Nasopharyngitis

Overview

Generally, Acute infection of the nasopharynx may be an isolated infection confined to this part only or be a part of the generalized upper airway infection. [1]

Epidemiology of Nasopharyngitis

Nasopharyngitis, commonly known as the common cold, is a highly prevalent condition in India. However, there is limited India-specific epidemiological data on nasopharyngitis.

A study titled "Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets" published in Frontiers in Public Health in 2022, reported that the National Family Health Survey-4 (NFHS-4) estimated the prevalence of acute respiratory infections (ARI), which includes nasopharyngitis, to be 2.7% in children under 5 years in 2015-2016. This was a significant decrease from the 5.6% prevalence reported in 2005-2006 by NFHS-3. [4]

Causes of Nasopharingitis

Acute Nasopharyngitis

It may be caused by viruses (for example; common cold, influenza, parainfluenza, rhino or adenovirus) or bacteria (especially streptococcus, pneumococcus or haemophilus influenzae)

Chronic Nasopharyngitis

It is often associated with chronic infections of nose, paranasal sinuses also pharynx. Additionally; It is commonly seen in heavy smokers, drinkers and those exposed to dust and fumes.

Types:

1. Acute Nasopharyngitis
2. Chronic Nasopharyngitis

Common risk factors include:

Pathogenesis

• Viral Entry: The virus enters the nasopharynx through inhalation of respiratory droplets or direct contact with contaminated surfaces.
• Attachment and Replication: The virus attaches to specific receptors on the epithelial cells lining the nasopharynx and replicates within these cells.
• Immune Response: The body’s immune system recognizes the viral infection and initiates an inflammatory response. This response includes the release of cytokines, recruitment of immune cells, and production of mucus.
• Symptoms: The inflammatory response and viral damage to the epithelial cells lead to the classic symptoms of nasopharyngitis, such as nasal congestion, runny nose, sore throat, cough, sneezing, and low-grade fever.
• Resolution: In most cases, the immune system successfully clears the virus, and the symptoms resolve within 7-10 days. [5]

Pathophysiology of Nasopharyngitis

• Viral Entry and Attachment: The virus enters the nasopharynx through inhalation of respiratory droplets or direct contact with contaminated surfaces. It then attaches to specific receptors on the epithelial cells lining the nasopharynx.

• Viral Replication and Cell Damage: Once inside the epithelial cells, the virus replicates rapidly, leading to cell damage and death.

• Inflammatory Response: The damaged epithelial cells release inflammatory mediators, such as cytokines and chemokines, which trigger a cascade of events leading to the recruitment of immune cells to the site of infection.

• Vascular Changes: The inflammatory mediators also cause vasodilation and increased vascular permeability, leading to edema and congestion of the nasal mucosa.

Other Pathophysiology

• Mucus Production: The goblet cells in the nasal mucosa increase mucus production in response to the inflammatory stimuli. This excess mucus contributes to nasal congestion and runny nose.

• Nerve Stimulation: The inflammatory mediators also stimulate sensory nerve endings in the nasal mucosa, causing sneezing and irritation.

• Systemic Effects: In some cases, the inflammatory response can spread beyond the nasopharynx, leading to systemic symptoms such as fever, malaise, and headache. [6]

Clinical Features of Nasopharyngitis

The clinical features of nasopharyngitis, commonly known as the common cold, typically include:

• Nasal symptoms: Nasal congestion, rhinorrhea (runny nose), sneezing, postnasal drip
• Throat symptoms: Sore throat, irritation, dryness
• Other symptoms: Cough, low-grade fever, malaise, headache, muscle aches, watery eyes, hoarseness

The presentation can vary depending on the causative virus, the individual’s age and immune status, and the presence of any underlying medical conditions. [7]

Sign & Symptoms

Basically, Dryness and burning of the throat above the soft palate is usually the first symptom as is commonly noted in common cold. In detail; This is followed by pain and discomfort localized to the back of nose with some difficulty on swallowing. Besides this; In severe infections, there is pyrexia and enlarge cervical lymph nodes. All in all; Examination of nasopharynx reveals congested and swollen mucosa often covered with whitish exudate.

