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RHINOPHARYNGITIS
Rhinopharyngitis
The term acute rhinopharyngitis is often used, especially in Anghophone literature,
as synonimous of common cold. It can be understood as an upper airway
inflammation lasting less than a week, or it can simply indicate an inflammation
of the lymphoid tissue in the rhinopharynx. The latter includes Santorini-Lushka’s
pharyngeal tonsil situated posterior to the superior wall of the rhinopharynx and
the tubal tonsils (or Eustachian or Gerlach tonsils), next to the fibrocartilagenous
portion of the tube to form, together with the palatine tonsils and the lingual tonsil,
the well known anatomo-functional unit called Waldeyer’s ring. The lymphoid
tissue in the rhinopharynx thus belongs to MALT (Mucosa Associated Lymphoid
Tissue), a proper secondary lymphatic organ, not to be confused with the NALT
(Nose Associated Lymphoid Tissue) which, instead, consists of lymphoid tissue
scattered in the nasal mucosa with lymphocyte aggregates and epithelial infiltration.
From the histologic viewpoint, the lymphoid tissue in the rhinopharynx is
not different from that of the palatine tonsils, except for the lining epithelium. As
regards the plasma cell populations, in the rhinopharynx there is a greater prevalence
of IgA, IgM and IgD producing plasma cells, compared to IgG producing
ones, which are predominant in the tonsils. With regard to sIgA, the secretory
component was found only in the respiratory lining epithelium of the lymphoid
tissue and not at the level of the tonsils.
Acute rhinopharyngitis is certainly the most frequent infectious disease in
paediatric age 1 with an average of about 5 episodes occurring every year in the
first five years of life. A slight prevalence has been recorded in male subjects
(1.2M:1F). In adolescents 2 and adults, the estimated incidence was 2-4 episodes/
year. No variations were recorded in relation to the nutritional status 3 . Rhinopharyngitis
is often part of a cold syndrome of the upper respiratory tract and is most
frequent in relation to temperature changes from the months of October to March,
also because people typically tend to spend most of the cold season inside. Other
contributing social environmental factors, besides schools and all types of communities,
are the family size, the educational level, malnutrition, the absence or
short duration of breastfeeding, pollution and exposure to passive smoking 3 . Individual
contributing factors are age, gender, iron deficiency, laryngopharyngeal
reflux episodes, presence of adenoid tissue, episodes of OMA during the previous
winter season, the occurrence of the first OMA episode before the first six months
of life, history of OME and an allergic condition.
From the aetiologic viewpoint, Rhinoviruses are present in 90% of cases of
acute rhinopharyngitis. Besides these, other responsible viral agents are Adeno-
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