Nasopharyngitis

Inflammation of the nasopharynx - associated with the nasal cavity of the upper and the shortest part of the pharynx, which ensures the passage of inhaled air - is called nasopharyngitis.

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

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the nasopharyngitis

Nasopharyngitis can cause over two hundred different viruses, but in eight cases out of ten of the causes of nasopharyngitis - human rhinovirus (HRV) family Picornaviridae, numbering more than a hundred serotypes, perfectly adapted to the human body.

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

[10], [11], [12], [13]

Pathogenesis

The pathogenesis of the disease is associated with airborne or contact spread of rhinoviruses and ingestion of them on the mucosa lining the nasopharynx. Access to the epithelial cells of nucleocapsid rhinoviruses is obtained by adhesion with special molecules (ICAM-1) on the surface of the membranes of the cells of the mucous membrane of the nasopharynx. Then the viruses begin to multiply rapidly, and the replication of their RNA triggers 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 immune reaction of the organism is triggered. After 24-72 hours after infection, the first signs of the disease begin to manifest, and acute nasopharyngitis develops.

This disease reduces the stability of the mucous membrane of the nasopharynx to bacteria, and when they attach to the rhinovirus, complications such as inflammation of the paranasal sinuses (sinusitis), acute tonsillitis (angina) can occur. In childhood, inflammation of the middle ear (otitis) often develops - due to the peculiarities of the structure 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, emphysema, cystic fibrosis) complications of nasopharyngitis - in the form of exacerbation of chronic diseases - are almost inevitable.

[14], [15], [16], [17], [18], [19], [20]

Symptoms of the nasopharyngitis

The earliest signs of rhinovirus nasopharynx and the resulting irritation of the mucosa lining it are prurit (pruritus) in the nose and sneezing, as well as a feeling of dryness and perspiration in the oropharynx and throat. Soon, rhinorrhea joins them, that is, a significant amount of colorless watery exudate is constantly released from the nose, which becomes thicker by the beginning of the third day and can become yellowish-greenish. Dense secretions are a favorable environment for the reproduction of bacteria in the nasal cavity, which causes consequences in the form of secondary infection.

Because of the accumulation of intracellular fluid in the mucous tissues (under the action of histamine), the nose lays, stops breathing and smells. There are other symptoms of nasopharyngitis: lacrimation, pain in the occipital part of the head, myalgia, chills, general malaise. Cough, in half the cases accompanying nasopharyngitis, usually dry and short. In most adults, body temperature remains within normal limits (see - Cold without fever ), but in younger children it can jump to + 38.5 ° C and higher. For more details, see - Rhinovirus infection in children.

A significant part of the symptoms last for about a week or slightly longer (which corresponds to the duration of the active phase of development of most rhinoviruses), but some manifestations of the disease may take a bit longer. This applies to a cough that lasts for a week even after the person has recovered. This fact is explained by the fact that the airways can remain inflamed and sensitive to various irritants (dry air, smoke, dust, etc.).

But the symptoms of nasopharyngitis, which should alert and force to seek help from an otolaryngologist, include: prolonged nasal congestion and the appearance of unpleasant sensations in the region of the paranasal or maxillary sinuses; The pain in the throat is worse, and purulent deposits appear on his mucous membrane; pain in the ears combined with noise and decreased acuity of hearing. All these are clear signs of bacterial infection.

And the therapist should go when swollen submandibular lymph nodes, and on the tonsils or on the wall of the throat there are whitish spots; when the cough became stronger, and thus there was a gray or greenish-yellow sputum, it hurts behind the sternum, the temperature is slightly raised and the general weakness is constantly felt. These are clear signs of a secondary bacterial infection, which must be treated with antibiotics.

Forms

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

In those 20% of cases, when nasopharyngitis has not a viral etiology, ENT doctors distinguish:

• chronic nasopharyngitis, in which the inflammatory process in the upper respiratory tract, caused by infections (including bacteria and fungi), takes a long time;
• recurrent nasopharyngitis - in which the inflammatory process in the nasopharynx due to various causes is often sporadically repeated;
• Atrophic nasopharyngitis is a form of chronic rhinitis flow in which the nasopharyngeal mucosa undergoes pathological changes (partially atrophic) due to vitamin deficiency, iron deficiency anemia or the constant inhalation of harmful chemicals;
• purulent nasopharyngitis or bacterial rhinopharyngitis - is diagnosed when nasal passages are exudate with an admixture of pus;
• allergic nasopharyngitis (J30-J31) is a sign of an allergy - increased sensitization of the body, which reacts to a certain irritant (allergen);
• catarrhal nasopharyngitis is the same as ARVI, which was formerly called catarrhus respiratorius (catarrhus in Greek means "outflow", in this case - the secretion product of the inflamed mucosa);
• meningococcal nasopharyngitis is a local clinical manifestation of an organism's defeat by meningococcus (Neisseria meningitidis);
• Herpes nasopharyngitis develops due to infection with Herpes simplex virus or its activation with a latent infection.

