What are nasopharyngeal disorders?

Causes and Symptoms

Nasopharyngeal disorders are all the diseases that can be present in the nasal cavity and the pharynx. These include the common cold, pharyngitis (sore throat), laryngitis (inflammation of the larynx), epiglottitis (inflammation of the lid over the larynx), tonsillitis (inflammation of the lymph nodes at the rear of the mouth), sinusitis (inflammation of the sinus cavities that surround the nose), otitis media (earache that is often associated with nasopharyngeal
infection), nosebleed, nasal obstruction, halitosis (bad breath), and various other disorders.

The
common cold is one of the most prevalent diseases that afflict humankind.
Pharyngitis, or sore throat, often accompanies the common cold, or it may appear by itself. Acute infections can be caused by viruses or bacteria, often by certain streptococcus strains—hence the common term for the disorder, strep throat. Acute pharyngitis can also be caused by chemicals or radiation. As a chronic disorder, pharyngitis can be caused by lingering infection in other organs such as the lungs and sinuses, or it can be attributable to constant irritation from smoking, drinking alcohol, or breathing polluted air. The usual symptoms of pharyngitis include sore throat, difficulty swallowing, and fever. The infected area appears red and swollen.

Ordinarily, pharyngitis is not serious. If certain strains of streptococcus are the cause, however, then the infection may progress to
rheumatic fever. This disease appears to be the result of an immune system reaction to some streptococcus bacteria. It can have painful effects in many parts of the body, including the joints, and can do permanent damage to parts of the heart. In rare cases, rheumatic fever can be fatal.

Acute
laryngitis is usually caused by a viral infection, but bacteria, outside irritants, or misuse of the voice are other causes. Ordinarily, the vocal cords produce sounds by vibrating in response to the air passing over them. When inflamed or irritated, they swell, causing distortion in the sounds produced. The affected person's voice becomes hoarse and raspy and may even diminish to a soft whisper. This distortion of sound is the main symptom of laryngitis; other possible symptoms include a sore throat and congestion that causes constant coughing. The condition generally resolves itself and requires no treatment. Chronic laryngitis has the same symptoms but does not go away spontaneously. It may be caused by an infectious agent but more likely is attributable to some irritant activity, such as constantly misusing one's voice, smoking, drinking alcohol, or breathing contaminated air.

The epiglottis is a waferlike tissue covered by a mucous membrane that sits on top of the larynx. It can become infected by such microorganisms as the bacteria
Haemophilus influenzae type b, causing a condition called epiglottitis. Although the symptoms of epiglottitis can resemble those of pharyngitis, the infection can quickly progress to a very serious, life-threatening disorder. Epiglottitis usually afflicts children from two to four years of age, but adults can also be affected. The infection can begin rapidly, causing the epiglottis to swell and obstruct the airway to the lungs, creating a major medical emergency. Within twelve hours of the onset of symptoms, 50 percent of patients require hospitalization and intubation (insertion of a breathing tube into the trachea). The symptoms are high fever, severe sore throat, difficulty breathing, difficulty swallowing, and general malaise. As the airway becomes more and more occluded, the patient begins to gasp for air. The lack of oxygen may cause cyanosis (blue color in the lips, fingers, and skin), exhaustion, and shock.

Another disease associated with the larynx is
croup, or laryngotracheobronchitis. As the medical name indicates, croup involves the larynx, the trachea, and the bronchi (the large branches of the lung). It is usually caused by a virus, but some cases are attributable to bacterial infection. Children from three to five years of age are the usual victims. This disease causes the airways to narrow due to inflammation of the inner mucosal surfaces. Inflammation causes coughing, but the narrowed airway causes the cough to be sharp and brassy, like the barking of a seal. Croup is usually relatively benign, but sometimes it progresses to a severe disease requiring hospitalization.

Various other disorders can afflict the larynx, such as damage to the vocal cords because of infection by bacteria, fungi, or other microorganisms. The vocal cords can also be damaged by misusing one's voice, smoking, or breathing contaminated air. Polyps (masses of tissue growing on the surface), nodes (little knots of tissue), or so-called singer’s nodules may develop. Sores called contact ulcers may form on the vocal cords.

