Sore Throat

Sore throat symptoms include pain with swallowing for pharyngitis and a hoarse voice when laryngitis is present.

Sore Throat Facts

1. Different parts of your throat can experience pain and soreness as a result of a bacterial infection, virus, or inhalation of toxic substances like tobacco smoke. Pharyngitis and laryngitis are two common types of sore throat named after the inflamed parts of the throat (pharynx and larynx, respectively).
2. Sore throat symptoms include pain with swallowing for pharyngitis and a hoarse voice when laryngitis is present. Cold viruses tend to cause more coughing and runny nose than strep throat. You can often treat these symptoms by gargling warm salt water and using over-the-counter painkillers and throat lozenges.
3. You should call the doctor if you think you’ve got a sore throat caused by a bacterial infection. Symptoms that indicate you have a sore throat caused by bacteria like strep include severe throat pain without much of a cough, a fever over 101 F, headache, or vomiting. You should also go to the doctor for a sore throat if you’ve recently been in contact with someone diagnosed with strep throat.

Sore throats are usually named for the anatomical site affected. The pharynx, the area of the throat directly behind the mouth and soft palate, is a common passageway for food, liquids, and air. Swallowing safely delivers solids and liquids to the stomach through the esophagus. Pharyngitis is pain and inflammation of the pharynx.

• Tonsillitis typically involves inflammation of the tonsils (tonsils are located on either side of the base of the tongue).
• The larynx, the top portion of your windpipe (trachea), has an important gatekeeper function. It allows the passage of air in and out of the lungs (through the trachea) but inhibits the entry of solids and liquids. Sound production at the vocal cords is an important side job of the larynx. Laryngitis is pain and inflammation of the larynx (often associated with a hoarse voice). Croup is a form of laryngitis in children (it tends to be associated with a seal barking-like cough and difficulty inhaling air).
• Epiglottitis is a rare type of sore throat is inflammation of the epiglottis (a tall semi-tubular structure at the opening to the larynx separating it from the base of the tongue). This type of sore throat problem is most common in children, and it is an emergency because the airway may quickly become blocked.

Common viruses, including the viruses that cause mononucleosis (mono) and the flu. Some viruses can also produce blisters in the mouth and throat.

A sore throat can have many causes including:

• Common viruses, including the viruses that cause mononucleosis (mono) and the flu. Some viruses can also produce blisters in the mouth and throat ("aphthous stomatitis").
• Infection of the tonsils or adenoids.
• Breathing through the mouth or smoking can produce throat dryness and soreness.
• Gastroesophageal reflux disease (GERD) while lying down or sleeping.
• Sinus drainage (post-nasal drip) from allergic or chronic sinusitis.
• Bacterial infections. The two most common bacteria to cause sore throats are Streptococcus (which causes strep throat) and Arcanobacterium haemolyticum. Arcanobacterium causes sore throats mainly in young adults and is sometimes associated with a fine red rash.
• Sore throat appearing after treatment with antibiotics, chemotherapy, or other immune-compromising medications may be due to the yeast Candida, commonly known as "thrush."
• A sore throat lasting for more than two weeks can be a sign of a serious illness, such as throat cancer or AIDS.

Symptoms of sore throat can be generalized symptoms that occur throughout the body such as fever, headache, nausea, and malaise. These may be present with either a viral or bacterial infection.

Symptoms specific to the throat include pain with swallowing for pharyngitis and a hoarse voice when laryngitis is present. Cold viruses tend to cause more coughing and runny nose than strep throat.

Signs of sore throat include the following:

• Pus on the surface of the tonsils (can happen with bacteria or viruses)
• Redness of the oropharynx (the pharynx viewed through the mouth)
• Tender and swollen lymph nodes in the neck ("glands")
• Drooling or spitting (as swallowing becomes too painful)
• Difficulty breathing (inhaling can be especially difficult when the passage through the pharynx or larynx becomes too narrow for a normal stream of air)
• Vesicles (bubbles of fluid on a red base) in the oral cavity or oropharynx may indicate the presence of coxsackievirus or herpes simplex virus

Two-thirds of people with strep throat have only redness with no pus on the tonsils.

The duration of a sore throat depends upon the cause. If the cause is a persistent irritation, like inhalation of cigarette smoke or other toxic substance, the sore throat can last as long as the exposure to the offending agent. Bacterial infections such as strep throat begin to improve once appropriate treatment with antibiotics is started.

• Viruses like the common cold typically produce a sore throat that lasts from several days to a week or more.
• The sore throat of infectious mononucleosis can last longer than that of the common cold.

Rarely, bacterial infections of the throat can lead to complications including abscess formation and spread of the infection.

• Rheumatic fever (a condition that can cause damage to the heart, nerves, skin, and joints) and
• post-streptococcal glomerulonephritis (a form of kidney inflammation) are rare complications of untreated strep throat.

When to call the doctor

When these conditions point to the possibility of a bacterial infection, the affected person should see the doctor.

• Severe sore throat without much of a cough
• Fever over 101 F (38.3 C)
• Associated headache, abdominal pain, or vomiting
• Drooling
• Another family member or close contact recently diagnosed with a strep throat

If the person seems to be dehydrated (dry mouth, sunken eyes, severe weakness, or decreased urine output), an urgent doctor's appointment is indicated. Symptoms of dehydration in adults may be different from symptoms of dehydration in children.

If the pain is not relieved by over-the-counter medicine, or if the person cannot sleep because of the pain, contact a health care professional.

