The Immunological Consequences of Pediatric Adenotonsillectomy: Myths, Evidence, and Unsolved Questions

Tonsillectomy is one of the most common surgical procedures in pediatric populations, indicated primarily for recurrent tonsillitis and upper airway obstruction. Palatine tonsils represent lymphoepithelial structures crucial for local and systemic immune surveillance, with a key role in lymphocyte maturation and the production of immunoglobulins, particularly secretory IgA. This review summarizes the available evidence on the immunological impact of tonsillectomy, including short- and long-term studies. Data show that tonsillar removal can result in transient changes in immunoglobulin and lymphocyte levels, often associated with resolution of a chronic inflammatory state, without compromising the global immune response. Clinical studies also indicate a benefit in reducing recurrent febrile episodes, such as in PFAPA syndrome. Some evidence suggests possible long-term effects, such as an increased risk of autoimmune or periodontal diseases, especially if the intervention is performed at an early age, although the causality is not yet clear. In conclusion, tonsillectomy performed according to selective clinical criteria generally appears immunologically safe and may provide targeted therapeutic benefits under conditions of local or systemic tonsil dysfunction.