Chronic Nasopharyngitis

Postnasal discharge also crusting with irritation at the back of nose is the most common complaint. Additionally; Patient has a constant desire to clear the throat either by hawking or inspiratory snorting (forcibly drawing nasal secretions back into the throat). Examination of nasopharynx reveals congested mucosa also mucopus or dry crusts. Lastly, In children, adenoids are often enlarged and infected (chronic adenoiditis)

Clinical Examination

The clinical examination of nasopharyngitis primarily involves a focused assessment of the upper respiratory tract. Here’s a typical approach:

1. Inspection:

   • General appearance: Assess the patient for signs of illness, such as fever, malaise, and lethargy.
   • Nose: Examine the external nose for erythema or swelling. Use a nasal speculum to visualize the nasal mucosa, noting any inflammation, congestion, or discharge.
   • Throat: Examine the oropharynx for erythema, exudates, or swelling of the tonsils.
   • Ears: Perform otoscopy to assess for signs of otitis media (middle ear infection), a potential complication of nasopharyngitis.

2. Palpation:

   • Sinuses: Gently palpate the frontal and maxillary sinuses for tenderness, which may indicate sinusitis.
   • Lymph nodes: Palpate the anterior and posterior cervical lymph nodes for enlargement, which could suggest a viral or bacterial infection.

3. Auscultation:

   • Lungs: Listen to the lungs for any adventitious sounds, such as wheezes or crackles, which might indicate lower respiratory tract involvement. [8]

Diagnosis

In general, Examination of nose, mouth, throat showing signs of inflammation.

Swab Collection for possible either bacterial infection or influenza.

Differential Diagnosis of Nasopharyngitis 

1. Allergic rhinitis: This is an inflammatory condition triggered by allergens, such as pollen, dust mites, or pet dander. It shares many symptoms with nasopharyngitis, including nasal congestion, rhinorrhea, and sneezing. However, allergic rhinitis is often accompanied by itchy eyes, nose, and throat, and it tends to be seasonal or perennial.

2. Sinusitis: This is an inflammation of the sinuses, the air-filled cavities in the skull. It can be caused by viruses, bacteria, or fungi. Sinusitis typically presents with nasal congestion, facial pain or pressure, postnasal drip, and cough.

3. Influenza: This is a viral infection that affects the respiratory system. It can cause symptoms similar to nasopharyngitis, such as fever, chills, muscle aches, headache, and cough. However, influenza is usually more severe than the common cold, with higher fever and more pronounced systemic symptoms.

Other Complications

1. Pharyngitis: This is an inflammation of the pharynx, the back of the throat. It can be caused by viruses or bacteria. Pharyngitis typically presents with sore throat, difficulty swallowing, and fever.

2. Laryngitis: This is an inflammation of the larynx, the voice box. It can be caused by viruses, overuse of the voice, or exposure to irritants. Laryngitis typically presents with hoarseness, loss of voice, and throat irritation. [9]

Complications of Nasopharyngitis 

• Sinusitis: Inflammation of the sinuses, often caused by bacterial superinfection. Symptoms include facial pain, pressure, headache, and purulent nasal discharge.

• Otitis media: Infection of the middle ear, common in children. Symptoms include ear pain, fever, and irritability.

• Lower respiratory tract infections: Bronchitis, bronchiolitis, or pneumonia can develop, particularly in individuals with underlying respiratory conditions.

• Asthma exacerbation: Nasopharyngitis can trigger or worsen asthma symptoms, leading to wheezing, shortness of breath, and chest tightness.

