-Head and Neck Surgery, along with the Infectious Diseases Society of America, provides guidelines for tonsillectomy in children, emphasizing its role in managing obstructive sleep-disordered breathing and recurrent throat infections.[3]

For recurrent tonsillitis, tonsillectomy can reduce the frequency and severity of throat infections, although the benefits are most pronounced in the first year post-surgery and tend to diminish over time.[4][5] The procedure involves the complete removal of the tonsils from the surrounding pharyngeal muscles, which can be performed using various surgical techniques, including cold dissection, electrocautery, or newer methods like coblation.[1][2]

Postoperative care typically includes pain management and monitoring for complications such as hemorrhage, which occurs in 2-4% of cases and can be life-threatening.[1] Overall, tonsillectomy is a well-tolerated procedure with a high satisfaction rate among patients and caregivers.[3][4]

The recovery process for children after a tonsillectomy typically takes about two weeks. During the first week, children experience significant pain, which is managed with simple analgesics like paracetamol and COX-inhibitors, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. Opioids are generally avoided due to risks of respiratory suppression.[1][2][3]

In the immediate postoperative period, children may exhibit negative behavioral changes and functional impairment, with most returning to baseline functioning by the end of the second week.[4] The American Academy of Otolaryngology-Head and Neck Surgery advises that children with severe OSA or significant comorbidities should be monitored overnight in a hospital setting to manage potential respiratory complications.[2]

Postoperative hemorrhage is a risk, occurring in 2-4% of cases, and can be life-threatening.[3] Overall, while the recovery process involves managing pain and monitoring for complications, most children resume normal activities by the end of the second week.[4]

Several studies have investigated the long-term impacts of tonsillectomy on both humoral and cellular immunity. A systematic review by Altwairqi et al. concluded that tonsillectomy does not negatively affect humoral immunity (IgA, IgG, IgM, C3, and C4) or cellular immunity (CD4+, CD3+, CD8+, CD19+, CD25+, CD16+, CD56+) in children.[1] Similarly, Liu et al. found no significant changes in humoral and cellular immune parameters post-tonsillectomy, although there may be an increased incidence of certain infectious diseases.[2]

Kaygusuz et al. conducted a follow-up study and found no significant differences in immune parameters between the short-term (1 month) and long-term (54 months) post-tonsillectomy, indicating that the immune functions of children recover over time and are comparable to age-matched healthy controls.[3]

The American Academy of Otolaryngology-Head and Neck Surgery guidelines also support the notion that tonsillectomy does not have a significant clinical impact on the immune system, despite minor alterations in immunoglobulin concentrations.[4][5]

Overall, the evidence suggests that while there may be minor transient changes in immune parameters, tonsillectomy does not compromise the immune functions of children in the long term.