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Acute nasopharyngitis

OVERVIEW

What is acute nasopharyngitis?

Acute nasopharyngitis refers to acute inflammation of the nasopharyngeal mucosa, submucosa, and lymphoid tissue, most commonly affecting the pharyngeal tonsils. It is the most prevalent type of acute upper respiratory tract infection. The condition is primarily caused by viral infections (e.g., rhinovirus, coronavirus) but may also result from bacterial infections (e.g., staphylococcus, streptococcus pneumoniae) [1,2].

Patients often exhibit prominent nasopharyngeal symptoms such as sneezing, nasal congestion, clear nasal discharge, cough, dry throat, and throat itching, while systemic symptoms are generally mild.

Clinical management follows the principles of etiological treatment (anti-infective therapy based on the causative agent) and symptomatic treatment (targeted relief or elimination of symptoms), primarily relying on medication for cure [3].

If left untreated, the condition may persist and progress to chronic nasopharyngitis or lead to adjacent organ complications, triggering systemic infections and ultimately causing acute sinusitis, otitis media, or even viral myocarditis.

Is acute nasopharyngitis common?

Acute nasopharyngitis is a common and frequently occurring disease [3], though authoritative literature lacks specific epidemiological data.

SYMPTOMS

What are the symptoms and manifestations of acute nasopharyngitis?

The clinical features of acute nasopharyngitis are characterized by prominent nasopharyngeal symptoms and mild systemic symptoms, as follows [1,2]:

  1. Nasopharyngeal symptoms: Patients primarily experience nasopharyngeal symptoms, such as sneezing, nasal congestion, and clear nasal discharge, which may thicken after 2–3 days. Other symptoms may include coughing, dry throat, throat itching, sore throat or burning sensation, and even postnasal drip.
  2. Systemic symptoms: Generally, there is no fever or other systemic symptoms, and the condition is often self-limiting. Some may experience only low-grade fever, mild chills, and headache. Systemic symptoms of acute nasopharyngitis are more common in infants and young children (aged 0–3 years), mainly presenting as high fever, vomiting, abdominal pain, diarrhea, and dehydration symptoms (manifested as dry mouth, reduced urine output, and decreased skin elasticity). In adults, systemic symptoms are usually not prominent.
  3. Other symptoms: Some patients may experience a foreign body sensation in the throat, swollen tonsils, and enlarged, painful lymph nodes in the jaw and neck.

What are the complications of acute nasopharyngitis?

  1. Acute sinusitis: Acute nasopharyngitis can affect adjacent organs, leading to acute sinusitis. Symptoms include worsened nasal congestion compared to nasopharyngitis, purulent nasal discharge, facial or nasal root pain, and reduced sense of smell [1].
  2. Acute otitis media: Acute nasopharyngitis can involve the middle ear, causing acute otitis media. Symptoms include ear pain, ear fullness, hearing loss, tinnitus, and ear discharge [1].
  3. Rheumatic fever: Streptococcal acute nasopharyngitis may trigger rheumatic fever, presenting as fever, malaise, fatigue, pallor, and excessive sweating.
  4. Glomerulonephritis: Streptococcal acute nasopharyngitis can also lead to glomerulonephritis, causing symptoms such as edema, proteinuria, and hematuria.
  5. Viral myocarditis: Most cases are caused by viral infections, with a minority due to bacterial infections. Prolonged illness may result in viral myocarditis, manifesting as fever, headache, sore throat, cough, abdominal pain, diarrhea, joint pain, as well as chest pain, palpitations, chest tightness, shortness of breath, and fatigue.

CAUSES

What Causes Acute Nasopharyngitis?

Acute nasopharyngitis occurs when viruses or bacteria enter the body through swallowing or breathing, or when nasal secretions flow backward into the nasopharynx, leading to bacterial or viral infections [3]. The specific causes are as follows:

  1. Viral factors: One of the main pathogenic factors, often caused by viruses such as rhinovirus, coronavirus, adenovirus, influenza and parainfluenza viruses, respiratory syncytial virus, echovirus, and coxsackievirus.
  2. Bacterial factors: The second most common pathogenic factor, primarily caused by colonization of oral bacteria like *Streptococcus pyogenes*, and occasionally by *Streptococcus pneumoniae*, *Staphylococcus*, *Haemophilus influenzae*, or gram-negative bacilli [2].

What Factors Can Trigger Acute Nasopharyngitis?

  1. Environmental factors: Dryness, dust, smoke, harmful gases, or allergens can damage the nasal mucosal barrier, increasing susceptibility to viral or bacterial infections. Additionally, exposure to rain, cold, climate changes, or poor living conditions may weaken systemic or local respiratory defenses, facilitating infections.
  2. Immune factors: Individuals with weakened immunity—such as the elderly, young children, those with chronic diseases, or excessive fatigue—are more prone to infections, leading to acute nasopharyngitis [2].
  3. Poor hygiene habits: Practices like nose-picking, plucking nasal hair, or excessive nose-blowing can compromise nasal protection, increasing infection risks.

