Introduction:
The majority of respiratory infections develop as a result of season change. The symptoms of such acute nasopharyngeal conditions are familiar to all. Symptoms from running nose, itchy throat, sneezing, fever, and nasal congestion are experienced by all. Apart from such acute conditions, cases of malignancies develop in the nasopharyngeal region.
What Are the Acute Conditions Affecting the Nasopharyngeal Region?
Many pathogens cause infection in the upper respiratory tract. Here are some of them:
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Common Cold: These are caused due to the invasion of viruses. It affects the mucosa of the nose, throat, and larynx region. The causative agent is the rhinovirus. Management is done by taking antihistamine medication.
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Acute Pharyngitis: It is the infection of the pharynx caused due to beta-hemolytic Streptococci and adenovirus infections. Symptoms include fever, cold, and sore throat. The severe form progresses into tonsillitis and can cause peritonsillar abscesses and rheumatic fever.
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Herpangina: Development of ulcers and pharyngeal vesicles due to Coxsackievirus A infection.
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Infectious Mononucleosis: This is also known as kissing disease, as the infection is believed to spread through kisses from an infected person to a non-infected person. The causative organism is the Epstein-Barr virus (EBV).
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Acute Bacterial Epiglottitis: This is mainly caused by H. influenzae in children. It obstructs the airway and hence can be life-threatening. Children with epiglottitis infection are more prone to it. Vaccinations are developed against H. influenzae.
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Acute Laryngitis: Any infectious agent that passes through the larynx can cause laryngitis, including the common cold. Infection acquired through infected sputum, like in tuberculous infection, can cause tuberculosis. Inhalation of Corynebacterium diphtheriae causes infection in the mucosal lining of the airway. It is more commonly seen in children. Presently, there is immunization against diphtheria toxins. Left untreated, it can cause airway obstruction, bacterial exotoxins causing myocarditis, peripheral neuropathy, and tissue injury in people.
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Bronchitis: It is a common illness among children caused by the Parainfluenza virus. It is followed by a persistent cough, fever, running nose, hoarse sound or stridor, and respiratory failure. It is also known as croup or laryngotracheobronchitis. Regular vaccination can be given to treat this condition.
How to Manage Acute Nasal Infections?
One can manage acute nasal infections in the following ways:
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Avoid infectious places and groups.
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Maintaining hygiene.
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Administration of vaccination.
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Taking Lozenges for sore throat.
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For nasal congestions, administration of Oxymetazoline and Xylitol nasal spray can treat stuffy noses and other allergens.
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Cough syrups containing antihistamines are effective against rhinitis conditions, and opioid-containing cough syrups are beneficial against fever.
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Antiviral and antibacterial medications against potential pathogens.
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Administration of antihistamines against viral bronchitis.
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Supplement tablets of zinc can help in boosting immunity.
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Putting a warm compressor to reduce throat pain.
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Gargling the throat with lukewarm salt water to soothe the sore throat.
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Taking ginger and honey mix and vitamin C supplements to eliminate the symptoms.
What Are Cancers of the Nasopharyngeal Region?
Cancers of the nasopharyngeal region rarely develop. Most of the time, they are caused due to gene mutations and viral oncogenes. It is common among Chinese people due to the Epstein-Barr virus (EBV). The EBV affects the nasopharyngeal epithelium and surrounding tonsillar area causing abnormal replication of cells. There are three most common types of nasopharyngeal cancers. They are:
i) Keratinizing Squamous Cell Carcinoma: This is caused mainly by the Human papillomavirus (HPV). The prognosis of these cancers is good when compared with other cancers.
ii) Non-Keratinizing Squamous Cell Carcinoma: These cancer cells spread to distant sites and show a poor prognosis. The average survival rate is five years. This is also positive for Human papillomavirus and negative for Epstein-Barr virus.
iii) Undifferentiated Carcinoma: This is caused due to Epstein-Barr virus. It shows metastasis. The prognosis is fair.
