What is wrong in chronic adenoiditis/tonsillitis anatomical considerations

Abstract

Waldeyer's ring is most prominent during childhood, when the size of the oro-nasopharyngeal space is not yet fully developed, but decreases spontaneously with age. In the child, enlarged tonsils and/or adenoids may cause Eustachian tube dysfunction/otitis media, rhinosinusitis, obstructive sleep apnea, voice changes, change in facial growth, swallowing problems and can affect overall quality of life. Consequently, tonsillectomy and/or adenoidectomy are among the most common surgical procedures in children. The size of the oro- and nasopharynx has been investigated in normal children with and without tonsil/adenoid hyperplasia, to assess whether or not it is the adenoid and tonsillar tissue that are enlarged and not the dimensions of the anatomic space that are reduced. Studies have supported that the nasopharyngeal space is not smaller in children with hyperplastic adenoids when compared to normal children. However, children with large obstructing tonsils have a smaller oropharyngeal diameter compared to children with small tonsils. Tonsil/adenoid hyperplasia appears to be due to an increase in the lymphoid elements. The size of the tonsil has been shown to be directly proportional to aerobic bacterial load and absolute number of B and T cells. Bacteria have been suggested in the etiology of the development of hyperplasia. Of interest is that of the different pathogens, Haemophilus influenzae in particular, has been associated with tonsil/adenoid hyperplasia. The distribution of dendritic cells, antigen presenting cells, is altered during disease, with fewer dendritic cells in the surface epithelium and more in the crypts and extrafollicular areas.