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Nasopharyngitis

OVERVIEW

What is nasopharyngitis?

Nasopharyngitis refers to inflammation of the mucous membrane, submucosal tissues, and lymphoid tissues in the nasopharynx (located behind the nasal cavities and at the uppermost part of the throat) [1]. The condition is often caused by viral infections (e.g., rhinovirus, coronavirus) but may also result from bacterial infections (e.g., staphylococcus, streptococcus pneumoniae) [1,2].

Patients with nasopharyngitis may experience symptoms such as sneezing, nasal congestion, runny nose, coughing, dry throat, and throat itching. Systemic symptoms like fever, irritability, headache, fatigue, and loss of appetite may also occur.

Doctors typically treat the condition with anti-infective medications, such as corticosteroids [3]. If left untreated, nasopharyngitis may persist, spread to nearby organs, or lead to systemic infections (e.g., fever, chills). Complications such as acute sinusitis or otitis media may also develop.

Is nasopharyngitis common?

This condition is common [4], but no authoritative literature provides specific epidemiological data.

What are the types of nasopharyngitis?

Based on disease duration, nasopharyngitis can be classified into [1]:

  1. Acute nasopharyngitis: Sudden onset, frequently occurring in autumn, winter, or seasonal transitions. Symptoms include pronounced sneezing, nasal congestion, runny nose, dry cough, and sore throat.
  2. Chronic nasopharyngitis: Persistent and stubborn symptoms, often difficult to cure completely. It may develop from acute nasopharyngitis, with symptoms such as dryness and discomfort in the nasopharynx, as well as difficulty expelling secretions.

SYMPTOMS

What are the symptoms and manifestations of nasopharyngitis?

Patients with nasopharyngitis may experience symptoms such as sneezing, nasal congestion, runny nose, coughing, dry throat, and throat itching. They may also exhibit systemic symptoms like fever, irritability, headache, fatigue, and loss of appetite [1,2].

Furthermore, different types of nasopharyngitis may present with varying symptoms.

  1. Acute nasopharyngitis: Symptoms may include sneezing, nasal congestion, runny nose, dry cough, sore throat, fever, irritability, headache, general weakness, loss of appetite, vomiting, abdominal pain, and diarrhea.
  2. Chronic nasopharyngitis: Symptoms may include dryness and discomfort in the nasopharynx, difficulty expelling secretions, pain in the nasopharynx, and nausea [1,2].

What are the complications of nasopharyngitis?

  1. Sinusitis and otitis media: Nasopharyngitis can affect nearby organs, leading to sinusitis (manifested as nasal congestion, runny nose, headache, and general discomfort) or otitis media (manifested as ear pain, tinnitus, and hearing loss).
  2. Rheumatic fever and glomerulonephritis: Streptococcal acute nasopharyngitis may trigger rheumatic fever, presenting as fever, malaise, lethargy, fatigue, pallor, and excessive sweating. It may also cause glomerulonephritis, resulting in edema, proteinuria, and hematuria.
  3. Viral myocarditis: Most cases of nasopharyngitis are caused by viral infections, with a minority due to bacterial infections. Prolonged illness may lead to viral myocarditis, with symptoms such as fever, headache, sore throat, cough, abdominal pain, diarrhea, joint pain, chest pain, palpitations, chest tightness, shortness of breath, and fatigue.

CAUSES

What causes nasopharyngitis?

Different types of nasopharyngitis have different causes. Acute nasopharyngitis is mostly caused by viral or bacterial infections, while chronic nasopharyngitis is often triggered by inflammatory stimulation.

  1. Acute nasopharyngitis is usually caused by microorganisms such as viruses or bacteria entering the nasopharynx through swallowing or breathing, or by the backflow of nasal secretions into the nasopharynx [3]. Specific causes include:
    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 major pathogenic factor, commonly caused by infections from oral colonizers like hemolytic streptococcus, or occasionally by Staphylococcus, Streptococcus pneumoniae, Haemophilus influenzae, and rarely Gram-negative bacilli [2].
  2. Chronic nasopharyngitis is mostly caused by inflammatory stimulation.
    1. Inflammatory stimulation: Long-term irritation of the nasopharyngeal mucosa by secretions from recurrent acute pharyngitis, acute nasopharyngitis, or chronic respiratory inflammation (e.g., acute/chronic sinusitis, chronic tonsillitis) can lead to chronic nasopharyngitis.

What factors can trigger nasopharyngitis?

