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PH-RS13

Rhinitis, sinusitis, pharyngitis and tonsillitis

How viruses, allergens and bacteria inflame the nose, sinuses and throat: why a blocked ostiomeatal complex turns a cold into sinusitis, how viral, streptococcal and EBV sore throats differ, and why rheumatic fever can follow.

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  • 5 steps · 10 questions
  • 3D anatomy, affected parts marked

By the end, you can

  • Describe the nasal and sinus lining, how the sinuses drain through the ostiomeatal complex, and the tonsils of Waldeyer’s ring.
  • Explain how infective and allergic rhinitis cause discharge, sneezing and blockage, and how nasal polyps form in chronic rhinosinusitis.
  • Explain how blocked drainage turns a viral cold into acute bacterial sinusitis, and how sinus infection can spread to the orbit and skull.
  • Compare viral, group A streptococcal and Epstein–Barr virus tonsillopharyngitis, and describe quinsy and the pseudomembrane of diphtheria.
  • Explain why rheumatic fever and glomerulonephritis can follow streptococcal infection, and recognise the classic scores, tests and treatment mechanisms.

What it is

Inflammation of the upper airway lining: rhinitis (the nose), rhinosinusitis (the nose and paranasal sinuses, which almost always inflame together) and pharyngitis and tonsillitis (the throat and its lymphoid tissue, often together as tonsillopharyngitis). Most is infective, usually viral; rhinitis is also commonly allergic.

4 types to tell apart
Infective rhinitis
The common cold: viral, mostly rhinoviruses; catarrhal inflammation that settles within about two weeks.
Allergic rhinitis
IgE-mediated (type I) hypersensitivity to pollens (seasonal) or indoor allergens such as house-dust mite (perennial).
Acute and chronic rhinosinusitis
Acute: usually viral, sometimes bacterial, resolving within weeks. Chronic: more than 12 weeks, with or without nasal polyps.
Tonsillopharyngitis
Mostly viral; group A streptococcus in a minority; Epstein–Barr virus in glandular fever; diphtheria rarely.

Normal function

Nasal lining, sinus drainage and the tonsils

The nasal cavity warms, moistens and filters inhaled air. Scroll-shaped conchae (turbinates) on its side walls enlarge the surface, which is covered by : ciliated respiratory epithelium with goblet cells over a lamina propria full of seromucous glands and wide venous sinusoids. The sinusoids act as erectile tissue: as they fill and empty, the lining swells and shrinks, normally alternating between the two sides every few hours (the nasal cycle).

The paranasal sinuses are air spaces in the skull bones, lined by the same mucosa. Cilia sweep a thin blanket of mucus along fixed paths to each opening (ostium), even uphill: the opening of the lies high on its inner wall. The and maxillary sinuses and the anterior all drain into the middle meatus through one narrow, shared channel, the ostiomeatal complex. The posterior ethmoid cells drain into the superior meatus and the into the recess above it.

A ring of lymphoid tissue guards the entry to the pharynx (Waldeyer’s ring): the pharyngeal tonsil (adenoids) in the roof of the nasopharynx, small tubal tonsils by the auditory tubes, the palatine tonsils between the arches of the soft palate and the lingual tonsil on the base of the tongue. The palatine tonsils have deep crypts lined by a thin, lymphocyte-filled epithelium that samples antigens, and drain to the deep cervical nodes, notably the jugulodigastric node below the angle of the jaw. Tonsils are largest in childhood and shrink after puberty.

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