Multiple: Sore Throat

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Sore throat, also known as pharyngitis, is a common symptom associated with upper respiratory infections, surgical procedures, and other irritants that may inflame the tissues of the throat. It is not a separate disease.

Description

The discomfort associated with a sore throat varies somewhat according to its cause. Most sore throats are caused by viruses, specifically the viruses that cause the common cold. A person with a viral sore throat will be sneezing and having a runny nose as well as coughing and feeling a mild headache. A sore throat caused by the flu, however, will usually be accompanied by a fever of 102°F (38.8°C) or higher, and muscle aches and general tiredness. A patient with a sore throat caused by the virus responsible for infectious mononucleosis may have swollen tonsils, swollen lymph glands in the neck, and be tired for several weeks after the sore throat goes away.

A sore throat caused by bacteria, such as those that cause strep throat, may be very painful; the patient may drool or spit because swallowing is difficult. Bacterial sore throats also often come on suddenly.

Sore throats caused by smoking, air pollution, allergies, or overuse of the voice are often characterized by a dry or scratchy feeling in the throat rather than an aching sensation. Some people also experience this type of sore throat during winter, particularly in the mornings, because dry heat from a furnace tends to irritate the tissues that line the throat.

A sore throat caused by an injury to the lining of the throat—for example getting a fish bone caught in the throat or having a medical examination that requires putting an instrument down the throat— usually involves pain only in the area of the injury. It is not accompanied by fever, sneezing, or other symptoms of an infection.

In rare cases, a sore throat is the first sign of throat cancer. Cancerous tumors in the throat are often accompanied by coughing up blood, pain

in the throat that does not go away with antibiotic treatment, difficulty in swallowing, and a hoarse voice.

Demographics

Sore throats are one of the most common reasons for staying home from school or work. The National Institutes of Health (NIH) estimates that sore throats are responsible for forty million doctor visits every year in the United States. Children have an average of five upper respiratory infections causing sore throats every ear, and adults have between one and three. About 90 percent of sore throats are caused by one type of virus or another, with most of the remaining 10 percent being caused by bacterial infections.

Sore throats caused by viruses are equally common in both sexes and in all racial and ethnic groups in the United States.

People at increased risk of sore throats include:

• Smokers or those exposed to secondhand smoke
• People whose jobs expose them to chemicals that irritate the throat
• People with seasonal allergies to plant pollen, or year-round allergies to household dust, pet dander, or molds
• People with diabetes
• People with weakened immune systems, including those with HIV infection and those receiving chemotherapy for cancer
• People who live or work in close quarters with others, such as college students, military personnel, child care workers, office workers, and hospital staff
• People with frequent sinus infections

Causes and Symptoms

Sore throat can have many possible causes, ranging from viruses and bacteria to smoking, air pollution, allergies, swallowing a foreign body, dry

air, and overuse of the voice; however, most cases of sore throat are caused by viruses. The different types of viral infection that may be accompanied by a sore throat include:

• Common cold (There are about 200 different viruses that can cause colds.)
• Influenza
• Infectious mononucleosis
• Cold sores
• Measles
• Chickenpox
• HIV infection

The most common bacterial cause of sore throat is the bacterium that causes strep throat. Other bacterial infections that can cause sore throat include gonorrhea, a sexually transmitted disease, and diphtheria. Diphtheria is a potentially life-threatening infection of the upper respiratory tract that has been virtually wiped out in the developed countries since the development of a vaccine against it in the 1980s.

The symptoms that accompany sore throat depend on its cause. In general, sore throat caused by a viral or bacterial infection will look red or swollen when the doctor examines the patient's upper respiratory tract, and the tonsils will often look enlarged and have a coating of pus. A sore throat caused by smoking, chemical irritants, tissue injury, or dry air will not be accompanied by swollen tonsils or pus. In the case of throat cancer, the tumor will often be visible when the doctor examines the inside of the patient's throat.

