Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery

Abstract

Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer’s ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable “gatekeepers” by screening microorganisms—both bacteria and viruses—with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.

Short-Term Weight Gain after Tonsillectomy Does Not Lead to Overweight: A Systematic Review

“…As previously reported, the surgical removal of tonsils might also improve the gag reflex and, therefore, eating patterns [47,48]. Rarely, adenoids will regrow after adenoidectomy, above all in young children, which could cause a plateau in weight gain [49,50], and the prevalence has been reported to be 8% [49].…”

“…Still, data on diet composition in children after TA are conflicting, and dietary interviews in the first few months after TA could elucidate this aspect. Furthermore, adenoids and tonsils represent vital constituents of the immune system, carrying profound implications also for immunology, physiology, and the microbiome [ 48 ]. The intricate interplay between adenoids, tonsils, and various aspects of human health has been reported [ 48 ], and their removal or reduction via surgery can profoundly affect growth through different pathways [ 48 ].…”

Short-Term Weight Gain after Tonsillectomy Is Not Leading to Overweight: A Systematic Review

“…As previously reported, the surgical removal of tonsils might also improve the gag reflex and, therefore, eating patterns [47,48]. Rarely, adenoids will regrow after adenoidectomy, above all in young children, which could cause a plateau in weight gain [49,50], and the prevalence has been reported to be 8% [49].…”