CLINICAL AND MORPHOLOGICAL CHARACTERISTICS AND EVALUATION OF TORUS TUBARIUS IN CHILDREN WITH PHARYNGEAL TONSIL HYPERTROPHY

Abstract

Introduction: Among children with hypertrophy of pharyngeal tonsils undergoing adenoidectomy, 31.3% of cases show hypertrophy of the torus tubarius, even in the absence of middle ear pathology. However, the nature of the changes in this anatomical area in these children has not been described. The aim of the study: to investigate and evaluate morphological changes of pharyngeal tonsil and torus tubarius in children with hypertrophy of pharyngeal tonsil. Materials and methods: histological investigation and scanning electron microscopy were performed on fragments of pharyngeal tonsil and torus tubarius, obtained during adenoidectomy of 12 children with nasal breathing disturbances (Group 1) and 13 children with concomitant inflammatory diseases of the upper respiratory tract (Group 2). Results: In patients of Group 2, changes in the pharyngeal tonsil were more pronounced, showing inflammatory alterations such as infiltration by polymorphonuclear leukocytes in the covering epithelium and subepithelial layer, as well as lymphocytes in the covering epithelium, along with the presence of fibrosis compared to patients of Group 1. Additionally, samples covered by biofilms were significantly more frequently identified in Group 2 compared to Group 1 (53.8% vs. 16.6%, p<0.05). The mucosal changes in the torus tubarius corresponded to the nature of the changes observed in the pharyngeal tonsil in the respective group. Biofilms in the torus tubarius samples were found in 38.5% of cases in Group 2 and 8.3% of cases in Group 1 (p<0.05). Conclusions: 1. In children with hypertrophy of pharyngeal tonsil and torus tubarius, the morphological characteristics of the mucous membrane of torus tubarius are similar to those observed in the mucous membrane of pharyngeal tonsil of the respective group. 2. Biofilms were reliably more frequently identified on the surface of pharyngeal tonsil and torus tubarius in children with upper respiratory tract infections than in patients with nasal breathing disturbances. 3. The detected changes provide a basis for revising the therapeutic approach to hypertrophic torus tubarius in children with pharyngeal tonsil hypertrophy.