Nasopharyngitis

Inflammation of the nasopharynx – the upper and shortest part of the pharynx connected to the nasal cavity, which ensures the passage of inhaled air – is called nasopharyngitis.

In medicine, nasopharyngitis is considered a synonym for acute viral rhinitis, colds or ARVI - acute respiratory viral infection of the upper respiratory tract. Acute nasopharyngitis is coded according to ICD 10 - J00, chronic - J31.1.

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Causes nasopharyngitis

Nasopharyngitis can be caused by over two hundred different viruses, but in eight out of ten cases, nasopharyngitis is caused by human rhinoviruses (HRV) of the Picornaviridae family, which has over a hundred serotypes that are well adapted to the human body.

The cold season is the season of viral inflammation of the nasopharynx, as rhinoviruses are more active in autumn and winter. Why? Because the optimal temperature for their reproduction is +33°C, and the upper respiratory tract, through which cold air passes, is the most suitable place for them (outside the upper respiratory tract of a person, HRV can survive for no more than 18 hours).

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Pathogenesis

The pathogenesis of the disease is associated with airborne or contact spread of rhinoviruses and their entry into the mucous membrane lining the nasopharynx. Rhinovirus nucleocapsids gain access to epithelial cells by adhesion to special molecules (ICAM-1) on the surface of the membranes of the cells of the nasopharyngeal mucosa. Then the viruses begin to multiply rapidly, and the replication of their RNA causes the activation of cytokines and kinins, which, in turn, transmit a signal about the pathogenic factor to the inflammatory mediators of the epithelium. That is, the mechanism of the body's immune response is triggered. 24-72 hours after infection, the first signs of the disease begin to appear, and acute nasopharyngitis develops.

This disease reduces the resistance of the nasopharyngeal mucosa to bacteria, and when they join rhinoviruses, complications such as inflammation of the paranasal sinuses (sinusitis), acute tonsillitis (tonsillitis) may occur. In childhood, inflammation of the middle ear (otitis) often develops - due to the structural features of the auditory tubes in children of the first 5-7 years of life.

And in the presence of chronic pulmonary pathologies (bronchial asthma, COPD, pulmonary emphysema, cystic fibrosis), complications of nasopharyngitis - in the form of an exacerbation of chronic diseases - are practically inevitable.

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Symptoms nasopharyngitis

The very first signs of rhinovirus infection of the nasopharynx and the resulting irritation of the mucous membrane lining it are pruritis (itching) in the nose and sneezing, as well as a feeling of dryness and irritation in the oropharynx and pharynx. Rhinorrhea soon joins them, that is, a significant amount of colorless watery exudate is constantly released from the nose, which thickens by the beginning of the third day and can become yellow-greenish. Thick discharge is a favorable environment for the reproduction of bacteria present in the nasal cavity, which causes consequences in the form of the development of a secondary infection.

Due to the accumulation of intracellular fluid in the mucous tissues (under the influence of histamine), the nose becomes blocked, breathing and smelling become blocked. Other symptoms of nasopharyngitis are also noted: lacrimation, pain in the back of the head, myalgia, chills, general malaise. Cough, which accompanies nasopharyngitis in half of the cases, is usually dry and short-lived. In most adults, body temperature remains within normal limits (see - Cold without fever ), but in young children it can jump to +38.5 ° C and higher. For more information, see - Rhinovirus infection in children.

A significant portion of symptoms last for about a week or a little longer (which corresponds to the duration of the active phase of development of most rhinoviruses), but some manifestations of the disease may be noted a little longer. This concerns cough, which lingers for a week even after the person has recovered. This fact is explained by the fact that the respiratory tract may remain inflamed and sensitive to various irritants (dry air, smoke, dust, etc.).

But the symptoms of nasopharyngitis that should alert you and make you seek help from an otolaryngologist include: prolonged nasal congestion and the appearance of unpleasant sensations in the paranasal or maxillary sinuses; the pain in the throat intensifies, and a purulent coating appears on its mucous membrane; painful sensations in the ears are combined with noise and decreased hearing acuity. All of these are clear signs of a bacterial infection.

You should go to a therapist when the submandibular lymph nodes are swollen, and there are whitish spots on the tonsils or on the wall of the throat; when the cough has become stronger, and gray or greenish-yellow sputum has appeared, there is pain behind the breastbone, the temperature is slightly elevated and general weakness is constantly felt. These are clear signs of a secondary bacterial infection that needs to be treated with antibiotics.

Forms

In otolaryngology, which tends to identify nasopharyngitis with a runny nose (since this is the key symptom of the disease), nasopharyngitis, as a separate nosological unit, includes rhinitis of a different origin. These are purulent, allergic and herpetic rhinitis, which, in fact, are symptoms and are excluded from the class of acute respiratory infections by ICD 10.