Tonsillitis
is an inflammation of the tonsils, two large lymph nodes located at the back of the throat. It may also involve the adenoids, lymph nodes located at the top of the throat. The function of these lymph nodes is to remove harmful pathogens (disease-causing organisms) from the nasopharyngeal cavity. At times, the load of microorganisms that they absorb becomes more than they can handle, and they become infected. The tonsils and adenoids may then become enlarged. A sore throat develops, along with a headache, fever, and chills. Glands of the neck and throat feel sore and may become enlarged. Young adults can also suffer from quinsy, or peritonsillar abscess. In this condition, one of the tonsils becomes infected and pus forms between the tonsil and the soft tissue surrounding it. Quinsy is characterized by pain in the throat or the soft palate, pain on swallowing, fever, and a tendency to lean one's head toward the affected side.

The nasal sinuses are four pairs of cavities in the bone around the nose. There are two maxillary sinuses, so called because they are found in the maxilla, or upper jaw. Slightly above and behind them are the ethmoid sinuses, and behind them are the sphenoid sinuses. Sitting over the nose in the lower part of the forehead are the two frontal sinuses. All these sinuses are lined with a mucous membrane and have small openings that lead into the nasal passages. Air moves in and out of the sinuses and allows mucus to drain into the nose. In acute sinusitis, infection builds up in the mucous membrane of any or all of the sinuses. The membrane lining the sinus swells and shuts the opening into the nasal passages. At the same time, membranes of the nose swell and become congested. Mucus and pus build up inside the sinuses, causing pain and pressure. Most often, sinusitis accompanies the common cold: the mucous membrane that lines the nose extends into the sinuses, so the infection of a cold can readily spread into the sinuses. The various viruses responsible for the common cold may be involved, as well as a wide group of bacteria. Chronic sinusitis can be caused by repeated infections that have allowed scar tissue to build up, closing the sinus openings and impeding mucus drainage, or it may be the result of allergies.

According to the Centers for Disease Control and Prevention, chronic sinusitis is the most common long-term illness in the United States, surpassing the rates for asthma, arthritis, and congestive heart disease and causing nearly fourteen million doctor's office visits per year. For reasons that are not yet understood, sinusitis sufferers are often beset with inflammation of the ducts, trapping mucus, bacteria, and viruses inside and allowing nasal polyps to develop. Researchers have been very interested in finding causes and effective treatments for sinusitis. In the late twentieth century, most chronic cases of sinusitis were treated with fiber-optic surgery that allowed access to the cramped sinus passageways. However, patients often returned within weeks or months with ongoing problems. This fact has recently prompted a reconsideration of the problem and its underlying causes as well as a struggle to redefine sinusitis. Some medical experts suspect that inflammation or the responses of the immune system are the culprit but note that additional research must be completed before any definitive answers are found.

Tissues in the nasopharyngeal cavity may be affected by conditions occurring in other parts of the body. For example, vocal cord paralysis may be caused by vascular accidents, certain cancers, tissue trauma, and other events.

Some infections in the nasopharyngeal cavity can spread to the ear through the eustachian tubes that connect the two areas. Chief among the diseases of the ear that can be associated with nasopharyngeal disorders are the various forms of acute otitis media, an earache occurring in the central part of the ear. There are four basic types of otitis media. In the first type, serous otitis media, there is usually no infection, but fluid accumulates inside the middle ear because of the blockage of the eustachian tube or the overproduction of fluid; the condition is usually mild, with some pain and temporary loss of hearing. The second type is otitis media with effusion; with this condition comes both infection and accumulation of fluid. The third form is acute purulent otitis media, the most serious type. Pus builds up inside the middle ear, and its pressure may rupture the eardrum, allowing discharge of blood and pus. The fourth type is secretory otitis media, which usually occurs after several bouts of otitis media. Cells within the middle ear start producing a fluid that is thicker than normal and produced in greater amounts.

Chronic otitis media is bacterial in origin. It is characterized by a perforation of the eardrum and chronic pus discharge. The eardrum is a flat, pliable disk of tissue that vibrates to conduct sounds from the outside to the inner-ear structures. The perforation that occurs in chronic otitis media can be one of two types: a relatively benign perforation occurring in the central part of the eardrum or a potentially dangerous perforation occurring near the edges of the eardrum. The latter perforation can be associated with loss of hearing, increased discharge of pus and other fluids, facial paralysis, and the spread of infection to other tissues. When the perforation of chronic otitis media is near the edges of the eardrum, something called a cholesteatoma develops. This accumulation of matter grows in the inner ear and can be destructive to bone and other tissue.

