Sore throat or Pharyngitis

Sore throat or Pharyngitis

Sore throat or pharyngitis symptoms are scratchiness, pain, or irritation aggravated by swallowing. Viral pharyngitis due to the common cold is the most common cause of a sore throat and usually resolves without treatment. On the other hand, a sore throat caused by bacterial infection, such as Strep throat (streptococcal pharyngitis), is less common and requires antibiotics to prevent complications. Sore throats from other causes require a diagnosis from a doctor.

Sore throat or pharyngitis symptoms

The presenting symptoms of sore throats or pharyngitis are diverse and may vary depending on the cause of the infection.

The common symptoms may include:

• Itching and pain in the throat
• White spots on tonsils
• Submandibular lymphadenopathy
• Difficulty swallowing
• Red and swollen tonsils
• Hoarseness

Other symptoms caused by viral infection include:

• A low-grade fever
• A cough
• Runny nose
• Sneezing
• Joint pain
• Headache
• Vomiting

When to see a doctor

It is recommended to see a doctor if the following symptoms accompany a sore throat.

For children:

• Difficulty breathing
• Dysphagia (Difficulty swallowing)
• Excessive saliva due to dysphagia

For adults:

• Severe pain in the throat (or when pain lasts longer than a week)
• Dysphagia
• Difficulty breathing
• Trismus (struggling to open your mouth)
• Joint pain
• Earache
• Skin rash
• High-grade fever (38.3 C)
• Blood in saliva
• Hoarseness for more than two weeks
• Throat swelling

Causes

In general, viral infection is a more prevalent cause of sore throats than a bacterial infection.

Viral illnesses that cause a sore throat or pharyngitis include:

• Influenza
• Common cold
• Mononucleosis
• Measles
• Chickenpox
• COVID-19

Bacterial infections can also result in a sore throat. Streptococcus pyogenes (group A streptococcus) is the most common agent of strep throat.

Other causes

• Allergies: Nasal congestion and allergic responses to animal fur, mold, and dust can lead to a sore throat. These may result in irritation as the air travels down the throat.
• Dry air: Chronic nasal congestion leads to mouth breathing, causing pain and dryness in the throat. 
• Air pollution: Environmental irritants such as chemicals in tobacco smoke, chewing tobacco, alcoholic beverages, and spicy food can play a role in the irritation of the throat.
• Muscle strain: Yelling and talking loudly and for a long time can strain your throat muscles. 

Risk factors

• Age: Children between the ages of 3 and 15 are at the highest risk of sore throat due to a weak immune system.
• Exposure to secondhand smoke: Both smoking and passive smoking can irritate the throat. Additionally, tobacco smoking increases the risk of mouth, throat, and laryngeal cancers.
• Allergies: Allergic responses to dust, fungus, or animal fur increase the risk of experiencing a sore throat.
• Exposure to chemical irritants: Airborne particles from the combustion of fossil fuels and common home chemicals can irritate the throat.
• Recurrent or persistent sinusitis: Nose blowing can irritate the throat and transmit pathogens.

Diagnosis

• Use a light source to help examine the throat, ears, and nasal passages.
• Lightly palpate the neck to detect swollen lymph nodes. 
• Listen to breath sounds with a stethoscope.
• Swab the throat for streptococcal bacteria by rubbing a sterile swab across the back of the throat for further examination.

