THE PROBLEM OF PHARYNGEAL DYSBIOSIS IN CHRONIC PHARYNGITIS AND TONSILLITIS

A sore throat, whether as the sole symptom or in combination with other symptoms of acute respiratory infections, is the most common reason for consulting general practitioners, paediatricians and ENT specialists. A sore throat lasting longer than 14 days is classified as chronic and, in most cases, is the result of a chronic inflammatory condition of the throat: pharyngitis or tonsillitis.

A healthy throat microbiota acts as a barrier against pathogens and is essential for maintaining respiratory health. When the respiratory microbiome becomes unbalanced, dysbiosis develops.

Determining whether pharyngeal dysbiosis is a risk factor for recurrence or chronicity of the pathological process is of social and economic interest. The aim of this review article is to analyse the role of pharyngeal dysbiosis in the development of chronic pharyngitis and/or chronic tonsillitis. To examine the results of scientific research on pharyngeal dysbiosis, we used the scientometric databases PubMed, Scopus, Web of Science, and e-Library. The keywords used to search for the necessary information were: «pharyngeal microbiome», «pharyngeal dysbiosis», «chronic pharyngitis» and «chronic tonsillitis.» All articles reviewed were published between 2020 and 2025.

An analysis of the literature has shown that chronic inflammatory diseases of the pharynx are caused not only by pathogens, but also by a complex balance between them, the commensal microbiota and the immune response. Findings from studies of the oropharyngeal microbiome highlight the importance of adopting comprehensive, patient-centred strategies for diagnosis, treatment and medical prevention – specifically, the modulation of the oropharyngeal microbiome – which represents a promising avenue of research given the growing global problem of antibiotic resistance.

We believe that a deeper fundamental understanding of the composition of the pharyngeal microbiome and its complex bacterial communities will shed light on why some people develop chronic pharyngeal conditions whilst others do not.

Definitions:

microbiota is the composition of all microorganisms in a particular area;

microbiome is the collection of microorganisms, their genes and environmental factors in a particular area;

dysbiosis is an imbalance of pathogenic and beneficial bacteria.

1. Rol topicheskoj terapii v kompleksnom lechenii tonzillofaringitov u detej [The role of topical therapy in the complex treatment of tonsillopharyngitis in children] / T. I. Garashenko, L. I. Ilenko, A. P. Yastremskij, N. E. Pajganova // Medicinskij sovet. – 2025. – Vol. 19, № 1. – S. 94–102 [In Russian].

2. Shen, Y. 16SrDNA-Based Detection Technology in Patients with Chronic Pharyngitis to Analyze the Distribution Characteristics of Pharyngeal Bacteria / Y. Shen, Ch. Liu, J. Luo [et al.] // J Healthc Eng, – 2022. – Vol. 2022. – S. 1–10. – doi: 10.1155/2022/5186991.

3. Prevalence and Risk Factors of Anxiety Among Adult Patients with Chronic Pharyngitis in Wuhu, China / Z. Zha, S. Gao, S. Liu, G. Hu // Neuropsychiatr Dis Treat., – 2023. – Vol. 19. – P. 1313–1319. – doi: 10.2147/NDT.S415938.

4. Palchun, V. T. Otorinolaringologiya: uchebnik [Otorhinolaryngology] / V. T. Palchun, A. I. Kryukov, M. M. Magometov. – 4-e izd., pererab. i dop. – M.: GEOTAR-Media, 2022. – 592 s. : il. [In Russian].

5. Molecular mapping to species level of the tonsillar crypt microbiota associated with health and recurrent tonsillitis / A. Jensen, H. Fagö-Olsen, Ch. Sørensen, M. Kilian // PLoS One. – 2013. – Vol. 8(2). – S. 1–15. – doi: 10.1371/journal.pone.0056418.

6. Mezhejnikova, M. O. Mikrobiom glotki [Pharyngeal Microbiom] / M. O. Mezhejnikova, A. D. Bulanova // Fundamentalnaya nauka v sovremennoj medicine – 2023: materialy nauchnoprakticheskoj konferencii studentov i molodyh uchenyh. – Minsk: BGMU, 2023. – S. 92–94 [In Russian].

7. The Human Respiratory System and its Microbiome at a Glimpse / L. Santacroce, I. A. Charitos, A. Ballini [et al.] // Biology (Basel). – 2020. – Vol. 9(10). – S. 1–16. – doi: 10.3390/biology9100318.

8. A systematic framework for understanding the microbiome in human health and disease: from basic principles to clinical translation / Z. Ma, T. Zuo, N. Frey, A. Y Rangrez // Signal Transduct Target Ther, – 2024. – Vol. 9(1). – S. 1–36. – doi: 10.1038/s41392-024-01946-6.

9. The impact of environmental factors on respiratory tract microbiome and respiratory system diseases / Y. Ge, G. Tang, Y. Fu [et al.] // Eur J Med Res. – 2025. – Vol. 30(1). – S. 1–8. – doi: 10.1186/s40001-025-02517-3.

10. Stoma, I. O Mikrobiom v medicine: rukovodstvo dlya vrachej [Microbiome in medicine: a guide for doctors] / I. O. Stoma //. – M.: GEOTAR–Media, 2024. – 320 s.: il. [In Russian].

11. Interactions between bacteria in the human nasopharynx: a scoping review / K. Yu, V. Tenaglia, E. G. Chua [et al.] // Lancet Microbe. – 2025. – Vol. 6(7). – S. 1–14. – doi: 10.1016/j.lanmic.2024.101062.

12. Beule, A. G. The Microbiome – The Unscheduled Parameter for Future Therapies / A. G. Beule // Laryngorhinootologie. – 2018. – Vol. 97. – P. 279–311. – doi: 10.1055/s-0043-122301.

13. The Respiratory Tract Microbiome and Human Health / P. F. de Córdoba-Ansón, I. Linares-Ambohades, F. Baquero [et al.] // Microb. Biotechnol. – 2025. – Vol. 18, № 5. – S. 1–19. – doi: 10.1111/1751-7915.70147.

14. Comprehensive human respiratory genome catalogue underlies the high resolution and precision of the respiratory microbiome / Y. Li, G. Pan, S. Wang [et al.] // Brief Bioinform. – 2024. – Vol. 26(1). – S. 1–18. – doi: 10.1093/bib/bbae620.

15. Transmission of the human respiratory microbiome and antibiotic resistance genes in healthy populations / L. Ren, J. Yang J, Y. Xiao Y [et al.] // Microbiome. – 2025. – Vol. 13(1). – S. 1–14. – doi: 10.1186/s40168-025-02107-9.

16. Differential nasopharyngeal microbiota patterns: A comparative study of pneumococcal pneumonia, COVID-19, and healthy adults / B. Dietl, D. Henares, E. Cuchí [et al.] // J Infect. – 2025. – Vol. 91(3). – S. 1–10. – doi: 10.1016/j.jinf.2025.106589.

17. Mitra, A. Combatting biofilm-mediated infections in clinical settings by targeting quorum sensing / А. Mitra // Cell Surf. – 2024. – Vol. 12. – S. 1–8. – doi: 10.1016/j.tcsw.2024.100133.