The clinical microbiology of Waldeyer's ring

The role of microorganisms in infections of Waldeyer's ring is reviewed. The agents involved are aerobic and anaerobic bacteria, viruses, chlamydia, fungi, parasites, and rickettsia. The therapeutic implications of the presence of beta-lactamase-producing bacteria are discussed.     

The embryogenesis and anatomy of Waldeyer's ring

The developmental history of the embryonic germ disk is briefly traced through the bilaminar, trilaminar, and bodyfold stages with emphasis on the pharyngeal arches, pouches, and clefts. This is followed by a discussion of the genesis and adult anatomy of the tonsillar tissues.     

Diagnostic imaging of Waldeyer's ring

Diagnostic imaging of Waldeyer's ring can be obtained by plain films, CT scans, and MRI. In most instances, physical examination and plain films are sufficient for diagnosis and therapy. In addition, plain films are inexpensive and readily available. Although more expensive and less available, CT and MRI allow further evaluation of deep tissues not seen by physical examinations and plain film and permit more complete evaluations of more complex pathologic processes in Waldeyer's ring. Although both CT and MRI are often complementary, the indications for each modality are still evolving.     

Amyloidosis of Waldeyer's ring and larynx

Amyloidosis of the upper aerodigestive tract is relatively rare. A case of localized amyloidosis involving all components of Waldeyer's ring with added laryngeal involvement is described. This has not been previously reported. A literature review of this conditions is presented.     

HLA in cancers of Waldeyer's pharyngeal ring

HLA antigens were investigated in 129 patients with various types of carcinomas of Waldeyer's ring; most of them were undifferentiated carcinomas. Significant relations were demonstrated to the antigens of the HLA system particularly in locus B (B17) and DR (DR4). Differences in the frequency of other antigens compared with a control group were not statistically significant. The presence of HLA antigens serves as a useful auxiliary clinical marker which does not change in the individual patient. It characterises the patient immunogenetically and it may also serve as guidance for differential diagnosis in the initial tumour stages. At this stage, diagnosis may be difficult with all known methods, particularly of occult head and neck tumours.     

The blastic variant of mantle cell lymphoma arising in Waldeyer's tonsillar ring

We present three cases of blastic mantle cell lymphoma with an unusual initial manifestation in Waldeyer's ring with methods for differentiating it from other blastic neoplasms of the head and neck. All cases presented with a feeling of fullness in the area of the mass. Morphologically, the tumours were blastic with a high mitotic rate (three to nine per high power field). All were B-cell phenotype with coexpression of CD43. In all cases cyclin D1 and bcl-2 were positive and CD23 negative. Blastic mantle cell lymphoma occurring in Waldeyer's tonsillar ring may be mistaken for other high grade haematopoietic neoplasms. Immunohistochemistry and awareness of this type of lymphoma are helpful in differentiating it from other neoplasms.     

Pediatric considerations of infections and inflammations of Waldeyer's ring

Acute suppurative streptococcal pharyngitis remains a significant pediatric problem, accounting for much time lost from both school and play. Antibiotic therapy will usually treat the acute symptoms; tonsillectomy is often needed when the inflammation becomes chronic and recurrent.     

Cryosurgical treatment of the lymphoid tissue of Waldeyer's ring

The role of cryosurgery in the treatment of tonsil disease is an unresolved issue. Initial favorable reports failed to provide the necessary incentives for larger well-controlled studies. Bacteriologic and immunologic response to the cryosurgical treatment of tonsils remains unclear. Without appropriate studies, cryosurgery has been relegated to a backup status for conventional tonsil surgery. At present, cryogenic treatment of lymphoid tissue is generally limited to tonsillectomy in patients with blood dyscrasias; elimination of palatine tonsil regrowth and posterior pharyngeal lymphoid hyperplasia; and occasional laryngeal and lingual tonsillectomy.     

Ear disease in patients with inflammations of Waldeyer's ring

The etiologies of otitis media with effusion are certainly multiple but remain incompletely understood. The treatment of otitis media with effusion varies considerably. A discussion of known facts as well as debated issues underlying these differences is presented.     

Infection of Waldeyer's ring: value of pernasal retropharyngeal swabs

The value of pernasal retropharyngeal swabs in chronic adenoid and tonsillar disease was assessed in a prospective study involving 52 patients. Prior to adenoidectomy (34 patients) or adenotonsillectomy (17 patients), pernasal and tonsillar swabs were taken and the culture compared to the bacteriology profile obtained in the adenoid and tonsil tissue following surgery. The pernasal swab correctly identified 76% of pathogens isolated in the adenoid tissue. In addition, pernasal swabs forecast the presence of pathogens in 64% of core tonsil specimens, compared to an accuracy of 38% when superficial tonsil swabs were compared to the microbes in the deep tonsil. H. influenzae was the predominant organism isolated in all cultures. Our results clearly demonstrate that pernasal swabs give a representative picture of the adenoid bacterial content. Pernasal swabs are also superior to superficial tonsil swabs in indicating the deep tonsillar organisms.     

Evaluation of coagulation disorders in patients with diseases of Waldeyer's ring

The presence of pre-existing hemostatic disorders in a surgical patient may pose difficulties in the care of patients during and after surgery. To reduce the risk of excessive hemorrhage, this article has stressed the value of a thorough medical history, physical examination, and appropriate laboratory assays before surgery. When these measures reveal no evidence of a coagulation disorder, the surgeon can have confidence that the patient's hemostatic system has the appropriate resources to prevent excessive bleeding during surgery. However, if the coagulation screening procedure suggests that an abnormality exists, specific diagnostic assays must be performed before any necessary surgery to determine the exact nature of the coagulopathy. When this information is present, specific forms of blood component therapy can be given to minimize the risk of excessive hemorrhage during the operative period.     

Waldeyer's ring and otitis media: the nasopharyngeal tonsil and otitis media

This overview of the relationship between the nasopharyngeal tonsil and otitis media will review three important concepts: (1) Adenoid inflammation leads to inflammatory obstruction of the Eustachian tube; (2) early colonization of the adenoid with the three major bacterial pathogens of otitis media is the most important factor in the early pathogenesis of otitis media; (3) the local immune system in the adenoid particularly specific secretory IgA directed against both viruses and bacterial pathogens are probably genetically controlled and represent the immunological factor in protecting the host against invasion of these agents in the Eustachian tube and middle ear. This overview of the relationship between the adenoid and the development of otitis media emphasizes that nasopharyngeal colonization with the three major middle ear pathogens is among the most important risk factors in the pathogenesis of otitis media. Inasmuch as these pathogens normally reside in the nasopharynges of most healthy children, the factors which trigger development of otitis media need to be carefully evaluated. Among these two triggers are viral infections and upper respiratory tract allergy.