Treatment for sore throat

Antibiotics do not relieve sore throat caused by viral infection. In addition, an unnecessary use of antibiotics heightens the risk of complications like rash, diarrhea, and severe allergic reactions. Normally, sore throats from viral infections go away in four to five days. Useful treatment modalities include ones that help reduce the pain. Examples include:

• Pain relievers: Over-the-counter pain relievers can relieve throat pain quickly and effectively. Acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug ("NSAID") like ibuprofen and naproxen can help alleviate the condition.
  Although oral steroids can be beneficial, they are recommended for short courses only as potentially harmful side effects can occur.
• Salt-water gargles: Despite no clear evidence of efficacy in pain relieving, gargling with salt water has been a remedy for throat pain for a long time. It is recommended to mix 1/4 to 1/2 teaspoon (1.5 to 3.0 g) of salt with 1 cup (250 mL) of warm water.
• Mouth sprays: Topical anesthetic sprays, such as benzocaine and phenol, can help treat sore throat. In spite of that fact, these sprays are not more effective than hard candies.
• Lozenges: Several throat lozenges have topical anesthetics. They can help treat throat pain and keep the throat moist. Moreover, lozenges provide longer effects compared to mouth sprays or gargles. Therefore, lozenges are more effective.
• Foods and beverages: Warm honey or lemon tea, chicken soup, and cold beverages or desserts like ice cream and popsicles can help with sore throat.
• Alternative modalities: Products for sore throat treatment can be found in offline and online health food and vitamin stores. However, these products can contain pesticides or herbicides or have inaccurate labeling and dosing information. In addition, there are inadequate studies guaranteeing the safety and efficacy of these products. Therefore, these types of treatments are not recommended.

Treatment for strep throat

Strep throat can resolve on its own within 2 – 5 days. However, since it is caused by bacterial infections, antibiotics are required for the treatment, especially in patients who tested positive for strep from a rapid test or a throat culture. Penicillin and related antibiotics are common antibiotics for strep throat. They are available in the form of tablets and liquids. Patients are advised to take antibiotics 2 - 4 times per day for 10 days. In addition, a single injection of penicillin can treat strep throat. Individuals who are allergic to penicillin may be able to take alternative antibiotics. Finishing a full course of antibiotics is important to successfully treat bacterial infections.

It is highly advised to see a doctor for further treatment if symptoms worsen after taking antibiotics for 3 days.

Recovery period

Patients with strep throat can return to regular activities 24 hours after taking the first dose of antibiotics. Antibiotics will improve their conditions and make them less contagious.

For patients diagnosed with COVID-19, it is recommended to stay home and isolate themself from other people, including those they live with. The self-isolation period varies, depending on symptoms and other factors. Consequently, it is important to ask for advice from your physician or hospital regarding when your isolation should end.

Patients with a sore throat, not diagnosed with strep throat or COVID-19, can return to their normal routines as soon as the symptom improves. However, patients should maintain good hand hygiene and perform cough etiquette to prevent the spread of infection.

Prevention

Practicing good hygiene and avoiding germs that cause sore throats are the most effective way to prevent sore throats. These guidelines may be helpful: 

• Regularly wash your hands for at least 20 seconds, especially after using the restroom.
• Do not touch your face. Try not to contact your eyes, nose, or mouth.
• Avoid sharing food, beverages, and eating utensils.
• Cough or sneeze into a tissue paper and dispose of it before washing your hands.
• Use hand sanitizers containing alcohol to clean your hands regularly.
• Avoid using public telephones or drinking water fountains.
• Regularly clean and disinfect telephones, doorknobs, light switches, remote controls, and computer keyboards.
• Avoid close contact with ill or symptomatic individuals.

Home remedies

• Get enough sleep and rest your voice.
• Drink fluids to correct dehydration and moisturize your throat. Avoid beverages containing caffeine and alcohol.
• Eat and drink warm foods and beverages, such as broth, caffeine-free tea, or warm water with honey.
• Moisturize the air with a humidifier. Be sure to clean the humidifier frequently to prevent mold and bacterial growth.
• Avoid exposure to irritants from cigarette smoke and cleaning products.
• Remain at home until you feel better to help prevent the spread of viruses or other pathogens.

Preparing for doctor’s appointment

Consult with your doctor if you or your children experience any symptoms of sore throats, such as dysphagia or others. You may also need to make an appointment with an ear, nose, and throat (ENT) specialist or an allergy specialist (allergist).