Essa M. Abdulla
Department of Microbiology and Parasitology, Faculty of Medicine, University of Garyounis, Benghazi, S.P. L.A.J.
Garyounis Medical Journal Vol. 2, No.1. January 1979:47-54
Although a more conservative attitude has developed towards tonsillectomy, the operation is still extremely common andprobablyperformed much too frequently. Indications for operation vary greatly emphasizing the lack of understanding of the basic function of the tonsil and the consequences of its early or unfounded removal. As the first lymphoidal structure in the body to come into contact with the external environment, it retaliates with immunological phenomena that aid in the body’s fight against disease. That the tonsil elaborates immunoglobulins, participates in cell-mediated immunity which apparently aborts certain kinds of malignancy, and contributes to the general resistance of the body such as in averting Hodgkin’s disease, multiple sclerosis, bowel infections, and bulbar poliomyelitis, has been established. The elective operation has been shown to have no prophylactic value in either reducing or modifying the clinical course of streptococcal throats, or in protecting rheumatic subjects against recurrences. In our laboratory, we have in addition demonstrated that tonsillectomy in children results in lowered anti-streptolysin 0 titers, circulating levels of IgA and 1gM, and salivary IgA amounts, as compared to children with intact tonsils and of similar age, sex and ethnic group. That this tissue releases interferon, lysozyme and possibly other nonspecific factors also supports the growing confidence in its role in innate immunity.
Children between the ages of 4—6 years get 3—5 throat infections each year decreasing to 1—2 by the age of 7—8 years. Approximately 80—85% of these attacks are due to a virus; the group A hemolytic streptococcus, which is the main bacterial pathogen, accounts for at least 95% of nonviral throats. The lingual tonsils, lateral pharyngeal bands, pharyngeal tonsils and adenoids are present at birth, increase in size with age and then tend to atrophy, commencing at 8—10 years; the adenoids almost completely disappear by 12—15 years. If the tonsils and adenoids are removed early in life, compensatory hypertrophy of the remaining pieces of lymphoid tissue occurs to a variable degree, demonstrating that the body needs lymphoid tissue and that it is there for a purpose. This treatise also presents increasing evidence that surgical removal should be a final resort in the event that therapeutic manipulations fail and the tonsils become a liability to health rather than a bulwark against infection.
Keywords: Assessment of the Role of the Tonsils in Immunity and Disease