Is Acute Nasopharyngitis Contagious? How Is It Transmitted?

Yes, it is contagious and can spread via respiratory droplets or close contact [2,4].

  1. Respiratory transmission: The primary route, involving inhalation of infected droplets (e.g., from talking) containing viruses (e.g., rhinovirus, coronavirus) or bacteria (e.g., *Staphylococcus*, *S. pneumoniae*).
  2. Contact transmission: Direct transmission (e.g., kissing) or indirect transmission (e.g., touching contaminated surfaces and then the eyes/mouth, sharing utensils or meals with an infected person).

DIAGNOSIS

Under what circumstances should patients with acute nasopharyngitis seek medical attention?

Seek prompt medical attention if symptoms such as runny nose, nasal congestion, sneezing, cough, fever (oral temperature >37.2°C), headache, sore throat, or diarrhea occur.

What tests are required for patients with acute nasopharyngitis?

  1. Your doctor may conduct a physical examination, such as checking for fever, or use instruments (e.g., electronic nasopharyngoscope) to observe the condition of your nasal cavity, including signs of mucosal congestion, swelling, or suppuration in the nasopharynx, to preliminarily assess the illness.
  2. After the initial physical examination, your doctor may order a complete blood count (CBC) to determine whether the infection is viral or bacterial. Viral infections often present with normal or decreased white blood cell counts and elevated lymphocyte ratios, while bacterial infections typically show increased white blood cell and neutrophil counts, indicating a left shift [1].
  3. If a viral infection is confirmed, the doctor may perform pathogen testing (e.g., nasal swab, throat swab, nasopharyngeal swab immunofluorescence, ELISA, serological diagnosis, or viral isolation) to identify the virus type. For bacterial infections, bacterial culture may be required to determine the bacterial strain. Once the infection type is identified, targeted medication is usually prescribed.
  4. The doctor may also recommend a CT scan of the nasopharynx. If the scan reveals the "small bubble sign" (air mixed with nasopharyngeal exudate), nasopharyngitis can be confirmed.

How to differentiate between acute and chronic nasopharyngitis?

The two conditions can be distinguished based on the following aspects:

  1. Definition: Acute nasopharyngitis is an acute inflammation of the nasopharyngeal mucosa, submucosa, and lymphoid tissue, while chronic nasopharyngitis is a chronic inflammation of these tissues.
  2. Causes: Acute nasopharyngitis is primarily caused by microorganisms (e.g., viruses like rhinovirus or coronavirus, or bacteria like staphylococci or streptococci) entering the nasopharynx via swallowing or breathing, or through nasal secretions. Chronic nasopharyngitis results from prolonged inflammatory stimulation.
  3. Clinical features: Acute nasopharyngitis has a sudden onset, commonly occurring in autumn, winter, or seasonal transitions, with symptoms like sneezing, nasal congestion, runny nose, dry cough, and sore throat. Chronic nasopharyngitis has a longer course, stubborn symptoms, and is harder to cure completely. It may develop from acute nasopharyngitis and often presents as nasopharyngeal dryness or difficulty expelling secretions.
  4. Treatment: Acute nasopharyngitis is treated with antiviral or antibacterial drugs (e.g., ribavirin, penicillin). Chronic nasopharyngitis focuses on addressing underlying conditions (e.g., acute pharyngitis) and correcting poor habits (e.g., nose-picking, plucking nasal hair).

TREATMENT

What department should patients with acute nasopharyngitis usually visit first when going to the hospital?

Otolaryngology, Respiratory Medicine, Pediatrics.

  1. Priority should be given to Otolaryngology or Respiratory Medicine;
  2. When the patient is a child under 12 years old, Pediatrics may also be consulted.

How is acute nasopharyngitis generally treated?

The treatment of acute nasopharyngitis mainly includes etiological treatment (anti-infection therapy based on the cause) and symptomatic treatment (targeted relief or elimination of symptoms), with clinical emphasis on drug therapy.