In the 20% of cases where nasopharyngitis has a non-viral etiology, ENT doctors distinguish between:

• chronic nasopharyngitis, in which the inflammatory process in the upper respiratory tract, caused by infections (including bacteria and fungi), lasts for a long time;
• recurrent nasopharyngitis - in which the inflammatory process in the nasopharynx, caused by various reasons, often recurs sporadically;
• atrophic nasopharyngitis is a form of chronic rhinitis in which the nasopharyngeal mucosa undergoes pathological changes (partially atrophies) due to vitamin deficiency, iron deficiency anemia, or constant inhalation of harmful chemicals;
• purulent nasopharyngitis or bacterial nasopharyngitis - is diagnosed when exudate mixed with pus is released from the nasal passages;
• allergic nasopharyngitis (J30-J31) is a sign of allergy - increased sensitization of the body reacting to a certain irritant (allergen);
• catarrhal nasopharyngitis – the same as ARVI, which was previously called catarrhus respiratorius (catarrhus in Greek means “outflow”, in this case – the secretion product of the inflamed mucous membrane);
• Meningococcal nasopharyngitis is a local clinical manifestation of infection of the body by meningococcus (Neisseria meningitidis);
• Herpetic nasopharyngitis develops as a result of infection with the Herpes simplex virus or its activation during a latent infection.

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Diagnostics nasopharyngitis

Diagnosis of nasopharyngitis in more common terminology - ARI or ARVI - is the prerogative of a therapist or family doctor who makes exactly this diagnosis.

Tests aimed at identifying the actual infectious agent causing nasopharyngitis include a smear of the mucous membrane of the nose and throat and a blood test (to identify or exclude secondary infection). However, detection and identification of human rhinoviruses in clinical settings is a matter for the future, as there are currently no readily available testing systems even in the best foreign clinics.

It is also impossible to determine the HRV serotype based on symptoms. Therefore, the diagnosis of nasopharyngitis is based on the complaints of the sick, assessment of the intensity of the symptoms, examination of the nasopharynx and checking the condition of the retropharyngeal lymph nodes. All this is done by otolaryngologists.

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Differential diagnosis

In clinical ENT practice, differential diagnostics is important, since acute nasopharyngitis is often mistaken for flu (with fever and cough). It is easy to confuse purulent nasopharyngitis with sinusitis or chronic inflammation of the adenoids. And otolaryngologists use instrumental diagnostics: the condition of the nasal mucosa is examined using rhinoscopy, the ears - otoscopy; the pharynx is examined with a fibrolaryngoscope; the condition of the paranasal sinuses will be shown by diaphanoscopy, and the general picture of the ENT organs is given by ultrasound.

Treatment nasopharyngitis

Medicine has not yet been able to combat rhinoviruses, because antimicrobial drugs, as is known, do not kill viruses. Therefore, antibiotics are not used for nasopharyngitis. Although, due to the expectation of bacterial infections, some doctors still prescribe them, despite the fact that antibacterial agents do not have preventive properties, but seriously disrupt the microbiocenosis of the body. See more about when antibiotics are needed for colds.

Treatment of nasopharyngitis is aimed exclusively at relieving symptoms. Many studies have established that the symptoms of nasopharyngitis (itching in the nasopharynx, increased transudation of nasal secretion, watery eyes, dry cough) develop not due to damage to the mucous membrane by viruses, but as a result of immune reactions such as allergies - with an increase in the release of the neurotransmitter histamine by mast cells and the participation of peripheral H-receptors.

Therefore, medications used for rhinorrhea and nasal congestion in nasopharyngitis include antihistamines. Moreover, as it turned out, only first-generation antihistamines, such as Suprastin (Chloropyramine, Halopyramine, etc.) or Tavegil (Angistan, Clemastine, Meclastene, etc.), affect the symptoms of nasopharyngitis or ARVI.

Suprastin is prescribed one tablet (25 mg) - twice a day, during meals. Tavegil should also be taken one tablet (1 mg) twice a day. But these drugs (like all other antihistamines) have many side effects, and their use can be accompanied by dry mouth; nausea and vomiting; weakness and drowsiness; convulsions and impaired coordination; headache, epigastric and muscle pain; increased blood pressure and heart and urinary system disorders. Contraindications for Suprastin and Tavegil include: cardiac arrhythmia, hypertension, stomach ulcers, prostate pathologies, glaucoma, pregnancy and lactation.

With the help of intranasal decongestants, which help to narrow the blood vessels, you can relieve swelling of the nasopharyngeal mucosa and restore nasal breathing. The most popular drops for nasopharyngitis are Naphthyzinum (other trade names are Naphazoline, Rinazin, Imidin) and Galazolin (Influrin, Rinazal, Otrivin). These drops are recommended to be instilled 2-3 times a day - 1-2 drops in each nostril. At the same time, the duration of use of these drugs should not exceed seven days, otherwise the mucous membrane in the nose may atrophy. Also, they should not be used to treat rhinitis in children under three years of age (in the USA, their use is prohibited for children under 12 years of age).

The drugs Naphthyzinum and Galazolin are contraindicated in atrophic nasopharyngitis, arterial hypertension, atherosclerosis, insufficient production of thyroid hormones, diabetes mellitus, closed-angle glaucoma, and during pregnancy.