• Chronic rhinosinusitis: In rare cases, nasopharyngitis can contribute to the development of chronic rhinosinusitis, a persistent inflammation of the sinuses and nasal passages. [10]

Investigations 

n most cases of nasopharyngitis, investigations are not necessary as the diagnosis is primarily clinical. However, in certain situations, the following investigations may be considered:

1. Viral Culture or Rapid Antigen Detection Test (RADT): These tests can identify the specific virus causing the infection. However, they are not routinely performed due to the self-limiting nature of nasopharyngitis and the wide variety of causative viruses.

2. Complete Blood Count (CBC): A CBC can help differentiate between viral and bacterial infections. Viral infections typically show a normal or slightly elevated white blood cell count with a predominance of lymphocytes, while bacterial infections often show a higher white blood cell count with a predominance of neutrophils.

3. C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): These are nonspecific markers of inflammation that can be elevated in both viral and bacterial infections. However, significantly elevated levels may suggest a bacterial infection.

4. X-ray or CT Scan of the Sinuses: These imaging studies can help identify sinusitis, a potential complication of nasopharyngitis. [5]

Treatment

Initially; Mild cases clear up spontaneously. In detail; Some analgesic may be required for relief of pain also discomfort.  Additionally; In severe cases with general symptoms, either systemic antibiotic or chemotherapy may be necessary. In children, there is associated adenoiditis which causes nasal obstruction and requires nasal decongestant drops.

Chronic infections of the nose, paranasal sinuses also oropharynx should be attended to.

Furthermore; Excessive smoking and drinking should be corrected.

Besides this, Preventive measures should be taken to avoid dust and fumes.

Lastly, Alkaline nasal douche helps to remove crusts and mucous.

Steam inhalations are soothing [1]

Prevention 

Preventing nasopharyngitis (the common cold) involves several strategies aimed at reducing exposure to and transmission of the causative viruses:

1. Hand Hygiene: Frequent handwashing with soap and water for at least 20 seconds is crucial. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.

2. Respiratory Hygiene: Cover your mouth and nose with a tissue or your elbow when coughing or sneezing. Dispose of used tissues properly and wash your hands immediately.

3. Avoid Close Contact: Avoid close contact with people who are sick. Maintain a distance of at least 6 feet from others, especially in crowded indoor settings.

4. Disinfection: Regularly clean and disinfect frequently touched surfaces, such as doorknobs, light switches, and countertops.

5. Vaccination: While there is no specific vaccine for the common cold, getting vaccinated against influenza can help prevent a major cause of nasopharyngitis.

6. Healthy Lifestyle: Maintain a healthy lifestyle by eating a balanced diet, getting regular exercise, and getting enough sleep. This can help strengthen your immune system and reduce your susceptibility to infections. [11]

Homeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination also case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Nasopharyngitis:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

 Kali Mur

Pharyngitis, GREAT DEAL OF FOETOR IN BREATH, hawks up cheesy lumps of the size of a split pea; throat swollen, spots or pustules appear with either gray or whitish exudation; adherent crusts in vault of pharynx; tongue coated grayish-white, either slimy or dry; biliousness, dyspepsia, either fatty or rich food causes indigestion.[2]

Diet & Regimen

• Steam Inhalation
• Drink more Fluid
• Keep nose clean
• Hand wash
• Good Breathing Yoga, also exercise
• Avoid Smocking
• Gargle with warm water also salt

The Do’s & Don’ts

Do’s:

• Rest: Get plenty of rest to help your body fight the infection.
• Hydrate: Drink plenty of fluids, such as water, clear broth, or herbal teas, to stay hydrated and help loosen mucus.
• Soothe symptoms: Use over-the-counter medications like decongestants, antihistamines, or pain relievers to manage symptoms.
• Gargle with salt water: This can help soothe a sore throat.
• Use a humidifier: This can help relieve nasal congestion and dryness.
• Wash your hands frequently: This helps prevent the spread of the virus to others.
• Stay home if possible: This prevents spreading the infection to others.

