Burning sensation in the nose and throat

Introduction The burning sensation of the nose and throat is one of the symptoms of acute nasopharyngitis. Acute nasopharyngitis is an acute inflammation of the mucosa, submucosa, and lymphoid tissues of the entire nasopharynx, which occurs mainly in the pharyngeal tonsils. It is a prodromal symptom of upper respiratory tract infection in adults and older children.

Cause

(1) Causes of the disease

The pathogen of the common cold is a virus. Commonly, rhinovirus, coronavirus, influenza and parainfluenza viruses are rare. Respiratory syncytial virus, adenovirus, enterovirus, reovirus, herpes simplex virus and Epstein-Barr virus are rare. . Mycoplasma pneumoniae, group A, C, G group streptococci and non-biological pathogenic factors such as allergic rhinitis, atrophic rhinitis, vasomotor rhinitis, nasal septum deviation, foreign body, etc. can cause cold-like symptoms, which is not true meaning The cold on it.

Rhinovirus

Isolated from a cold patient in 1956, it is a genus of microRNA virus population, a genus of non-enveloped single-stranded RNA virus, a non-enveloped single-stranded RNA virus with a diameter of 15-30 nm and resistance to ether. It is not acid resistant (easy to be inactivated in a solution of pH 3) and can survive for 3 days in a dry environment. According to the serum neutralization test, there are more than 120 serum strains, which are best grown at a temperature of 33 °C in diploid cell culture, long-term survival at -70 °C, and can survive for several weeks at 4 °C, while 56 °C It can be inactivated in 30 minutes. 30% to 50% of patients with colds are caused by a certain serotype of rhinovirus.

Coronavirus

A coronavirus group, which is an enveloped single-stranded RNA virus, sensitive to both ether and acid. The diameter of 80 ~ 150nm, there are unique rod-shaped granules (peplomers) protruding from the capsule, proliferating in the cytoplasm, mature through the cytoplasmic network. At least 3 strains (B814, 229E and 0C43) can cause respiratory infections, of which 229E and OC43 are the cause of upper respiratory tract infections in children and adults, accounting for 15% to 20% of adult colds, occasionally causing pneumonia and epidemics. Chest pain.

Adenovirus

It is a double-stranded DNA virus with no envelope and nuclear replication. It is 70-90 nm in diameter and has a symmetrical 20-facet body. It is stable at -20 °C at low temperature. 41 strains have been isolated from humans, and there are still many intermediate strains. It can be clinically manifested as various types of infections.

4. Respiratory syncytial virus

In 1956, it was first isolated from the orangutan with upper respiratory tract infection in the laboratory. It is an enveloped single-stranded RNA virus with a diameter of 120-200 nm. It belongs to the genus Pneumovirus of the Paramyxoviridae family and has only one serotype. . The virus is extremely unstable, reducing the amount of virus by a factor of 100 in 2 days at room temperature and 100 times in 4 to 6 days in a refrigerator at 4 °C. It is the main pathogen of lower respiratory tract infection in children. It usually causes mild upper respiratory tract infection in adults, but it is more critical in elderly and immunosuppressed patients.

5. Other viruses

Coxsackie virus, echovirus, reovirus type 1 to 3, herpes simplex virus type 1 and EB virus in enterovirus can be used as pathogens of colds.

(two) pathogenesis

The rhinovirus is mainly caused by the contact of the nasopharyngeal secretions of the cold patients (hand-eye, hand-nose), and there are also droplets. The latter is far less important than the flu in acute nasopharyngitis. After rhinovirus infection, virus replication reached a peak concentration at 48h, and the transmission period lasted for 3 weeks. Individual susceptibility is associated with nutritional health and upper respiratory tract abnormalities (such as tonsil enlargement) and smoking. The cold itself does not cause a cold. Part of the reason for the cold in the cold season is related to the type of virus, and may also be related to the increase in congestion and the crowds of indoor family members or people. Symptoms of infection are affected by the physiological state of the host. Overwork, depression, nasopharyngeal allergic diseases, and menstrual periods can all aggravate symptoms.

