Sequential Immune Dynamics in Chronic Nasopharyngeal Inflammation

Chronic nasopharyngeal inflammation represents a state of persistent mucosal immune dysregulation within the nasopharynx, a key inductive site of upper airway immunity. In this review, we propose a hypothesis-generating conceptual framework in which disease progression reflects a sequential shift in dominant immune pathways—from early CD4+ T-cell-driven activation, through to T helper 17 (Th17)-mediated epithelial barrier dysfunction, and ultimately to CD8+ T-cell-mediated cytotoxic injury. These transitions are characterized by dynamic alterations in CD4/CD8 and Th17/Treg balance, contributing to epithelial fragility and sustained inflammatory activity. Beyond local pathology, prolonged inflammation may engage neuro-immune circuits, including vagal and neuroendocrine pathways, potentially linking mucosal immune activation to systemic physiological dysregulation. While several elements of this model are supported by existing knowledge in mucosal immunology, the integration of local and systemic immune processes remains partly hypothetical and requires further experimental validation. Epipharyngeal Abrasive Therapy (EAT) may represent a potential intervention within this framework, although its immunological mechanisms remain incompletely understood. However, the underlying mechanisms and clinical efficacy of EAT remain to be fully elucidated. This framework integrates local mucosal immune dynamics with potential systemic consequences and provides a conceptual basis for future investigations into chronic mucosal inflammation. It is intended as a hypothesis-generating conceptual review that integrates existing observations and proposes a conceptual framework to guide future mechanistic and clinical studies.