Decongestants have side effects that include dryness and burning in the nasal cavity (overdose causes atrophy of the ciliated epithelium), increased heart rate, increased blood pressure, headache, sleep disturbances and decreased reaction speed (the latter should be kept in mind by those who drive or operate machinery in production).

To prolong the vasoconstrictive effect of nasal drops, it is more appropriate to use prolonged-release drugs, such as drops Vibrocil, Nazivin, Nazol, Polydexa, Rinza, sprays Vibrocil, Rinofluicil, etc.

Vibrocil drops for adults (and children aged 6 years and older) are recommended to be instilled into each nasal passage two drops three times a day. And Vibrocil spray is injected with one or two presses on the spray nozzle no more than three times a day. The safe duration of use for the nasal mucosa is seven days.

When treating nasopharyngitis, vitamins should not be forgotten. In particular, vitamin C, being a strong antioxidant, can reduce the severity and duration of the disease (large doses of ascorbic acid are not recommended for children). Read more - Vitamin C and cold treatment.

From the very beginning of acute nasopharyngitis, physiotherapy treatment can be carried out in the form of UHF of the nose, as well as with the help of warm steam inhalations with soda, a decoction of chamomile flowers, sage grass, eucalyptus leaves (or its essential oil), etc.

There is no set of exercise therapy exercises for nasopharyngitis, but you should know what kind of physical activity during a cold will not harm your health.

Homeopathy for nasopharyngitis

Is homeopathy used for nasopharyngitis? Its use is possible, and pharmacies have a number of homeopathic preparations for the treatment of rhinitis.

The multicomponent drug Coryzalia in tablet form reduces the intensity of nasal discharge and relieves swelling of the nasopharyngeal mucosa, including acute nasopharyngitis. Method of administration - sublingual (dissolution under the tongue). Recommended dosage: on the first day of treatment - one tablet every 60 minutes, but no more than 12 tablets per day. In the following three days, the intervals between doses are increased to two hours. An allergic reaction to this drug often occurs, and contraindications are pregnancy and age under two years.

The remedy Cinnabsin contains cinnabar (mercuric sulfide), extracts of the plants goldenseal and echinacea, as well as highly toxic potassium dichromate (Kalium bichromicum), which is widely used in homeopathy. The method of using Cinnabsin is the same as the previous remedy, but at two-hour intervals; after the condition improves, the daily intake is limited to three tablets. Side effects include hypersalivation (drooling).

For allergic nasopharyngitis, homeopaths recommend the drug Rhinital, which contains tropical plants cardiospermum and galfimia, whose phytosterols have antipruritic properties. The method of administration, dosage, side effects and contraindications are similar to the drug Coryzalia.

Folk remedies

It has long been recognized that folk treatment of nasopharyngitis and any respiratory viral infection copes well with the symptoms of the disease. The main thing is to do everything according to the rules.

It is correct to rinse the nasal cavity and gargle with a warm solution of common salt (a teaspoon per glass of boiled water).

It is correct to drink three cups of tea with ginger root during the day. See more details – how to use ginger for colds.

The correct way to do hot foot baths is to add mustard powder or a teaspoon of turpentine to the water.

It is correct to do inhalations, for which you can use not only chamomile, eucalyptus and sage, but also calendula flowers, thyme and horsetail grass, ginkgo biloba leaves. Essential oils of rosemary, geranium and cypress (in an aroma lamp) are very useful for nasopharyngitis. You can finely chop half an onion or 2-3 cloves of garlic, put them in a saw and breathe in phytoncides.

At the first signs of illness, you need to begin treatment with herbs:

• drink tea made from linden blossom or raspberry leaves with the addition of cinnamon, lemon and honey;
• brew like tea and drink 1-2 times a day an infusion of hyssop, echinacea, fireweed, watercress or mullein (20 g of herbs per 200 ml of boiling water);
• drink a decoction of dried black elderberry flowers, lemon balm leaves and yarrow herb (a dessert spoon of each ingredient per half liter of water, boil for 10 minutes, cool and take 100-150 ml three times a day);
• gargle with a decoction of plants such as sage, cinquefoil, plantain, calendula;
• drink an infusion of thyme for dry cough (a dessert spoon of the herb per 250 ml of boiling water, take a few sips 3-4 times a day);
• bury the nose with Kalanchoe pinnate juice, a strong decoction of St. John's wort or a mixture of oils - almond, menthol and tea tree (in equal proportions), 2-3 drops in each nasal passage.

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Prevention

Prevention of nasopharyngitis – in the sense of preventing a respiratory viral infection – is considered impossible because these viruses are everywhere and highly contagious. However, there are some ways to help reduce their spread, read more in our article Cold Prevention.

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Forecast

The prognosis for nasopharyngitis is favorable: most people begin to feel better on the 4th-5th day, since the body produces antibodies, and within 10 days the disease usually passes without complications. But there is also a secondary bacterial infection. According to statistics from the European Society of Virology (ESV), bacterial complications that nasopharyngitis causes in 8% of cases lead to sinusitis, in 30% - to otitis, in other cases pharyngitis and tonsillitis are observed.

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