Inflammation of the nasopharynx, pharyngitis: symptoms, pain and other troubles

Pharyngitis is defined as inflammation of the mucous membrane of the pharynx. Many of us confuse pharyngitis with other respiratory diseases. In many scientific articles, inflammation in the pharynx is referred to as tonsillopharyngitis.

The basic concepts are explained as follows:

• pharyngitis - inflammation of the pharyngeal mucosa
• laryngitis - inflammation of the larynx
• tonsillitis - most often affects the tonsils
• tonsillopharyngitis - inflammation of the pharyngeal wall and tonsils

The pharynx is important for breathing and swallowing. It is also referred to as the junction of the airway and the swallowing passages. The pharynx is a muscular tube located under the cervical spine. It is 13 cm in size.

The pharynx is divided into 3 parts:

• nasal (nasopharynx, epipharynx)
• oral (oropharynx, mesopharynx)
• the larynx (hypopharynx)

Part of the pharynx are the tonsils, which are made up of lymphoid tissue. The tonsil tissue is largely involved in the proper functioning of the immune system.

Did you know that...

Pharyngitis is a common condition. In one scientific study, 16% of adults and 41% of children experienced it at least once a year.

Pharyngitis rarely occurs in infants younger than 1 year. It is less common in infants younger than 2 years. Pharyngitis most often affects children ages 4 to 7 years.

The disease can also occur in adults, but to a lesser extent than in children. It most often affects parents of school-age children and people who work in children's groups.

Pharyngitis occurs throughout the year. Most cases occur in the autumn and winter months. It is transmitted by respiratory secretions. The incubation period is 24 to 72 hours.

Pharyngitis is a common disease, especially in countries where antibiotics are overprescribed and overused.

In practice, there are 2 types of pharyngitis:

1. Acute pharyngitis - The causative agents of the disease are viruses (influenza, parainfluenza) or bacteria (streptococci, staphylococci, haemophilus). Acute pharyngitis is characterized as a superficial inflammation of the pharyngeal mucosa.
   • Typical symptoms are swelling of the mucosa, swelling of the mucosa and impaired secretion.
   • It often occurs as part of upper and lower respiratory tract inflammation.
2. Chronic pharyngitis - Causes of the disease are smoking, consumption of alcoholic beverages or various types of allergies.
   • From mechanical causes, it is mainly polyps or violations of the nasal septum.
   • Viruses, bacteria and fungi (streptococci, haemophilus, staphylococci, E. coli, candida) easily take hold and multiply on the chronically inflamed and often agitated pharyngeal mucosa.

In most cases, the cause of pharyngitis is an infection, either viral or bacterial.

Viruses are the most common cause of acute pharyngitis. Approximately 6 to 20% of cases are caused by rhinoviruses and adenoviruses.

In 1 to 5% of all cases, these viruses cause the disease:

• Epstein-Barr virus (EBV).
• herpes simplex
• influenza virus
• parainfluenza virus
• coronavirus

In the case of bacterial infections, approximately 6 to 20% of cases are caused by Streptococcus pyogenes. To a lesser extent (1 to 5%), mycoplasma or Arcanobacterium haemolyticus is the causative agent of pharyngitis.

Age, season and environment are thought to play a significant role in the onset of the disease. In young children, viruses are the most common cause. In older children and adolescents, the disease is in most cases caused by bacteria.

Chronic inflammation of the pharyngeal mucosa can be caused by the following factors:

• external factors such as dust, smoke, gases, smoking, chemicals, hot and dry air, cold, large temperature changes, alcohol, can cause long-term damage to the pharyngeal mucosa
• can cause repeated bacterial infections in rhinosinusitis or tracheobronchitis
• the influence of various allergens
• chronic systemic diseases (diabetes, kidney disease, hormonal changes)
• poor speech technique (especially in presenters and singers)

Symptoms of pharyngitis are non-specific.

In general, the most common symptoms of pharyngitis include:

• sore throat
• scratching in the throat
• difficulty swallowing
• swollen cervical lymph nodes
• body temperature above 38 °C
• bad breath

It is not easy to distinguish between viral and bacterial pharyngitis. Viral infections often present with the following symptoms:

• conjunctivitis
• cough
• runny nose
• muscle pain
• headache

Infectious mononucleosis causes up to 10% of cases of pharyngitis in adolescents. Manifestations include enlarged lymph nodes, tonsillar discharge (exudate) and enlarged spleen (splenomegaly).

The following table describes the symptoms of viral and streptococcal pharyngitis

What are the symptoms of acute pharyngitis?

The general symptoms of acute pharyngitis include increased body temperature and sweating. The above symptoms occur mainly in young children. In older children and adults, the general symptoms are insignificant.

Of the local symptoms of acute pharyngitis, the following appear:

• dryness, scratching and burning in the throat
• sore throat (especially when swallowing)
• urge to cough
• feeling of mucus oozing

On examination, the physician will find blood-soaked, swollen, inflamed mucous membranes. Sometimes yellow dots of purulent follicles appear. In some cases, regional lymph nodes may be enlarged and palpably tender.

What are the symptoms of chronic pharyngitis?

The symptoms of chronic pharyngitis include:

• scratching, dryness, burning or foreign body sensation in the throat.
• increased mucus production and leakage
• pain when swallowing
• irritation to cough

Clinical examination is important for the diagnosis. The aim of the clinical examination is to determine the subjective and objective symptoms.

The next step to establish a correct diagnosis is to perform laboratory tests. Laboratory tests will prove the causative agent of the disease.

The following table summarizes the subjective and objective symptoms that are part of the clinical examination

Laboratory examination includes:

1. Laboratory tests to directly identify the causative agent of the disease:

• culture
• detection of streptococcal antigen

2. laboratory tests for indirect evidence of the causative organism:

• detection of streptococcal antibodies

3. Laboratory examination for the detection of bacterial infection:

• specific immunochemical test for quantitative determination of C-reactive protein (CRP)
• erythrocyte sedimentation rate (FW)

Most patients recover spontaneously within 7 to 10 days. Most cases of streptococcal pharyngitis improve within 24 to 48 hours after treatment. Flu-like symptoms may persist for 5 to 10 days.

Both viral and bacterial forms of pharyngitis are contagious. The bacteria that cause pharyngitis reside mainly in the nose and throat. They enter the environment in the form of tiny droplets when coughing or sneezing.

A person can become infected:

• by inhaling tiny droplets
• contact with a contaminated object
• by eating contaminated food and drink

Death is very rare but can occur due to upper respiratory tract obstruction.

Complications of pharyngitis occur in less than 1% of patients. They may include:

• otitis media
• pneumonia
• inflammation of the kidneys
• meningitis

If pharyngitis is caused by Streptococcus pyogenes, patients may develop scarlet fever and a rash (exanthema).

Scarlet fever usually manifests as streptococcal tonsillitis (pharyngitis, tonsillitis). It occurs mainly in children aged 3 to 10 years. The gateway of infection in most cases is the nasopharynx.

It is manifested by the onset of tonsillitis with fever followed by seeding. Seeding can be imagined as goose bumps.