  1. Environmental factors: Exposure to rain, cold, climate changes, or poor living conditions can weaken systemic or local respiratory defenses, making infections by bacteria or viruses more likely and ultimately triggering (acute) nasopharyngitis.
  2. Immune factors: Individuals with weakened immunity, such as the elderly, young children, those who are overworked, or those with chronic underlying diseases, are more susceptible to infections by bacteria or viruses, leading to (acute) nasopharyngitis [2].
  3. Poor lifestyle habits: Unhygienic practices like nose-picking, plucking nasal hair, or excessive nose-blowing can damage the nasal protective barrier, increasing the risk of bacterial or viral infections and triggering (acute) nasopharyngitis.

Is nasopharyngitis contagious? How is it transmitted?

Nasopharyngitis caused by viral or bacterial infections can be transmitted to others through respiratory droplets or close contact [2,5], while cases caused by physical factors like dust, smoke, or irritating gases are not contagious.

  1. Respiratory transmission: Acute nasopharyngitis caused by viruses (e.g., rhinovirus, coronavirus) or bacteria (e.g., Staphylococcus, Streptococcus pneumoniae) is primarily spread via respiratory droplets, such as inhaling infected droplets when talking to a patient.
  2. Contact transmission: Acute nasopharyngitis can also spread through direct close contact (e.g., kissing) or indirect contact (e.g., touching contaminated surfaces and then the eyes or mouth, sharing utensils or meals with an infected person).

DIAGNOSIS

When should patients with nasopharyngitis seek medical attention?

  1. If a routine blood test during a physical examination reveals an increase in white blood cells, further tests should be conducted under a doctor's guidance;
  2. When local symptoms of the nasopharynx occur, such as nasal congestion, runny nose, sore throat, cough, or postnasal drip, prompt medical attention is required;
  3. When systemic symptoms such as fever, headache, fatigue, or loss of appetite appear, medical care should be sought as soon as possible.

What tests do patients with nasopharyngitis need?

  1. Physical examination: The doctor may perform a physical examination, such as checking for fever, or use instruments (e.g., electronic nasopharyngoscope) to observe the nasal cavity for signs like mucosal congestion, swelling, or pus, providing an initial assessment of the condition.
  2. Routine blood test: After the initial physical examination, the doctor may order a blood test to determine whether the infection is viral or bacterial. Viral infections often show normal or low white blood cell counts with elevated lymphocyte ratios, while bacterial infections typically present with increased white blood cells and neutrophil ratios (a left shift phenomenon) [1].
  3. Pathogenic testing:
    1. If a viral infection is confirmed, the doctor may collect nasal swabs, throat swabs, or nasopharyngeal swabs for immunofluorescence, ELISA, serological diagnosis, or viral isolation to identify the virus type;
    2. If a bacterial infection is confirmed, the doctor may perform bacterial culture to determine the bacterial species.
  4. Nasopharyngeal CT scan: If small air bubbles (formed by the mixture of air and nasopharyngeal exudate) are detected on CT, nasopharyngitis can be diagnosed.

Which diseases can nasopharyngitis be easily confused with?

Nasopharyngeal cancer: Both nasopharyngitis and nasopharyngeal cancer affect the nasopharynx and share symptoms like nasal congestion and runny nose. Doctors primarily differentiate them using nasopharyngeal CT scans and pathological biopsies. In nasopharyngitis, CT scans may reveal small air bubbles (from air mixed with exudate), whereas nasopharyngeal cancer typically lacks this feature. Additionally, pathological biopsies of nasopharyngeal cancer patients show cancer cells, which are absent in nasopharyngitis [1].

TREATMENT

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

Otolaryngology, Respiratory Medicine, Pediatrics.

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

How is nasopharyngitis generally treated?

The treatment of nasopharyngitis mainly includes etiological treatment and symptomatic treatment, with clinical emphasis on drug therapy.

1. Etiological Treatment

  1. Actively treat primary diseases of the nasopharynx, such as acute pharyngitis, chronic rhinitis, or chronic tonsillitis;
  2. Avoid exposure to harmful dust (e.g., cement, asbestos) and allergens;
  3. Abandon unhygienic habits like nose-picking, plucking nasal hair, or excessive nose-blowing.

