Doctor, I have some questions about my sore throat …
What is a sore throat?
Sore throat is a common symptom that may manifest not just as pain but sometimes scratchiness, dryness, ticklish sensation, or simply vague discomfort.
It can also be accompanied by other throat symptoms such as swallowing difficulty, hoarseness, or even breathing problems.
Fever and swollen glands in the neck may also occur with a sore throat.
What causes sore throat?
There are many causes, some common ones include:
Viral infections. Viral infection such as a common cold, influenza, or glandular fever, is the most common cause.
Bacterial infections. Bacterial infections such as strep throat, caused by the bacteria streptococcus pyogenes, is another common cause. Sometimes bacterial and viral infections can occur together.
Tonsillitis. Viral or bacterial infections can also lead to inflamed tonsils, which can become enlarged or ulcerated.
Large inflamed tonsils can cause severe sore throat
Allergies. Allergic reactions to things like dust, mold, or pet dander can irritate the throat. Allergies can also lead indirectly to throat discomfort by causing a blocked nose and mouth breathing.
Irritants. Exposure to smoke and some chemicals can irritate the throat.
Gastroesophageal reflux disease (GERD). Stomach acid and digestive juices can flow back into the esophagus and injure the throat. Throat symptoms may be the only symptom of GERD. GERD often co-exists with other causes to prolong a sore throat.
Snoring. Snoring causes throat tissues to vibrate vigorously during sleep which can cause soreness.
Muscle strain. Voice overuse, for example after projecting your voice for prolonged periods or yelling or singing, can strain or injure the throat muscles and cause soreness.
Certain medications. Some medications such as certain blood pressure medications can also irritate the throat.
Is sore throat dangerous?
Most of the time sore throat is not dangerous and settles down within a few days. Increasing pain and swallowing difficulty may mean a more serious condition such as a quinsy or peri-tonsillar abscess; or epiglottis, in which there is swelling of the deeper structures in the throat with the potential to obstruct breathing. Both conditions need immediate attention. If throat symptoms persist for more than 2 weeks it can be a sign of an underlying medical condition, or even cancer.
How do we diagnose sore throat?
It is important to diagnose the cause of severe or persistent throat symptoms. Examining the back of the mouth may provide the answer, for example in tonsillitis. A neck examination can help identify swollen lymph glands or injured muscles. If the cause remains unexplained, you may need an examination of your nose and throat with a flexible camera known as a nasendoscope. Other tests are sometimes necessary. For example, a throat swab, blood test, or biopsy.
How do we treat sore throat?
Treatment depends on the underlying cause.
Viral infection
We treat most viral infections symptomatically. This means taking over-the-counter painkillers such as paracetamol and ibuprofen and using anti-inflammatory gargles and lozenges. It is important to rest, sleep as much as possible, and stay hydrated to help your body recover. Three grams of vitamin C per day may also aid recovery.​
Bacterial infection
Bacterial infections may need antibiotics. Distinguishing bacterial from viral infection can be difficult. Reasons for starting antibiotics include fever, symptoms persisting beyond three days, and badly inflamed tonsils. Severe symptoms that make swallowing difficult may need admission to hospital for intravenous fluids fluids to prevent dehydration. During a hospital admission antibiotics and steroids given intravenously can speed up recovery.
Allergy
Allergy testing can sometimes identify an allergic cause. Avoiding the offending allergen may reduce symptoms. Antihistamines may help reduce throat irritation. Nasal sprays to improve nasal breathing may help reduce mouth breathing, leading to a less irritated throat. Read more about allergies & blocked nose.
GERD
If GERD causing throat symptoms, start by examining your eating habits to see if they are contributing to the problem. We will sometimes recommend medications such as antacids, alginates, and proton pump inhibitors. Read more about GERD.
Snoring
We examine the nose and throat to identify the reason for snoring. We may also need to rule out obstructive sleep apnea using an overnight sleep study. Read more about snoring & obstructive sleep apnea.
Muscle strain
Muscle strain causing throat soreness may need rest to avoid further injury to the muscle. Sometimes this may involve working with a speech therapist (rather like a physiotherapist for the voice!).
Chronic tonsillitis
Repeated infection of the tonsils may mean that you have chronic tonsillitis. In this case you may benefit from undergoing surgery to have your tonsils removed. However you would usually need to have quite a few episodes of tonsillitis before considering this! Read more about tonsillectomy.
When should I see the doctor?
If your sore throat does not settle down within a few days or if symptoms are frequent e.g. 3-4 times a year, you should consult your doctor. If you have severe pain that is affecting swallowing or breathing, you should consult your doctor immediately.
Read more about our services for throat, voice and swallowing symptoms here, or contact AdvancedENT for an appointment with the specialist.