Don’ts:

• Don’t smoke: Smoking can worsen symptoms and prolong the duration of illness.
• Don’t take antibiotics: Antibiotics are not effective against viral infections like nasopharyngitis.
• Don’t share personal items: Avoid sharing utensils, cups, or towels with others to prevent the spread of the virus.
• Don’t overdo it: Avoid strenuous activities and allow your body to rest and recover.
• Don’t ignore worsening symptoms: If your symptoms worsen or persist for more than 10 days, consult a doctor.

Terminology 

• Rhinitis: Inflammation of the nasal mucosa, often causing congestion, runny nose, and sneezing. It can be caused by allergies (allergic rhinitis) or infections (viral or bacterial).

• Rhinorrhea: Excessive discharge of thin nasal mucus, commonly known as a runny nose.

• Nasal congestion: A feeling of stuffiness or blockage in the nose due to swollen nasal tissues.

• Sinusitis: Inflammation of the sinuses, the air-filled cavities in the skull. It can be caused by viruses, bacteria, or fungi.

• Pharyngitis: Inflammation of the pharynx, the back of the throat. It can be caused by viruses or bacteria.

• Laryngitis: Inflammation of the larynx, the voice box. It can cause hoarseness or loss of voice.

• Otitis media: Inflammation of the middle ear, often caused by a bacterial or viral infection.

• Viral shedding: The release of virus particles from an infected individual, which can transmit the infection to others.

Other Terminologies

• Incubation period: The time between exposure to the virus and the onset of symptoms.

• Contagious period: The period during which an infected individual can transmit the virus to others.

• Self-limited: A condition that resolves on its own without specific treatment.

• Symptomatic treatment: Treatment aimed at relieving symptoms rather than curing the underlying cause of the illness.

• Over-the-counter (OTC) medications: Medications that can be purchased without a prescription.

• Antihistamines: Medications that block the action of histamine, a substance involved in allergic reactions.

• Decongestants: Medications that reduce swelling in the nasal passages, relieving congestion.

• Antipyretics: Medications that reduce fever, such as acetaminophen or ibuprofen.

In the context of homeopathy

• Remedy: A homeopathic medicine prepared from natural substances, diluted and succussed (shaken vigorously) to potentize its effects.

• Potency: The degree of dilution and succussion of a homeopathic remedy. Higher potencies are believed to have stronger effects.

• Similia Similibus Curentur: The fundamental principle of homeopathy, meaning "like cures like." This suggests that a substance that can cause symptoms in a healthy person can also cure similar symptoms in a sick person.

• Acute prescribing: The selection of homeopathic remedies for acute conditions, such as nasopharyngitis, based on the individual’s specific symptoms and modalities.

• Modalities: Factors that make symptoms better or worse, such as time of day, temperature, position, or specific triggers.

• Repertory: A reference book listing symptoms and the homeopathic remedies associated with them.

• Materia Medica: A collection of descriptions of the symptoms and effects of homeopathic remedies.

Some common homeopathic remedies used for nasopharyngitis include:

• Aconitum napellus: For sudden onset of symptoms after exposure to cold or wind, with high fever, restlessness, and anxiety.

• Allium cepa: For runny nose with clear, watery discharge that irritates the nose and upper lip.

• Arsenicum album: For thin, watery discharge, burning sensation in the nose, sneezing, and restlessness.

• Euphrasia: For profuse, acrid discharge that irritates the eyes and cheeks, with burning and itching.

• Gelsemium sempervirens: For slow onset of symptoms with chills, fatigue, headache, and muscle aches.

• Nux vomica: For stuffy nose, dry cough, irritability, and a feeling of being chilly.

• Pulsatilla: For thick, yellow or green discharge, loss of taste and smell, and a weepy disposition.