How Are Cancer Cells Formed in the Nasopharyngeal Area?
The EBV attacks the B lymphocytes in the lymph nodes in infectious mononucleosis conditions. It then causes the proliferation of T lymphocytes causing atypical lymphocytosis. Similarly, in nasopharyngeal carcinomas, there is an increased proliferation of mature lymphocytes. These are also referred to as lymphoepithelioma. Cancer of the nasopharyngeal region spreads to distant areas and lymph nodes. They are considered advanced cancers with a fifty percent chance of survival. One of the primary symptoms noticed is the change of sound.
How Do Malignant Tumors Differ From Non-malignant Tumors?
Neoplastic or cancer cells arise from different cell origins, like the mesenchymal, squamous epithelial, vocal cord nodules, and papillary cells. Depending upon the type of origin, they are classified under malignant and nonmalignant lesions.
1. Non-malignant Lesions:
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Vocal Cord Polyps: Small polyps and nodules are projections on the vocal cords of the mucosal lining. They are smooth and about 0.5 cm in diameter. These nodules are made up of fibrous tissue and can eventually develop into ulcers upon further trauma. Such cases are common among heavy smokers and singers.
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Laryngeal Papilloma or Squamous Papilloma: These are benign lesions on the larynx's vocal cord. It appears in the form of a raspberry and is smooth. It measures up to one centimeter in diameter and appears as a single lesion in adults and multiple lesions in children. In children, this is referred to as juvenile laryngeal papillomatosis. These lesions are caused by Human papillomavirus (HPV) types 6 and 11. Children usually show no symptoms once they reach puberty. But it recurs in children once exercised. So one must be very careful in exercising it. These papillomas show no malignancies at all. On microscopic examination, it appears as multiple finger-like projections which are slender and consist of central fibrovascular cores. They are uniformly covered with stratified squamous epithelium.
2. Malignant Lesions: Cancer of the nasopharyngeal region is very rare and accounts for two percent of all cancers. It is caused primarily by the Epstein-Barr virus.
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Risk Factors: It is more common in men rather than women. There are risk factors that can trigger such conditions in people, like heavy smoking, consuming alcohol, radiation exposure, people working in the marine industry, or who are exposed to asbestos inhalation. In smokers, the condition calms down upon quitting the habit. But in asbestos inhalation, these crystals get trapped in the lungs forever without a way out. During the latter years of life, these asbestos crystals start creating stress and thus causing abnormal replication of cells promoting neoplasm.
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Site of Occurrence: About 95 % of pharyngeal cancers are caused by squamous cells. The tumors arising from the vocal cords are called glottic tumors and account for 60 to 75 % of cases. Rarely it arises from above the vocal cords, or supraglottic region, which is seen in 25 to 40 % of cases, and tumors arising from beneath the vocal cords or subglottic area are less than five percent.
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Microscopic Examination: Lab studies show these squamous cells in a shiny gray appearance. The surface shows wrinkled plaque deposition, which can slowly ulcerate depending on the lesion's progression. Most of the time, these tumors are keratinized and well differentiated.
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Rate of Metastasis: Tumors arising from the glottic region rarely metastasize due to poor blood supply. Tumors arising above the glottis area or supraglottis are rich in blood supply. Hence, the spread of cancer cells to the surrounding lymph nodes occurs. However, the tumors beneath the glottis or subglottis remain quiet for a long time. They are often considered advanced tumors.
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Treatment: Malignant conditions can be treated with surgery, radiation, or adjuvant therapy. However, about one-third of patients die due to this condition. The mortality rate is high among metastatic patients and patients with other chronic illnesses.
Conclusion:
Nasopharyngeal diseases are rare disorders and can cause real discomfort in patients. Any discomfort in the throat, like a lump, must be immediately brought to the notice of a medical practitioner, and cessation of any bad habits, if present, is highly advised.
