1. Pharyngitis (Sore Throat)

Definition:
Inflammation of the pharynx, usually caused by viral or bacterial infections.

Causes:

• Viral: Rhinovirus, adenovirus, influenza, Epstein-Barr virus

• Bacterial: Streptococcus pyogenes, Haemophilus influenzae

Symptoms:

• Sudden onset sore throat

• Painful swallowing (odynophagia)

• Fever (more common in bacterial cases)

• Red, swollen pharyngeal mucosa; sometimes exudates

• Swollen cervical lymph nodes

• Runny nose, cough, hoarseness (usually viral)

Duration:

• Acute; usually resolves within 5–10 days with symptomatic treatment

Red Flags / Complications:

• Severe sore throat with difficulty swallowing

• Drooling, muffled voice, or respiratory distress → consider peritonsillar abscess

• Persistent symptoms >2 weeks are unusual for simple pharyngitis

Investigations:

• Rapid antigen detection test or throat culture (for bacterial pharyngitis)

• Usually no imaging required

Treatment:

• Symptomatic for viral causes

• Antibiotics if bacterial infection is confirmed

2. Nasopharyngeal Cancer (NPC)

Definition:
Malignant tumor originating in the nasopharynx, often associated with Epstein-Barr virus (EBV) infection.

Risk Factors:

• EBV infection

• Genetic susceptibility

• Consumption of salted fish and preserved foods

• Male gender, age 40–60 (most common)

Symptoms:

• Early-stage NPC: Often asymptomatic

• Nasal obstruction or persistent congestion

• Nosebleeds (epistaxis)

• Hearing loss or ear fullness (due to eustachian tube obstruction)

• Neck mass (cervical lymphadenopathy, often painless)

• Chronic sore throat or sensation of something stuck in the throat

• Headache, facial numbness if advanced

Duration:

• Persistent and progressive; does not resolve spontaneously

Red Flags / Complications:

• Unilateral neck mass >2–3 weeks

• Persistent nosebleeds

• Cranial nerve involvement (double vision, facial paralysis)

• Recurrent or unexplained ear symptoms

Investigations:

• Nasopharyngoscopy with biopsy (definitive diagnosis)

• MRI/CT of nasopharynx for local extension

• EBV serology or DNA PCR (supportive)

• Chest X-ray or PET-CT for metastasis assessment

Treatment:

• Radiotherapy (primary treatment)

• Chemotherapy for advanced stages

Key Distinguishing Points

Feature Pharyngitis Nasopharyngeal Cancer (NPC) Onset Sudden Insidious, gradual Duration Short, <2 weeks Persistent, progressive Pain Throat pain prominent Sore throat mild or absent Fever Common in bacterial/viral cases Rare Cervical lymph nodes Tender, often small Painless, firm, unilateral/bilateral Nasal/ear symptoms Usually absent Nasal obstruction, epistaxis, ear fullness Response to treatment Improves with antibiotics/symptomatic Does not improve with usual treatments Red flag signs Difficulty breathing/swallowing Persistent neck mass, cranial nerve palsy

Summary:

• Pharyngitis is usually acute, self-limited, and associated with pain and systemic symptoms.

• Nasopharyngeal cancer is insidious, often painless, may present with a neck mass, nasal obstruction, or ear symptoms, and does not resolve spontaneously.

• Any persistent unilateral neck mass or unexplained ENT symptoms warrants nasopharyngoscopy and biopsy to rule out NPC.