Nasopharyngeal lymphoid tissue--a threat to the middle ear?

Microorganisms responsible for upper respiratory tract infection reside on the mucous membranes of the pharynx, where distinct surfaces are selectively colonized. The nasopharynx in children can be considered a unique ecologic niche colonized, in comparison with the throat, with rather few bacterial species such as Streptococcus pneumoniae and Haemophilus influenzae. These bacteria adhere to the mucosa in close contact with the lymphatic tissue of the adenoid. Recently, several well-designed studies have shown statistically significant effect of adenoidectomy on the resolution of secretory otitis media. This effect does not seem to correlate to mechanical obstruction of the eustachian tube by the adenoid, but may be due to an increased antigenic load on the lymphatic tissue. It is therefore of interest to study the interaction between microorganisms and the lymphatic tissue.