• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - Pathophysiology - General information
    • 2 - Rhinopharyngitis
      • 2.1 - Etiologies
      • 2.2 - Diagnosis
      • 2.3 - Treatment
      • 2.4 - Complications associated with rhinopharyngitis
      • 2.5 - Differential diagnosis
      • 2.6 - Hypertrophy of adenoid vegetations causing recurrent rhinopharyngitis
      • 2.7 - Other factors favoring nasopharyngeal infections
    • 3 - Angina
      • 3.1 - Etiology
      • 3.2 - Clinical diagnosis
      • 3.3 - Bacteriological diagnosis
      • 3.4 - Clinical forms
        • 3 . 4 . 1 - Acute catarrhal angina (or erythematous angina)
        • 3 . 4 . 2 - Angina with purulent exudate (or erythemato-pultaceous angina)
        • 3 . 4 . 3 - Pseudomembranous angina (or false-membrane angina)
        • 3 . 4 . 4 - Ulcerative and necrotic angina
        • 3 . 4 . 5 - Vesicular angina
        • 3 . 4 . 6 - Gangrenous, necrotizing angina
      • 3.5 - Treatment
      • 3.6 - Differential diagnosis of angina
    • 4 - Chronic tonsillitis
      • 4.1 - Chronic tonsillitis in children
      • 4.2 - Chronic tonsillitis in adults
    • 5 - Complications of tonsillar infection
      • 5.1 - Local complications
      • 5.2 - General complications
    • 6 - Tonsillectomy indications
      • 6.1 - Indications
      • 6.2 - Contraindications
  • Key points
  • Teachers version
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• Appendix
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Introduction

This chapter covers :

• rhinopharyngitis (also known as adenoiditis), which constitutes the majority of nasopharyngeal pathologies encountered in children;
• other rare nasopharyngeal conditions in children are evoked as differential diagnosis;
• acute (angina) and chronic (chronic tonsillitis) tonsillar infections that occur at any age.

All of these reactional and infectious manifestations are disorders of Waldeyer's tonsillar ring (or Waldeyer's lymphatic ring), located at the entrance of the upper aerodigestive tract. It represents an important part of the peripheral lymphoid system, along with the lymph nodes, spleen and lymphoid formations of the digestive tract. It consists essentially of  (Fig 1.) :

• palatine tonsils, located at the isthmus faucium;
• pharyngeal tonsils (adenoids), located in the nasopharynx area;
• lingual tonsils, located at the basis of the tongue.

Fig 1.

Fig 2.

1  -  Pathophysiology - General information

At birth, children possess only maternal immunoglobulins G (IgG) as humoral anti-infectious immune defense system: this defense system is passive and temporary (lasting approximately 6 months). During this period, the child develops its own means of immune system acquisition, namely its own lymphoid tissue.

The antigens required for this immune system synthesis enter the body through the nasal orifices and first come into contact with the mucosal lining of the nasopharynx, resulting in the development of the pharyngeal tonsil, and then secondly, with the oropharynx (palatine tonsils), and finally with the digestive tract (Peyer plates).

After passing through the mucosa, viral or bacterial antigens are captured by macrophages and transported to germinal centers of lymphoid tissue that are immune synthesis centers (due to B- and T-lymphocytes), which thus multiply, increase in volume, and result in pharyngeal tonsil hypertrophy, i.e., adenoid vegetations.

Adenoidal hypertrophy (as well as tonsillar hypertrophy) must thus not be seen as a pathological manifestation, but rather as a normal reaction of an organism undergoing immune maturation.

Inflammation of the nasopharynx (rhinopharyngitis) in children represents a natural adaptation to the microbial world, and one must consider a frequency of four to five trivial rhinopharyngeal infections per annum as normal, up to the age of 6 to 7 years. This is the period within which children acquire immunity, and as such, this condition is an ailment of the adaptation process.

However, rhinopharyngitis or angina in children is considered as truly pathological when infection occurs too often or is associated with complications.