[21], [22], [23], [24], [25], [26]

Diagnostics of the nasopharyngitis

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

Analyzes aimed at detecting the actual infectious agent that caused nasopharyngitis consist of a smear from the nose and throat mucosa and a blood test (to identify or exclude a secondary infection). However, the detection and identification of human rhinovirus in clinical settings is a matter of the future, since there are currently no readily available assay systems even in the best foreign clinics.

Based on the symptoms, it is also impossible to determine the HRV serotype. Therefore, the diagnosis of nasopharyngitis is based on complaints of patients, evaluation of the intensity of symptoms, examination of the nasopharynx and checking the status of retrofaringealnyh lymph nodes. All this is done by otolaryngologists.

[27], [28], [29], [30], [31], [32], [33]

Differential diagnosis

In clinical practice, differential diagnosis is important, as often acute nasopharyngitis is taken for influenza (in the presence of fever and cough). It is easy to confuse purulent nasopharyngitis with sinusitis or chronic inflammation of the adenoids. And the otolaryngologists use instrumental diagnostics: the condition of the mucosa of the nasal cavity is examined with the help of rhinoscopy, the ears - otoscopy; the pharynx is examined by a fibrolaringoscope; the state of paranasal sinuses will be shown by diaphanoscopy, and the total picture of ENT organs is given by ultrasound.

Treatment of the nasopharyngitis

To overcome rhinovirus medicine is not yet possible, because antimicrobial drugs, as is known, do not kill viruses. Therefore, antibiotics for nasopharyngitis are not used. Although, due to the expectations of joining bacterial infections, some doctors still prescribe them, despite the fact that antibacterial agents do not possess prophylactic properties, but seriously disrupt the microbiocenosis of the organism. See more details about when antibiotics are needed for a cold.

The treatment of nasopharyngitis is aimed solely at alleviating the symptoms. Many studies have established that the symptoms of nasopharyngitis (nasopharyngeal itching, increased secretion of nose secretions, watery eyes, dry cough) develop not because of mucosal damage to the viruses, but due to immune reactions of the type of allergy - with an increase in the release of the neurotransmitter histamine by mast cells and participation peripheral H-receptors.

Therefore, drugs used for rhinorrhea and nasal congestion with nasopharyngitis include antihistamines. And, as it turned out, only the antihistamines of the first generation, such as Suprastin (Chloropyramine, Halopyramine, etc.) or Tavegil (Anghistan, Clemastin, Meklastin, etc.) affect the symptoms of nasopharyngitis or ARVI.

Suprastin is prescribed one tablet (25 mg) - twice a day, during the meal. Tavegil also should take one tablet (1 mg) twice a day. But these medications (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 impaired cardiac and urinary system. Among the contraindications of Suprastin and Tavegil: cardiac arrhythmia, hypertension, gastric ulcer, prostate pathology, glaucoma, pregnancy and lactation.

With the help of intranasal decongestants-decoestants, which contribute to the narrowing of the vessels, you can remove the swelling of the mucous nasopharynx and restore nasal breathing. The most popular drops for nasopharyngitis are Naphthyzinum (other trade names are Nafazolin, Rinazine, Imidine) and Galazolin (Influrin, Rinazal, Otryvin). These drops are recommended to instill 2-3 times a day - 1-2 drops in each nostril. In this case, the duration of application of these funds should not exceed seven days, otherwise mucous in the nose may atrophy. Also, they should not be used in the treatment of rhinitis in children under three years of age (in the United States, they are not allowed to use up to 12 years).

Medicines Naphthyzine and Galazolin are contraindicated in the atrophic form of nasopharyngitis, arterial hypertension, atherosclerosis, insufficient production of thyroid hormones, diabetes, closed-angle glaucoma, and during pregnancy.

Decoestants have side effects, which are manifested by dryness and burning in the nasal cavity (an overgrowth develops atrophy of the ciliated epithelium), increased heart rate, increased blood pressure, headache, sleep disturbance and decreased reaction speed (the latter should be borne in mind by those who sit behind the wheel or controls the mechanisms of production).

