Immunodeficiency in pediatric otolaryngology

The relationship between the individual's aerodigestive tract and the external environment is a delicate balance maintained by a competent immune system. An understanding of the immune system and the various immune defects thus enables the practitioner to diagnose and treat an otherwise unrecognized cause of recurrent respiratory and ear infections. In this article a review of the immune system is presented. The structure and function of cell mediated and humoral immunity as well as the corresponding deficiency states are discussed. Specific emphasis is placed on immunity as it relates to the air and food passages and the ear. All charts of patients with immune deficiency seen at the Children's Hospital of Philadelphia were reviewed. Thirty patients were found to be immunodeficient. Hypogammaglobulinemias accounted for 50.0 per cent, IgA deficiency accounted for 33.3 per cent, and chemotactic defects occurred in 13.3 per cent. All patients exhibited some type of otolaryngologic disease, characterized by frequent infections of the middle ear, upper respiratory tract, paranasal sinuses, or lungs. Because of this pattern of presentation, the otolaryngologist should be aware of these disorders and participate in their diagnosis and treatment.