In the case of rhinovirus, the nasal cavity or the eye is the portal to the body, and the nasopharynx is the initial site of infection. M cells in the adenoid lymphoid epithelial area contain the rhinovirus intercellular adhesion molecule-I (ICAM-1) receptor, where the virus first adheres and reaches the posterior nasopharynx by the mucociliary activity of the nasal cavity. At this point the virus replicates quickly and spreads forward to the nasal passages. Nasal epithelial cell biopsy and nasal secretion studies suggest that increased secretion of inflammatory mediators (bradykinin, prostaglandins), interleukin-1 and -8 may be partially responsible for the clinical symptoms of the cold. The role of histamine is unclear. Although intranasal instillation of histamine can cause cold symptoms, the anti-histamine treatment effect is not certain. Parasympathetic blockers are effective in relieving cold symptoms, suggesting that the nerve reflex mechanism also plays a role in the pathogenesis of colds. The immune response (IgA, interferon production) is usually transient, plus the diversity and drift of viral antigens, so repeated infections throughout life.

Pathological changes are related to viral virulence and the extent of infection. Respiratory mucosa edema, hyperemia, exudate (leakage or exudation), but no significant changes in cell population, repair is relatively rapid, generally does not cause tissue damage. Different viruses can cause different degrees of cell proliferation and degeneration. The destruction of nasal mucociliary can last for 2 to 10 weeks. When the infection is severe, the sinus, eustachian tube and middle ear canal may be blocked, causing secondary infection.

an examination

Related inspection

Otolaryngology CT examination of nasopharyngeal MRI

Clinical manifestations:

The incubation period varies from 1 to 3 days, depending on the virus, and the enterovirus shortest adenovirus and respiratory syncytial virus are longer. Suddenly, most of the onset has a burning sensation of the nose and throat, followed by stuffy nose, sneezing, salivation, general malaise and muscle aches. Symptoms peak at 48h (virus shelling), acute nasopharyngitis usually does not produce fever or only low fever, especially when rhinovirus or coronavirus infection. There may be conjunctival congestion, tearing, photophobia, swelling of the eyelids and swelling of the throat mucosa. The presence or absence of throat and bronchitis varies from person to person and from virus to virus. The nasal secretions are initially a large amount of watery sputum, which later becomes mucinous or purulent and purulent secretions. Unhealthy search must indicate secondary bacterial infection. Cough is usually not intense and can last up to 2 weeks. Purulent sputum or severe lower respiratory tract symptoms suggest a combination of viruses other than rhinovirus or secondary bacterial infections. When children have a cold, their symptoms are more severe than adults, with lower respiratory symptoms and gastrointestinal symptoms (vomiting, diarrhea, etc.). Most colds are self-limiting, such as no complications, the course of disease is 4 to 10 days.

complication:

Complications of acute nasopharyngitis include suppurative pharyngitis, sinusitis, otitis media, bronchitis, acute exacerbations of chronic respiratory diseases (chronic bronchitis, asthma), and worsening of obstructive sleep-disordered breathing. In children, there are occasional serious complications such as viral or bacterial pneumonia.

According to the characteristics of clinical symptoms, the upper respiratory tract symptoms are obvious and the systemic symptoms are relatively light, and the non-infectious upper respiratory tract inflammation such as allergic rhinitis is excluded, and a diagnosis can be made. Since virus culture and immunological serological diagnosis require certain equipment, and in addition to influenza virus and respiratory syncytial virus can be applied to effective antiviral drugs, it is of no practical significance for most viral infection-specific pathogenic diagnosis.

Differential diagnosis

It should be differentiated from nasal and throat infections.

Identification with nasal diseases:

(1) allergic rhinitis: a history of allergies, seasonal (hay fever) or sneezing all year round, nasal overflow, nasal congestion with itching. Symptoms and increased eosinophils in nasal secretions contribute to the diagnosis of this disease.

(2) vasomotor rhinitis: no history of allergies characterized by intermittent vascular filling of the nasal mucosa, sneezing and sputum, dry air can make the symptoms worse. According to the medical history and without purulent and molting, it can be differentiated from viral or bacterial infections.

(3) Atrophic rhinitis: the nasal cavity is abnormally patency, the lamina propria is thinned and the blood vessels are reduced, the sense of smell is reduced and there is molt formation and odor, which is easy to identify.

(4) nasal septum deviation, nasal polyps: nasal examination can confirm the diagnosis.

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