To prolong the vasoconstrictive effect with a drop for the nose, it is more expedient to use sustained-release drugs, for example, Vibrozil, Nazivin, Nazol, Polidexa, Rinza, Vibrocil sprays, Rinofluicil and others.

Drops Vibrocil adults (and children 6 years and older) are recommended to instill in each nasal passage two drops three times a day. And the Vibrozil spray is injected with one or two clicks on the spray nozzle no more than three times a day. Safe for the nasal mucosa duration of application - seven days.

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

From the very beginning of acute nasopharyngitis, it is possible to perform physiotherapeutic treatment in the form of UHF nose, and also with the help of warm steam inhalations with soda, decoction of chamomile flowers, sage grass, eucalyptus leaves (or its essential oil), etc.

Complex LFK with nasopharyngitis is not, but you should know what physical load during the cold does not hurt your health.

Homeopathy with Nasopharyngitis

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

Multicomponent drug Corizalia in the form of tablets reduces the intensity of discharge from the nasal cavity and relieves swelling of the nasopharyngeal mucosa, including, and with acute nasopharyngitis. Method of application - sublingual (resorption under the tongue). Recommended dosage: on the first day of treatment - one tablet every 60 minutes, but not more than 12 tablets per day. In the next three days, the intervals between doses increase to two hours. Often there is an allergic reaction to this drug, and contraindications are pregnancy and age of up to two years.

Cinnabsin contains cinnabar (mercuric sulphide), extracts of Canadian yellow-root plants and echinacea, as well as highly toxic potassium dichromate (Kalium bichromicum), which widely uses homeopathy. The way of applying Cinnabsin is the same as the previous one, but with two-hour intervals; after improvement, the condition of daily intake is limited to three tablets. Side effect is manifested by hypersalivation (drooling).

In allergic nasopharyngitis, homeopaths recommend the drug Rinalital, which includes tropical plants cardiospermus and galfimia, whose phytosterols possess antipruritic properties. The method of administration, dose, side effects and contraindications are similar to the drug Corizal.

Alternative treatment

It has long been recognized that an alternative treatment for 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.

Properly rinse the nasal cavity and gargle with a warm solution of ordinary salt (a teaspoon in a glass of boiled water).

It is right to drink during the day three cups of tea with the root of ginger. See more details on how to apply ginger for colds.

It is correct to make hot foot basins with the addition of mustard powder or a teaspoon of turpentine to the water.

It is correct to make inhalations for which you can use not only chamomile, eucalyptus and sage, but also calendula flowers, thyme grass and horsetail, leaves of ginkgo biloba. Very useful in nasopharyngitis, essential oils of rosemary, geranium and cypress (in aromalamp). You can finely chop half a bulb onions or 2-3 cloves of garlic, put it in a saw and breathe phytoncids.

At the first signs of the disease you need to start treatment with herbs:

• to drink tea from lime-colored or raspberry leaves with the addition of cinnamon, lemon and honey;
• brew like tea and drink 1-2 times a day infusion of hyssop medicinal, echinacea, ivan-tea, watercress or mullein scepeter-like (20 g of herb per 200 ml of boiling water);
• drink a decoction of dried flowers of black elderberry, melissa leaves and yarrow herbs (according to a dessert spoon of each ingredient for half a liter of water, cook for 10 minutes, cool and take 100-150 ml three times a day);
• gargle with a decoction of plants such as sage, cattail, plantain, calendula;
• drink water infusion of thyme with a dry cough (dessert spoon of herbs for 250 ml of boiling water, take a few gulps 3-4 times a day);
• bury your nose with calanchoe pinnate juice, a strong broth 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.

[34], [35], [36], [37], [38], [39], [40]

Prevention

Prevention of nasopharyngitis - in the sense of preventing respiratory viral infection - is considered impossible, because these viruses are everywhere and very contagious. Nevertheless, there are some ways that help to reduce their spread, similar read in our material Prevention of colds.

[41], [42], [43], [44], [45], [46], [47], [48]

Forecast

The prognosis of nasopharyngitis is favorable: most people start to feel better already on the 4th-5th day, as the body produces antibodies, and within 10 days the disease passes, as a rule, without complications. But there is also a secondary bacterial infection. According to the statistics of the European Society of Virology (ESV), the bacterial complications that nasopharyngitis gives result in 8% of cases lead to sinusitis, 30% to otitis media, in other cases there is pharyngitis and tonsillitis.

[49], [50], [51]