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• 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
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2  -  Rhinopharyngitis

Rhinopharyngitis is the most frequently encountered infectious disease in children and is the leading cause of pediatric consultation.
Its incidence is higher in children, particularly preschoolers, than in adults.
It is defined as an inflammatory disorder of the upper pharyngeal region (nasopharynx) that is variably associated with nasal impairment.
Rhinopharyngitis, mainly of viral origin, is a benign disease, with spontaneous improvement seen in 7-10 days.

2 . 1  -  Etiologies

Viruses are, by far, the major causal pathogens of rhinopharyngitis, including rhinovirus, coronavirus, respiratory syncytial virus (RSV), influenza virus and para-influenza virus, adenovirus, enterovirus, etc. More than 200 viruses are likely to induce rhinopharyngitis, which can be accompanied by clinical symptoms, reflecting the affliction of another part of the respiratory tract.

These viruses induce a local short-term immunity that does not protect against heterologous-type viruses and therefore, allows re-infection to occur. The number of causal viruses, infection or re-infection status, as well as patient age account for the variability of the clinical picture. Infectivity is high for all of these viruses, especially for rhinovirus, RSV, and influenza virus.

Bacteria found in nasopharyngeal secretions (notably S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus) are part of the commensal flora of the nasopharynx of the child. The same bacteria species are found in healthy children and those with a rhinopharyngitis.

2 . 2  -  Diagnosis

A diagnosis is easily established in a child aged from 6 months to 8 years, with a brutal infectious syndrome combining:

• fever at 38.5-39°C, sometimes higher at 40°C, mainly in the morning, with agitation and, in some cases,  vomiting and diarrhea;
• nasal obstruction with mucopurulent rhinorrhea, potentially resulting in severe feeding disorders in infants;
• acute tubal obstruction with slight transmission deafness;
• painful bilateral cervical adenopathies.

Increased mucus secretions are visible on examination of the nose, and flowing on the posterior wall of the pharynx is visible on oral examination. The eardrums are congested.

Clinical examination, which is not very helpful, is aimed at eliminating another infectious site in the context of childhood fever (meningeal, joints, digestive, lung, urinary, otitis, and angina).

2 . 3  -  Treatment

Antibiotic treatment for acute uncomplicated rhinopharyngitis is not justified in either adults or children. Its effectiveness has not been demonstrated, as based on the duration of symptoms or prevention of complications, even in the presence of risk factors.

In case of uncomplicated rhinopharyngitis, symptomatic treatment (antipyretics, nose blowing, decongestants, and local antiseptics) should be implemented, and it is appropriate to inform parents/patients on the viral nature of the pathology, average duration of symptoms (7-10 days), usually spontaneously favorable progression, but also on possible complications along with their respective symptoms. Antibiotic treatment is only justified in cases of complications, most likely of bacterial origin, such as acute otitis media and sinusitis. Antibiotic treatment is not justified for preventing these complications.

2 . 4  -  Complications associated with rhinopharyngitis

The occurrence of bacterial complications justifies the prescription of antibiotics :

• acute otitis media (AOM) often occurs at early onset and is commonly seen in children aged between 6 months and 2 years;
• sinusitis:
  • from an early age, acute ethmoid sinusitis,
  • later and mostly after the age of 6, maxillary sinusitis.
• and incidentally, the following complications:
  • ganglion: cervical adenophlegmon, retropharyngeal abscess, and torticollis,
  • laryngeal: subglottic acute laryngitis and pseudocroup,
  • Digestive: diarrhea, vomiting, and dehydration of the infant,
  • hyperthermia: febrile seizures, etc.

The occurrence of a lower respiratory infection, such as a bronchitis, bronchiolitis or pneumonia, is not considered to be a complication or secondary infection of rhinopharyngitis (in this case, rhinopharyngitis is rather a prodroma or associated symptom).

The purulent features of rhinorrhea and presence of a fever (within the normal time limits of rhinopharyngitis) are not risk factors for developing complications.