The role of the palatine tonsils in the regulation of the state of humoral local immunity in patients with chronic inflammatory diseases of the nose and perinasal sinuses when infected with viruses of the respiratory group
Authors: Melnikov Oleg F. , Zabolotnyi Dmitry I. , Sambur Marina B. , Zabolotna Diana D. , Timchenko Мarina D. , Faraon Inna V. , Zayets Tetiana A. 
Published: December 2022

Topicality: Acute respiratory diseases of the upper respiratory tract, which in the vast majority of cases are caused by viruses, especially with frequent recurrences of diseases, reduce local and system immunity, which often leads to the accumulation of bacterial infection due to the activation of endogenous microflora or exogenous infection and causes the development of viral-bacterial diseases. Recurrent respiratory diseases contribute to the formation of chronic pathology of the oro- and nasopharynx, which in turn supports the violation of the body's protective mechanisms. Previous studies have shown that the tonsils of the lymphadenoid pharyngeal ring perform the function of immunological protection, and the absence of palatine tonsils (PT) negatively affects the state of both local and system immunity.
Aim: to determine the role of the palatine tonsils in the realization of local humoral reactions in patients with chronic inflammatory diseases of nose and paranasal sinuses when infected with viruses of the respiratory group.
Materials and methods: Studies were conducted in 134 patients with chronic inflammatory diseases (CID) of nose and paranasal sinuses (PNS) in remission, among whom 93 had a diagnosis of chronic rhinosinusitis, 27 – chronic catarrhal rhinitis, 14 – allergic rhinitis with chronic bronchitis. The control group consisted of 47 practically healthy persons without pathology from the ENT organs.
The examined persons were divided into those who had PT and those from whom they were surgically removed no earlier than five years ago.
All examinees were divided into those who had anamnestic antibodies in their blood to one or more of the respiratory viruses, such as: adenovirus, respiratory syncytial virus and influenza A virus in a clinically significant titer, and those in whom antibodies were not detected.
The local humoral immunity state of patients was assessed by the content of immune complexes (IC) and concentrations of secretory immunoglobulin A (sIgA), interferons alpha- (α-IFN) and gamma- (γ-IFN) in the oropharyngeal secretion (OS), which were determined by the immunoenzymatic method using sets of reagents for enzyme-linked immunosorbent assays ("Cytokin", RF) and the Stat Fax-2100 analyzer (USA).
All examined patients had a healthy state of the oral cavity.
Results: The presence or absence of palatine tonsils changes the levels of number of humoral factors of local immunity in oropharyngeal secretion in practically healthy donors and in patients with chronic inflammatory diseases of the nose and PNS. The production of sIgA and α-IFN in OS depends on PM, decreasing in practically healthy persons of the control group who underwent tonsillectomy.
Chronic inflammatory diseases of the nose and PNS caused a decrease in the concentration of IC and α-IFN in the OS of patients of both groups- with or without PT. In patients with normal PMs who got sick with viral infections, in contrast to those with removed PMs, α-IFN level in OS increased and practically did not differ from those in healthy donors. The greatest suppression of α-IFN production was determined in patients with CID of the nose and PNS with removed PM and with the absence of clinically significant titers of antiviral antibodies.
The level of γ-IFN production did not reliably change in the OS of patients with CID of nose and PNS in the remission phase both with normal PT and after tonsillectomy, but depended to a greater extent on the transferred infectious disease caused by viruses of the respiratory group.
Conclusion: PTs play a significant role in the formation of a number of reactions of local immunity in the naso- and oropharynx, both in practically healthy individuals and in patients with chronic inflammatory disease of nose and paranasal sinuses. Therefore, the determination of local immunity indices in patients with chronic inflammatory diseases of the upper respiratory tract with different status of the palatine tonsils, who are in contact or had contact with respiratory viruses, provides an opportunity to identify the most vulnerable links in the system of their anti-infective protection, which should first of all be paid attention to during examination and treatment of patients with chronic inflammatory diseases of the upper respiratory tract, especially in cases of frequent recurrence of acute respiratory diseases.