The same organisms that cause otitis media can be responsible for a condition called mastoiditis. The mastoid process is a bone structure lined with a mucous membrane. Infection from otitis media can spread to this area and in severe cases can destroy the bone. Mastoiditis used to be a leading cause of death in children.

Nosebleeds are common and most often result from a blow to the nose, but they can also be caused by colds, sinusitis, and breathing dry air. The septum (the cartilaginous tissue that separates the nostrils) and the surrounding intranasal mucous membrane contain many tiny blood vessels that are easily ruptured. If an individual receives a blow to the nose, these vessels can break and bleed. They can also rupture due to irritation from a cold or other condition. Breathing very dry air sometimes causes the nasal mucous membrane to crust over, and bleeding can follow. Nosebleeds are not usually serious, but sometimes they are indicative of an underlying condition, such as hypertension (high blood pressure), a tumor, or another disease.

Nasal obstruction is common during colds and allergy attacks, but it can also be caused by a deviated septum, a malformation in the cartilage between the nostrils that can be congenital or caused by a blow to the nose. Nasal obstruction can also be attributable to
nasal polyps, nasal tumors, or swollen adenoids. A common source of nasal obstruction is overuse of nasal
decongestants. These agents relieve nasal congestion by reducing intranasal inflammation and swelling. If used too often or for too long, however, they can cause the very problem that they were intended to cure: intranasal blood vessels dilate, the area swells, secretions increase, and the nose becomes blocked. This is known as rebound congestion or, in medical terminology, rhinitis medicamentosa (nasal inflammation that is caused by a medication).

Halitosis, or bad breath, can be considered a nasopharyngeal disorder in the sense that it can originate in the mouth. It can be caused by diseases of the teeth or gums, but the most common causes are smoking or eating aromatic foods such as onions and garlic. Bad breath may also be a sign of disease conditions in other parts of the body, such as certain lung disorders or cancer of the esophagus. Hepatic failure, a liver dysfunction, may be accompanied by a fishy odor on the breath. Azotemia, the retention of nitrogen in the blood, may give rise to an ammonia-like odor. A sweet, fruity odor on the breath of diabetic patients may accompany ketoacidosis, a condition that occurs when there are high levels of glucose in the blood. Sometimes, young children stick foreign objects or other materials into their noses; it has been reported that these materials can fester, causing severe halitosis. Bad breath is rarely apparent to the individual who has it, however offensive it may be to others. A good way to check one’s breath is to lick the back of one’s hand and smell the spot; malodor, if it exists, will usually be apparent.

Treatment and Therapy

Nasopharyngeal disorders are most often mild illnesses that can be treated at home. For example, acute pharyngitis, or sore throat, is easily managed most of the time. The patient is advised to rest, gargle with warm salt water several times a day, and soothe the pain with lozenges or anesthetic gargles. If the infection is caused by a virus, it usually will clear without further treatment. If the physician suspects that the infection is bacterial in origin, throat smears may be taken so that the organism can be identified. If bacteria are discovered, antibiotic therapy will be undertaken to eradicate the pathogens. This is particularly important if the infection is caused by certain strains of streptococcus bacteria. In this case, it is vital to destroy the organism in order to avoid the development of rheumatic fever.

In cases of acute laryngitis caused by viral infection, the patient is advised to rest his or her voice, inhale steam, and drink warm liquids. If bacteria are the cause of the laryngitis, antibiotic therapy is undertaken. In treating chronic laryngitis, the physician must discover the cause and remove it. If allergy is the cause, antihistamine therapy could help. If the cause is bacterial, antibiotic therapy is used. If smoking or drinking alcohol is the problem, the patient should be counseled to stop. The simple palliative measures used for acute laryngitis—resting the voice, drinking warm liquids, and breathing steam—are also useful for chronic laryngitis.

