Razi Journal of Medical Sciences

    Background & Aim: Chronic infection of tonsils in childhood is a leading cause of adeno-tonsillectomy. A question has been asked for a long time to find out whether there is any risk of immune impairment after adenotonsillectomy. Therefore, the present study was undertaken to evaluate immunologic parameters in children before and after adenoidectomy. Patients & Methods: In this cohort study, 25 children(14 male and 11 female) candidate for adenotonsillectomy enrolled in Rasoul-e-Akram Hospital. Adequate blood samples were taken in 3 intervals(before surgery and 2 and 6 months after surgery) from patients to measure immunoglobulins IgA, IgM, IgG and IgG subclasses by nephlometry assay and count lymphocyte subsets(markers CD2, CD3, CD4, CD8, CD19, CD23 and CD56) by flowcytometry and ELISA methods. The data was analyzed by repeated measures (Anova and Bonferroni statistical tests). Results: Enrolled patients had median age of 8 years(range 3 to 16 years). IgM and IgG were equal in 3 intervals. IgA somewhat dropped after surgery(2 and 6 months after surgery vs. before surgery) and IgG subclasses(IgG1, IgG2, IgG3 and IgG4) had small rise after surgery. According to lymphocyte subsets CD4+ and CD23+ cells and CD4/CD8 ratio were constant through the 3 intervals. CD23+ and CD56+ cells had small drop in both intervals after surgery vs. before surgery, but these differences were not statistically significant(P>0.05). Mean CD8+ cells had significant changes during these intervals(P=0.02) especially between specimens before and 2 months after surgery(P=0.03). Same pattern was seen for CD19+ cells(P=0.012 and 0.01 respectively). Conclusion: Comparing immunoglobulins of the patients with normal ranges revealed that all antibody classes were highly above normal levels. IgM level in patients with 3 to 8 years remained above median normal level even 6 months after surgery. High antibody level in patients is related to recurrent antigenic stimulation of their immune system. Evaluation of the results in age groups also revealed that changes in immunoglobulins and T and B lymphocytes after adenoidectomy seems to be related to age. Results showed that immune system did not change in short term after adenoidectomy. However, more studies must be conducted to compare patients’ immune system with that of normal subjects in a long term evaluation.