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ARTICLE IN PRESS
Acta Otorrinolaringol Esp. 2017;xxx(xx):xxx---xxx
www.elsevier.es/otorrino
LETTER TO THE EDITOR
Response to: Is the Nasal Airway
the Main Mode of Transmission
for Pharyngeal Tuberculosis?夽
Respuesta a: ¿Es la vía aérea nasal el principal
medio de transmisión para la tuberculosis
faríngea?
Dear Editor,
On receiving the letter to the Editor, the first response to
the question ‘‘Is the nasal airway the main mode of trans-
mission for primitive cavum tuberculosis?’’ would, of course,
be yes. However, several questions then arise such as ‘‘by
what mechanism?’’, or ‘‘what is the pathophysiology caus-
ing the nasal airway to be the main route of transmission or
contagion of primitive cavum tuberculosis?’’.
When a contaminated person coughs, sneezes, shouts or
sings, they can expel droplet nuclei that contain Mycobac-
terium tuberculosis.1 These airborne nanoparticles measure
between 1 and 5 ␮m, and can remain infectious in air for
sometime and can be inhaled by other people.2
The nasal vestibule vibrissae filter the inhaled air and
trap macroscopic particles, while smaller particles will be
deposited in the posterior segments.3
This might be explained by a review of the respiratory
cycle mechanisms of the upper airways, since there are vari-
ations in air flow. Respiratory air flow can be laminar or
turbulent, depending on the area or the phase of respiration
in question.3
Bernouilli’s principle, the Venturi effect, states that air
flow velocities are affected by the diameter of a tube. A
narrowed area causes an increase in velocity while pressure
reduces and conversely, when the air flow passes through a
widened area, velocity decreases and the flow becomes tur-
bulent. If this is applied to the upper airways, after passing
DOI of original article:
http://dx.doi.org/10.1016/j.otoeng.2016.07.010
夽 Please cite this article as: Temsamani H. Respuesta a:
¿Es la vía aérea nasal el principal medio de transmisión
para la tuberculosis faríngea? Acta Otorrinolaringol Esp. 2017.
http://dx.doi.org/10.1016/j.otorri.2016.07.004
2173-5735/© 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringologı́a y Cirugı́a de Cabeza y Cuello. All rights reserved.
through the nostrils and nasal valve at 12---18 m/s, the air
flow reaches the cavum at a velocity of 3---4 m/s. In other
words, when it reaches the wider rhinopharyngeal region,
air flow slows down and is no longer laminar.
These circumstances facilitate more contact between
the air and the mucosa, which is rich in lymphoid tissues,
enabling effective exchange between them both.3 Hence
the strength of the affirmative answer to the initial ques-
tion ‘‘is the nasal airway the main means of transmission
for primitive cavum tuberculosis?’’
References
1. Centers of disease control and prevention. Transmission and
pathogenesis of tuberculosis. In: Core curriculum on tuber-
culosis: what the clinician should know. sixth ed; 2013. p.
19---43 [chapter 2]. Available from: https://www.cdc.gov/tb/
education/corecurr/pdf/chapter2.pdf [accessed June 2016].
2. Sequeira de Latini MD, Barrera L. Manual para el diagnóstico
bacteriológico de la tuberculosis. Santa Fé, Argentina: Pan Amer-
ican Health Org; 2014, 66 pp. Available from: http://files.sld.cu/
tuberculosis/files/2009/12/tb-labs-baciloscopia1.pdf
3. Martínez Ruiz-Coello A, Ibáñez Mayayo A, Pinilla Urraca
MT. Sociedad Española de Otorrinolaringología y Patología
Cérvico-Facial. Libro virtual de formación en ORL 1 II. Nariz
y senos paranasales. Capítulo 42. Fisiología de la nariz y
de los senos paranasales. Mecanismos de la olfacción. pp.
1---15. Available from: http://seorl.net/PDF/Nariz%20y%
20senos%20paranasales/042%20%20FISIOLOG%C3%8DA%20DE%
20LA%20NARIZ%20Y%20DE%20LOS%20SENOS%20PARANASALES.%
20MECANISMOS%20DE%20LA%20OLFACCI%C3%93N.pdf [accessed
12.03.16].
Hind Temsamani
Otorrinolaringología y Cirugía Cervicofacial, Cabinet Dr.
Temsamani, Rabat, Morocco
E-mail address: htemsamani@gmail.com
OTOENG-746; No. of Pages 1