An immunological analysis of the effects of T & A on seventeen patients with a history of recurrent tonsillitis and/or otitis media was conducted. Serum IgG and IgA levels of patients before surgery were found to be elevated above normal. Following T & A a statistically significant drop in the serum IgG levels to the normal range occurred, while serum IgM, IgA and IgD levels remained unchanged. Total salivary IgA levels were assayed by electro-immunodiffusion (EID) and found to be unaltered after surgery. A serological survey of antibody levels to several childhood respiratory viruses and bacterial pathogens present in their oropharynx indicated T & A did not significantly reduce antibody levels present before surgery. In fact, several children were exposed to rubella, mumps, influenza A-2 (Hong Kong, 1968), and parainfluenza 3 viruses during the interim following T & A and all responded immunologically. In view of the findings in this patient sample, it is suggested that T & A doesn't modify the host's systemic immunological competence. In summary, we have demonstrated that the E.N.T. patient sample has elevated levels of serum IgA and IgG which has been reported by others in children with recurrent infections and allergies. Total serum IgA, IgM, IgD, and secretory IgA were shown not to be significantly reduced following T & A. However, serum IgG levels did decrease significantly following T & A but to the normal range for both age groups. Furthermore, the serologic response of these children to numerous human respiratory viruses was unaltered by T & A, and in fact several children acquired infections a short time after T & A and responded normally. Hence, the ability to respond to infection and immunological memory are unaltered. We are currently investigating the possibility that alterations imposed on the oral bacteria flora may provide the answer to this question. Also, continued investigations of the microbiological and immunological ramifications of T & A and extension to include other parameters involving control of otolaryngic infections are in progress.
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