When to go to the hospital

If swallowing hurts enough that drooling occurs, the affected person should go to a hospital's emergency department. Difficulty breathing from a sore throat can also be a symptom of a more serious illness. Significant dehydration associated with the inability to drink fluids is often best treated at the hospital.

Because doctor's offices vary in their ability to treat serious conditions in the office or see people on an urgent basis, the person might want to call your doctor to get advice on whether he or she should come to the office or go to the emergency department. Keep in mind that urgent care centers are generally poorly equipped for treatment of serious conditions and may quickly send the patient in an ambulance to an emergency department.

History and physical examination are the most important tools in diagnosis. When epiglottitis or occasionally croup is suspected, neck X-rays may be helpful. A blood count and antibody test may be helpful when mononucleosis is suspected to confirm the diagnosis.

A throat swab to check for a strep throat infection (strep throat is a common name for streptococcal pharyngitis) is useful in selected cases. The so-called "rapid strep" test is sometimes unreliable, however, so often a doctor prescribes antibiotics based on the history and examination alone. A throat culture is a more reliable test, but the results take 24 hours to return. Treatment with antibiotics can be either initiated on a delayed basis or discontinued if begun already based on this final result.

The cure for a sore throat depends upon the exact cause.

• Antibiotics can cure bacterial infections but are not effective in viral infections.
• There is no medical cure for sore throats caused by viral infections, and supportive care is usually all that is needed.
• People with epiglottitis usually require IV antibiotics and hospital admission; a few people may require breathing assistance (intubation).

Treatment of pain is often the number one priority if you have a sore throat. Some of these home remedies and self-care steps may help alleviate the pain from a sore throat.

• Throat lozenges often prove inadequate for all but the most minor cases.
• Gargling with salt water is sometimes helpful. (The person may try mixing table salt with warm water and gargling.)
• Although they may be rough on the stomach, NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen) are often more effective pain relievers than acetaminophen (Tylenol).
• Drinking plenty of fluids is very important.
  • A fever can increase fluid requirements, and painful swallowing can decrease fluid intake.
  • When it is hard for a person to drink, it is important to decrease the body's requirements for fluid through rest and lowering any fever.
  • Pain treatment can help increase fluid intake.
  • Choose high-quality fluids such as soup broth (replaces both salt and water losses) and sugar-containing solutions (they help the body absorb the fluids more rapidly).
  • Avoid caffeine because it can cause water loss.
• Getting extra sleep can promote more rapid recovery, especially if a virus is the cause. Malaise (a general feeling of illness) is the body's cry for rest.

Care of a sore throat involves treatment of pain, dehydration, or difficulty breathing (airway problems are common with croup or epiglottitis).

• Antibiotics
• Antibiotics are not helpful when a virus is the cause of a sore throat.
• Sometimes it is difficult to determine whether the cause is viral or bacterial, so antibiotics may be prescribed as a precaution. Rely on your physician's recommendation of whether atibiotics are needed.
• Antibiotics speed the resolution of a strep throat by an average of only 1.5 days.
• Antibiotics are helpful in preventing rheumatic fever (an uncommon but severe complication of a streptococcal infection, which may cause severe inflammation of the heart muscle and heart valves).
• Corticosteroids can be helpful in the treatment of a few select types of sore throats. Although they impair immune function, the anti-inflammatory effect can be very useful. They are mostly used in cases of severe tonsillitis, eppiglottitis, or in cases of croup.

Surgical drainage of an abscess behind a tonsil (peritonsillar abscess) or between the spine and pharynx (retropharyngeal abscess) is required in rare cases.

• Tonsillectomy or surgical removal of the tonsils is occasionally indicated for tonsillitis that returns often (once a month) or that causes breathing or sleep problems.

Pregnant women who develop a sore throat can still receive treatment for the condition.

• Viral illnesses only require supportive treatment, and home remedies and self-care steps (described above) are generally safe in pregnancy.
• Talk to your doctor about the right choice for pain medication if it is required.
• Some antibiotics are safe for pregnant women; if you develop a bacterial infection, your doctor can prescribe antibiotics that have been proven to be safe for both mother and baby.
• It is very important not to abstain from treatment for bacterial infection; since if untreated, the infection may cause serious complications.

As with other illnesses, a doctor should be contacted doctor if a person becomes worse despite treatment. Sometimes, determining whether a condition became worse because of the natural course of the illness, or because of a side effect of the medication, the patient is taking can be difficult. (For example, both the infection causing a sore throat and a reaction to medication can cause nausea.)

Avoiding close contact with ill people can help a person from getting a throat infection. Cold viruses appear to be more readily transmitted than Streptococcal infections. Only some family members exposed to Streptococcus develop strep throat. Usually, a person with strep throat becomes noninfectious within 24 hours after the first antibiotic dose. The incubation period (the time between exposure to strep germs and onset of illness) is usually 2-5 days. Children should stay home from school and daycare during infectious periods.

• Being vigilant about handwashing is the best way to prevent any kind of infection.
• Many viruses can be transmitted by contamination of common surfaces.
• It is important to teach children the importance of handwashing using soap and water and/or hand sanitizer.
• Avoid sharing of drinking and eating utensils and other personal items can also be an effective preventive measure.

• Only in very rare cases are sore throats due to serious conditions.
• Although rare, complications of strep throat such as rheumatic fever, post-streptococcal glomerulonephritis, and epiglottitis can cause serious illness or death.