2. Drug Therapy

  1. Antiviral drugs: Used for acute nasopharyngitis caused by viral infections. Common drugs include Ribavirin. Side effects may include nausea, vomiting, and loss of appetite. Contraindicated for those allergic to these drugs, pregnant women, women planning pregnancy, or patients with pancreatitis or heart disease.
  2. Antibacterial drugs: Used for acute nasopharyngitis caused by bacterial infections. Common drugs include Penicillin and Ceftriaxone. Penicillin may cause allergic reactions like rashes or asthma attacks—contraindicated for those allergic to penicillin. Ceftriaxone may cause abdominal pain, diarrhea, nausea, vomiting, loss of appetite, rashes, erythema, or itching—contraindicated for those allergic to such drugs.
  3. Corticosteroids: Often combined with saline to relieve symptoms like nasal congestion, nasopharyngeal mucosal congestion, or swelling. Common drugs include Budesonide and Mometasone Furoate. Mild nosebleeds may occur but are usually self-limiting. Allergic reactions like rashes or urticaria may also occur—contraindicated for those allergic to any component of these drugs.
  4. Antipyretics: If the patient has a fever, antipyretics like Ibuprofen or Acetaminophen may be prescribed to prevent convulsions. Ibuprofen may cause nausea, vomiting, abdominal pain, diarrhea, or constipation—contraindicated for those allergic to such drugs, pregnant or breastfeeding women, or patients with liver/kidney dysfunction or severe heart failure. Acetaminophen may cause nausea, vomiting, sweating, abdominal pain, or pale skin—contraindicated for those allergic to such drugs, patients with peptic ulcers/bleeding, or liver/kidney dysfunction/severe heart failure.
  5. Decongestants: Used to relieve nasopharyngeal mucosal congestion and swelling-induced nasal obstruction. Common drugs include Ephedrine and Oxymetazoline. Overuse may lead to rebound nasal congestion (prolonged use of nasal vasoconstrictors causing vascular dilation after contraction, mainly manifesting as nasal obstruction), so usage is generally limited to one week. Minor side effects may include burning, tingling, dry nasal mucosa, headache, dizziness, or increased heart rate. Contraindicated for those allergic to these drugs, pregnant women, or children under two. Use with caution in elderly patients or those with hypertension, coronary heart disease, or diabetes.

Can nasopharyngitis be cured?

Most cases can be cured.

  1. With timely and standardized treatment, symptoms like sneezing, nasal congestion, runny nose, cough, dry throat, or throat itch can be effectively relieved or eliminated;
  2. If left untreated, the condition may persist, lead to adjacent organ lesions, trigger systemic infections, or cause complications like acute sinusitis or otitis media, affecting the patient's quality of life.

DIET & LIFESTYLE

What should patients with 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 antipyretic treatment.
  2. Patients should consume high-quality protein to enhance immunity and aid faster recovery. Common sources include milk, eggs, fish, and beef.
  3. Adequate vitamins help the body eliminate toxins. Patients should eat more fresh fruits and vegetables rich in vitamins, such as kiwis, apples, carrots, and spinach.
  4. Avoid spicy and irritating foods like spicy duck necks or hot pot, as they may worsen throat inflammation [7].
    5.Drink plenty of water daily, with a recommended intake of at least 1,500 mL (equivalent to three standard bottles of mineral water) to keep the nasal passages moist [8].

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

  1. Wear protective gear (e.g., masks) when going out to avoid harmful gases or high concentrations of dust entering the nasal cavity and irritating the nasopharyngeal mucosa.
  2. Correct bad habits like nose-picking promptly.
  3. Maintain a regular sleep schedule (e.g., sleeping at 10 PM and waking at 6 AM), avoid staying up late or overexertion, ensure good ventilation and sunlight in living spaces, and engage in moderate exercise (e.g., running or playing badminton) to balance work and rest, thereby strengthening the body's resistance to bacteria and viruses.
  4. Take medications strictly as prescribed by the doctor and avoid arbitrarily reducing or stopping doses.

PREVENTION

Can nasopharyngitis be prevented? How to prevent nasopharyngitis?

This disease can be prevented, primarily by improving lifestyle habits. Specific methods are as follows:

  1. Maintain oral and nasal hygiene, and avoid poor personal habits such as picking the nose, plucking nose hairs, or excessive nose blowing.
  2. Adopt a light diet, avoiding high-fat, high-salt, and high-sugar foods (such as fried foods, pickles, honey, etc.). Maintain a regular sleep schedule (e.g., sleeping at 10 PM and waking at 6 AM), avoid staying up late, and engage in moderate exercise (such as running or playing badminton) to fundamentally improve physical fitness and resist disease [9].
  3. Actively treat underlying conditions (such as acute pharyngitis, chronic rhinitis, or chronic tonsillitis) to prevent secretions from irritating the nasopharyngeal mucosa and triggering chronic nasopharyngitis.
  4. Those who smoke or drink alcohol excessively must quit to avoid irritating the nasopharynx [9].
  5. Individuals exposed to harmful gases or high concentrations of dust in their work environment should take respiratory protective measures to reduce irritation to the nasopharyngeal mucosa.