References

1. Diseases_of_Ear_Nose_and_Throat_6Edition
2. Homoeopathic Therapeutics by Lilienthal
3.  https://www.wikidoc.org/index.php/Acute_viral_nasopharyngitis_risk_factors
4. Kumar, A., Singh, A., Gupta, V., Kumar, R. R., & Jena, P. K. (2022). Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets.Frontiers in Public Health, 10.
5. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (9th edition) John E. Bennett, Raphael Dolin, Martin J. Blaser (2020, Elsevier)
6. Harrison’s Principles of Internal Medicine (21st edition) Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo (2022, McGraw Hill)
7. Kumar and Clark’s Clinical Medicine (10th Edition) Parveen Kumar, Michael L. Clark (2021, Elsevier)
8. Bates’ Guide to Physical Examination and History Taking (13th Edition) Lynn S. Bickley, Peter G. Szilagyi (2021, Wolters Kluwer)
9. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (9th Edition) udith E. Tintinalli, J. Stephan Stapczynski, O. John Ma, Donald M. Yealy, Garth D. Meckler, David M. Cline (2020, McGraw Hill)
10. Nelson Textbook of Pediatrics (21st Edition) Robert M. Kliegman, Bonita F. Stanton, Joseph St. Geme, Nina F. Schor, Richard E. Behrman (2020, Elsevier)
11. Goldman-Cecil Medicine (26th edition) Lee Goldman, Andrew I. Schafer (2020, Elsevier)

Also Search As

There are several ways people can search for homeopathic articles on nasopharyngitis:

1. Online Databases:

   • Homeopathic Library: Several online libraries specialize in homeopathic literature, like the National Center for Homeopathy (NCH) and the Homeopathic Educational Services (HES). These resources may have articles, cases, or Materia Medica entries related to nasopharyngitis.
   • Pubmed: While not specifically for homeopathy, PubMed includes some homeopathic research articles that may be relevant. Use search terms like "homeopathy AND nasopharyngitis" or "homeopathy AND common cold."

2. Homeopathic Journals and Websites:

   • Reputable homeopathic journals like The American Homeopath, Homeopathy, and Simillimum may have articles on nasopharyngitis.
   • Websites of homeopathic organizations like the NCH or the Council for Homeopathic Certification (CHC) may have articles or resources.

3. Homeopathic Software:

   • Software like RadarOpus or Complete Dynamics is used by practitioners and contains vast amounts of homeopathic information, including repertories, Materia Medica, and cases.

4. Books:

   • Classic homeopathic texts like Materia Medica Pura by Samuel Hahnemann and Kent’s Repertory can be helpful resources.
   • Look for books specifically about homeopathic treatment of colds and flu.

5. Consult a Homeopathic Practitioner:

   • The most reliable way to get personalized information is to consult a qualified homeopath. They can guide you through the relevant literature and provide tailored advice based on your specific symptoms and constitution.

There are several ways to search for information on nasopharyngitis (the common cold):

1. Online Search Engines:

• General search engines: Use search engines like Google, Bing, or DuckDuckGo to search for "nasopharyngitis" or "common cold." This will provide a wide range of results, including general information, news articles, and medical websites.
• Specialized medical websites: Consider searching on reputable health websites like WebMD, Mayo Clinic, or Healthline for more in-depth medical information.

2. Medical Databases:

• PubMed: This is a free database of biomedical literature maintained by the U.S. National Library of Medicine.
  
  It includes a wide range of medical research articles and abstracts.
• Google Scholar: This is a search engine for scholarly literature, including articles, theses, books, and abstracts from academic publishers, professional societies, and online repositories.

3. Books and Textbooks:

• Medical textbooks: Consult medical textbooks like Harrison’s Principles of Internal Medicine or Kumar and Clark’s Clinical Medicine for detailed information on nasopharyngitis.
• Popular science books: Look for books on the common cold or respiratory infections for a more accessible overview of the topic.

4. Health Professionals:

• Your doctor: Consult your primary care physician or a specialist for personalized information and advice on nasopharyngitis.
• Pharmacists: Pharmacists can provide information on over-the-counter medications and treatments for the common cold.

5. Other Resources:

• Health organizations: Check the websites of organizations like the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) for reliable information on nasopharyngitis.
• Patient support groups: Connect with online or in-person support groups for individuals with nasopharyngitis to share experiences and learn from others.