Dear Doctors: My 22-year-old son was tested for sleep apnea because of his snoring. The ENT suggested a tonsillectomy as an option. He also has a severe nut allergy with anaphylaxis reactions. I was wondering if removing his tonsils would affect the immune system and his allergic reaction.
Dear Reader: Let's begin with tonsils. Those twin mounds of tissue look unassuming, like a physiological afterthought. But as your question suggests, they are front-line organs of the immune system. Perched at the entrance to the respiratory tract, tonsils intercept incoming bacteria, viruses and other pathogens. Then, by producing antibodies and activating certain types of immune cells, they help teach the body's defenses to recognize potential threats in the future.
Building this kind of long-term immune memory is crucial in a child's early years. By the time we reach our late teens and early 20s, though, tonsils have completed most of that work. At the same time, due to their shape and location, they can become a source of health problems.
Tonsils can become chronically inflamed or infected, interfere with breathing or swallowing, contribute to snoring or even cause obstructive sleep apnea. This is a potentially dangerous condition in which breathing repeatedly stops and starts during sleep. In those cases, a tonsillectomy may be helpful.
Considering the role that tonsils play in immune function, your concern about your son's nut allergy is understandable. However, food allergies are driven by immune pathways that do not depend on the tonsils. As a result, a tonsillectomy would not worsen -- or ease -- an existing food allergy. What it could do is free up room in the back of his throat. That additional space could widen his airway, which is likely why his doctor has presented it as an option.
Although tonsillectomy is often associated with childhood, adults like your son often undergo the procedure. Benefits include less snoring, lowered risk of obstructive sleep apnea and fewer recurring infections. The most common risks of the surgery include excessive bleeding during or after the surgery, swelling of the surgical area, infection and reaction to anesthesia.
As with all surgeries, the process begins with a health evaluation to make sure the person can withstand the rigors of surgery. A pre-op assessment typically includes a medical history, a physical exam and diagnostic testing. This may consist of blood work, urinalysis and in some cases, cardiac testing.
The surgery itself takes about 30 minutes. The entire visit for the operation, from check-in to discharge, typically takes several hours. Recovery from a tonsillectomy takes about two weeks. Unfortunately, post-surgical pain is common. Removing the tonsils leaves raw, open surfaces, which can remain painful for up to two weeks.
Most people notice improvements in snoring and breathing within a few weeks. However, post-surgical swelling can temporarily mask the full benefit. That means it can take a month or longer to judge the results. If sleep apnea remains a concern, a follow-up sleep study may be recommended.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