Symptoms of epiglottitis are often similar to those of sore throat. If there is any evidence of difficulty in breathing, however, the patient should be seen by a physician quickly, as an emergency situation may be developing. If epiglottitis is obstructing the airway, the patient should be treated in an intensive care setting. Antibiotics must be given to the patient to treat the infection. It is important to make an airway for the patient, and it may be necessary to insert a tube into the trachea to allow the patient to breathe.

Before the age of antibiotics, tonsillitis was often treated surgically, with both tonsils and adenoids removed. This procedure is now rare, as the infection usually responds to antibiotic therapy. Similarly, in the case of peritonsillar abscess or quinsy, antibiotics usually clear the condition satisfactorily. In some cases, accumulations of pus may be removed surgically. If the abscesses return, it may be advisable to remove the tonsils.

As a rule, a child with croup is treated at home. Because the disease is usually caused by viruses, antibiotics are not used unless bacteria are known to be involved. Steam is often used to help liquefy mucus deposits on the interior walls of the trachea, the larynx, and the bronchi. The patient is given warm liquids to drink and is closely watched so that any signs that the condition is getting worse will be detected. The following symptoms should alert the caregiver to the possibility that an emergency situation is developing and that medical help is needed quickly: drooling, difficulty breathing or swallowing, inability to bend the neck forward, blue or dark color in the lips, high-pitched sounds when inhaling, rapid heartbeat, and loss of consciousness.

The main goals of therapy for sinusitis are to control infection, relieve the blockage of the sinus openings to permit drainage, and relieve pain. When sinusitis is known to be of bacterial origin, an appropriate antibiotic will be used to eradicate the organism. Often, however, sinusitis is attributable to viral infection, and other procedures are used to treat it. Inhaling steam is useful for thinning secretions and promoting drainage, as are mucolytic agents such as guaifenesin. Decongestant sprays and oral decongestants reduce swelling and open passages. Analgesics can be given for pain. In certain circumstances, the sinuses are drained surgically.

Acute otitis media is most often diagnosed with the aid of an otoscope, an instrument that the doctor uses to look at the eardrum and surrounding tissues. The eardrum will be a dull red color, bulging, and perhaps perforated. While a viral infection may precede otitis media, the causative microorganisms for this and related ear infections, such as mastoiditis, are usually bacteria. Antibiotics are used both to treat the infections and to prevent the spread of disease to other areas. The drugs are usually taken orally. Penicillin and its derivatives are used, as are erythromycin and sulfisoxazole. Antibiotic therapy for acute otitis media is usually continued for ten days to two weeks. Sometimes pus and other fluids and solid matter build up in the inner ear, and it may be necessary to pierce the eardrum in order to remove these deposits. To help relieve blockage of the eustachian tubes, a topical vasoconstrictor may be used in the nose to reduce the swelling of blood vessels. Antihistamines could be helpful to patients with allergies but are otherwise not indicated.

For chronic otitis media, it is necessary to clean both the outer ear canal and the middle ear thoroughly. A mild acetic acid solution with a corticosteroid is used for a week to ten days. Meanwhile, aggressive oral antibiotic therapy is undertaken to eradicate the pathogen. The perforated eardrum associated with chronic otitis media can usually be repaired surgically with little or no loss of function, and the cholesteatoma must be surgically removed.

Simple nosebleeds can be treated by pinching the nose with the fingers and breathing through the mouth for five or ten minutes to allow the blood to clot. Also, a plug of absorbent paper or cloth can be inserted into the bleeding nostril. A nosebleed that does not stop easily should be seen by a physician.

Nasal obstruction resulting from colds or allergies is treated by appropriate medications, decongestants for colds and antihistamines for allergies. A deviated septum may require surgery. The only therapy for rhinitis medicamentosa, or rebound congestion caused by overuse of nasal decongestants, is to stop the medication and endure the congestion for as long as it takes the condition to clear. Sometimes it is necessary to consult a physician.

For simple halitosis caused by smoking or food, breath fresheners (with or without “odor-fighting” chemicals) are often used, even though they usually simply replace a “bad” odor with a “good” one. Some people believe that chewing parsley or other leaves rich in chlorophyll will counteract the smell of garlic. When halitosis is attributable to tooth or gum disease, it will persist until the condition is cured. Halitosis may be of diagnostic value in certain situations where a characteristic odor could alert the physician to the possibility of a disease condition.

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