POST-ADENOTONSILLECTOMY INCREASE OF IMMUNE RESPONSE IN CHILDREN WITH OBSTRUCTIVE CHRONIC

Adenotonsillectomy (ATE) procedure may restore immune response. However, the mechanism, by which the immune response is restored, remains unknown. OCAT results in obstruction that may lead to hypoxia. Furthermore, hypoxia induces learning process in brain tissues that affect the balance between Th1 and Th2, and the latter may conversely affect the learning process of brain tissues. This reciprocal relation is known as brain-immune system bidirectional. The objective of this study was to disclose the mechanism of immune response restoration due to the effect of ATE procedure in children with obstructive chronic adenotonsillitis (OCAT) based on pyschoneuroimmunology paradigm using the concepts of Th1 and Th2. A pre-experimental study using one group pre-test posttest design was carried out to children with obstructive chronic adenotonsillitis (OCAT) admitted at the Otolaryngology Outpatient Clinic, Sebelas Maret University School of Medicine, Dr Moewardi Hospital, Surakarta. The criteria of OCAT consisted of the enlargement of Adeno-Nasopharynx (A-N) ratio of > 0.72 and tonsil enlargement to the level of T2 and T3. The independent variable in this study was ATE procedure, while the dependent variables were monocyte, neutrophil, IFN-γ, IL-1ß, IL-10, and IgG. Results of homogeneity test revealed that the moderating variables (age, body weight, A-N ratio, erythrocyte, hemoglobin, HCT, SGOT, SGPT, creatinin, total protein plasma) were homogeneous. Furthermore, homogeneity and normality tests (IIDN) were also carried out to early data of the dependent variables (monocyte, neutrophil, IFN-γ, IL-1ß, IL-10, and IgG), revealing homogeneous and normal results (p > 0.05). Since observed group was only one and without control, a cluster analysis was performed to immune response before the ATE procedure was undertaken and revealed that the immune status of the respondents were similar (p > 0.05). Further cluster analysis was done to determine immune status after ATE. Results of this latter analysis revealed two groups of immune status (p < 0.05). All samples in this study, therefore, could be assumed into two groups. Group I consisted of 5 samples, while Group II consisted of 10 samples. Results of Manova test on the response data of both new groups (i.e., data on the change before and after ATE) revealed difference (Wilks Lambda, p < 0.05). These results confirmed that ATE might induce change in immunity system. A discriminant analysis was subsequently done to find relationship between OCAT and immunity system, resulting in three discriminant variables, i.e., neutrophil, IFNg, and IgG in the immune response. Theoretical interpretation to these findings suggested that both groups demonstrated similar immune response pattern based on its magnitude in the three contributing variables. However, those patterns were differentiated only in their magnitude. In group I (5 samples) the magnitude of the pattern in three discriminant variables (neutrophil, IFN-γ, and IgG) was higher than that in group II (10 samples), while the dynamic appearance of both immune response patterns was similar. It can be concluded that ATE procedure is capable in restoring immune response.