When to See the Doctor

Most sore throats, particularly those caused by cold viruses, go away on their own after a few days without the need for a visit to the doctor. People should, however, see their doctor if they have any of the following symptoms, which could indicate a serious condition:

• Severe difficulty in swallowing or breathing
• A sore throat that lasts longer than a week, or hoarseness that lasts longer than two weeks
• Problems sleeping because of pain in the throat
• Fever of 102°F (38.8°C) or higher
• Sunken eyes, weakness, low urine output, and other signs of dehydration
• Pus in the back of the throat
• Skin rash
• Lump in the neck
• Coughing up blood, or blood in the saliva
• Family member or acquaintance diagnosed with strep throat
• Pain in the abdomen or vomiting

Diagnosis

In most cases, the doctor can diagnose the cause of the patient's sore throat by taking a history (asking about recent exposure to people with colds, flu, mononucleosis, or strep throat; occupation; history of allergies; smoking habits; and similar questions), and by examining the inside of

the patient's mouth and throat. It is not always easy to distinguish between a sore throat caused by a virus and strep throat just by looking, however, so the doctor will take a sample of fluid from the patient's throat on a cotton swab. The fluid can be sent to a laboratory for a throat culture, which is an accurate test that takes two days. The doctor may also perform what is called a rapid strep test in the office.

A blood test called the monospot test can be performed if the doctor thinks that the patient may have mononucleosis.

If there is a tumor in the throat, the doctor can take a sample of tissue to be analyzed for evidence of cancer. In addition, the patient will be given a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the head and neck to see whether the tumor is limited to the throat or has started to spread to other parts of the body.

Treatment

Antibiotics are not effective in treating a sore throat caused by a virus. Most doctors prefer to wait until they have the results of a throat culture to prescribe antibiotics.

Adults or children with strep throat or a sore throat caused by colds or flu can also take ibuprofen, acetaminophen, or another nonaspirin pain reliever to bring down fever and relieve muscle cramps or headache. Gargling with salt water—a half teaspoon of salt in a glass of warm water— is recommended for easing the throat discomfort.

Other remedies recommended by doctors for sore throats include:

• Using a humidifier in the home to help keep the throat tissues moist
• Drinking lots of liquids
• Drinking warm tea with honey and a small amount of lemon juice
• Getting enough sleep

The doctor may recommend a tonsillectomy (surgical removal of the tonsils) for children with recurrent severe sore throats. Tumors in the throat are treated with surgery and radiation therapy.

Prognosis

Sore throats caused by viral infections other than HIV usually clear up with no long-term complications once the person has recovered from the illness. Most people with strep throat also recover completely; however, about two patients per 1,000 who are not treated for strep throat will

develop rheumatic fever and another two per 1,000 will develop a severe infection of the tonsils. Other possible but rare complications of strep throat include ear infections, kidney or liver damage, pneumonia, inflammation of the bones or joints, or sinusitis.

The prognosis of throat cancer depends on the stage of disease at the time of diagnosis. Early-stage throat cancers have a high cure rate.

Prevention

It is difficult to completely prevent sore throat, particularly during cold and flu season, but people can reduce their risk by taking the following precautions:

• Wash the hands frequently, and use hand sanitizers containing alcohol when soap and water are not available.
• Do not share drinking glasses, food utensils, towels, or other personal items with others.
• Avoid close contact with people who have colds or other upper respiratory infections.
• Quit smoking (or do not start in the first place) and avoid exposure to secondhand smoke.
• Use a humidifier in the home during the winter.
• Stay indoors on high pollution or high pollen count days.
• If the sore throat is related to overusing the voice, give the voice a rest for several days.

The Future

Because of the many different possible causes of sore throat and the near impossibility of eliminating the common cold and other viral illnesses, the condition will continue to be a frequent health problem for children and adults alike.

SEE ALSO Allergies; Common cold; Infectious mononucleosis; Influenza; Laryngitis; Smoking; Strep throat; Tonsillitus

For more information

BOOKS

Blenkinsopp, Alison, Paul Paxton, and John Blenkinsopp. Symptoms in the Pharmacy: A Guide to the Management of Common Illness. 5th ed. Malden, MA: Blackwell Publishing, 2005.

Powell, Jillian. Sore Throat. North Mankato, MN: Cherrytree Books, 2007.

WEB SITES

American Academy of Family Physicians (AAFP). Sore Throat: Easing the Pain of a Sore Throat. Available online at http://familydoctor.org/online/famdocen/home/common/infections/cold-flu/163.html (accessed July 27, 2008).

American Academy of Otolaryngology—Head and Neck Surgery. Sore Throats. Available online at http://www.entnet.org/HealthInformation/soreThroats.cfm (accessed July 27, 2008).

JAMA Patient Page: Sore Throat. Journal of the American Medical Association 291 (April 7, 2004). Available online at http://jama.ama-assn.org/cgi/reprint/291/13/1664.pdf (accessed July 27, 2008).

Mayo Clinic. Sore Throat. Available online at http://www.mayoclinic.com/health/sore-throat/DS00526 (accessed July 27, 2008).