  1. Anti-infective drugs
    1. Antiviral drugs: Suitable for acute nasopharyngitis caused by viral infections. Common drugs include Ribavirin. Adverse reactions such as nausea, vomiting, and loss of appetite may occur after use. These drugs are contraindicated in patients allergic to them and in pregnant women or those planning pregnancy.
    2. Antibacterial drugs: Suitable for acute nasopharyngitis caused by bacterial infections. Common drugs include Penicillin and Cefuroxime. Allergic reactions such as rash or asthma may occur after taking Penicillin, so it is contraindicated in patients allergic to penicillin. Adverse reactions such as abdominal pain, diarrhea, nausea, vomiting, loss of appetite, rash, erythema, and itching may occur after taking Ceftriaxone. These drugs are contraindicated in patients allergic to them.
  2. Corticosteroids: If patients experience symptoms such as nasal congestion or nasal mucosal congestion and swelling, doctors may prescribe corticosteroids such as Mometasone Furoate or Budesonide, often combined with saline to relieve nasal congestion and mucosal swelling. Mild nasal bleeding may occur after use, but it is usually self-limiting. Allergic reactions such as rash or urticaria may also occur. These drugs are contraindicated in patients allergic to any of their components.
  3. Decongestants: If corticosteroids effectively relieve nasal congestion caused by mucosal congestion and swelling, doctors may also prescribe decongestants such as Oxymetazoline or Ephedrine. However, overuse may lead to rebound nasal congestion, so the duration of use should generally not exceed one week. Mild burning, stinging, nasal dryness, headache, dizziness, or increased heart rate may occur. These drugs are contraindicated in patients allergic to them, pregnant women, and children under two years old. Caution is advised for elderly patients and those with hypertension, coronary heart disease, or diabetes.
  4. Antipyretics: If patients have a fever, doctors may prescribe antipyretics to prevent convulsions. Common drugs include Acetaminophen and Ibuprofen. Adverse reactions such as nausea, vomiting, sweating, abdominal pain, or pale skin may occur after taking Acetaminophen. These drugs are contraindicated in patients allergic to them or with conditions such as peptic ulcers, bleeding, liver or kidney dysfunction, or severe heart failure. Adverse reactions such as nausea, vomiting, abdominal pain, diarrhea, or constipation may occur after taking Ibuprofen. These drugs are contraindicated in patients allergic to them, pregnant or breastfeeding women, or those with liver or kidney dysfunction or severe heart failure.

Can acute nasopharyngitis resolve on its own?

Acute nasopharyngitis generally cannot resolve on its own. No authoritative literature confirms that acute nasopharyngitis can resolve without treatment. Therefore, if symptoms such as sneezing or nasal congestion occur, prompt medical attention is advised [1].

Can acute nasopharyngitis be cured?

Most cases can be cured.

  1. With timely and standardized treatment, symptoms such as sneezing, nasal congestion, and clear nasal discharge can be effectively relieved or eliminated;
  2. If left untreated, the condition may persist, potentially leading to complications such as chronic nasopharyngitis, acute sinusitis, otitis media, or even viral myocarditis, affecting the patient's quality of life.

DIET & LIFESTYLE

What should patients with acute nasopharyngitis pay attention to in their diet?

  1. Patients should adopt a light diet, avoiding high-fat, high-salt, and high-sugar foods such as fried foods, pickles, and honey. They should also choose easily digestible foods like noodles, millet porridge, and fruits to prevent constipation caused by fever-reducing medications.
  2. Consuming high-quality protein can enhance the body's resistance and speed up recovery. Common sources of high-quality protein include milk, eggs, fish, and beef.
  3. Adequate vitamins help the body eliminate toxins. Patients should consume fresh fruits and vegetables rich in vitamins, such as kiwis, apples, carrots, and spinach.
  4. Avoid spicy and irritating foods like spicy duck necks and hot pot to prevent worsening throat inflammation [5].

What should patients with acute nasopharyngitis pay attention to in daily life?

  1. To avoid adverse effects from improper medication, patients should strictly follow the doctor's instructions.
  2. Ensure adequate rest, avoid overexertion, and maintain good ventilation and sunlight in the living environment.
  3. Adjust clothing according to environmental changes to avoid getting wet in the rain or catching a cold.
  4. Engage in regular physical exercise, such as running or playing badminton, to boost immunity.

PREVENTION

Can acute nasopharyngitis be prevented? How to prevent acute nasopharyngitis?

Acute nasopharyngitis can be prevented, generally through the following methods:

  1. Develop good lifestyle habits, maintain a regular schedule (go to bed and wake up early, such as sleeping at 10 PM and waking up at 6 AM, avoid staying up late), eat a healthy diet (such as fresh fruits and vegetables), and engage in regular exercise (such as running or playing badminton) to help strengthen the body's resistance;
  2. Adjust clothing according to weather changes to avoid getting too cold or overheated;
  3. Maintain personal hygiene—wash hands after returning home, before meals, after using the toilet, after sneezing or coughing, and avoid sharing utensils with others;
  4. During outbreaks of respiratory diseases, try to avoid crowded or poorly ventilated areas and develop the habit of wearing masks in public places;
  5. Patients with chronic underlying conditions should actively manage their illnesses and improve their body's resistance through exercise, such as running or playing badminton.