Title:Adenotonsillar Disease
Volume: 6
Issue: 2
Author(s): Andreas E. Zautner
Affiliation:
Keywords:
Adenoiditis, mucosal biofilm, recurrent tonsillitis, Staphylococcus aureus
Abstract: Adenotonsillar disease (adenoiditis and recurrent tonsillitis) is a prevalent otolaryngologic disorder aetiologically
based on chronic inflammation triggered by a persistent bacterial infection. These bacteria, mostly Staphylococcus
aureus, Haemophilus sp., and Streptococcus sp., persist predominantly intracellular and within mucosal biofilms. The recurrent
or chronic inflammation of the adenoids and faucial tonsils leads to chronic activation of the cell-mediated and
humoral immune response, resulting in hypertrophy of the lymphoid tonsillar tissue. This hypertrophic tissue is the cause
for the prominent clinical symptoms: obstruction of the upper airways, snoring, and sleep apnea for adenoiditis or sore
throat, dysphagia and halitosis for recurrent tonsillitis. Treatment strategies should target the persisting bacteria within
their biofilm or intracellular shelter. Macrolide antibiotics like clarithromycin are able to modulate the immune system
and to interfere in bacterial signaling within biofilms. Clindamycin, quinupristin-dalfopristin, and oritavancin are intracellular
high active compounds. Surgical removal of the hypertrophic tissue by modern procedures like laser tonsil ablation,
eliminates not only a mechanical obstacle of the airways, it removes also the basis for the aetiologic cause, the “biofilm
carrier”. This review summarizes the role of bacterial persistence in mucosal biofilms for the aetiology, diagnosis and
treatment of adenotonsillar disease and relevant patents.
