Sore Throat

A sore throat is a very common symptom seen in people of all age groups. It is a condition where the throat becomes red and inflamed making it difficult for the person to swallow food. Acute episodes of a sore throat are usually caused by viruses, though they may also be caused by bacteria or other infectious agents. One of the important group of bacteria that causes a sore throat is a group A Streptococcus (GAS), which is seen in 15% to 20% of the cases in children. Even in India, cases of GAS are between 11% to 34%.

Depending on the cause, signs and symptoms of a sore throat can be different. They include:

• Throat pain.
• Itchy throat.
• Difficulty swallowing food and/or water.
• Inflamed glands of the neck.
• Hoarse voice.

Along with the above-mentioned common complaints of a sore throat, it may also be accompanied by:

• Cough.
• Fever.
• Runny nose.
• Sneezing.
• Body ache.
• Headache.
• Joint pain.
• Blood in sputum.
• Rash on the trunk, back, and limbs.
• Ear pain.
• Difficulty in breathing.
• Nausea.
• Vomiting.
• Weakness.
• Malaise or a general feeling of discomfort.

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Causes

The common causes of a sore throat include:

• Viral infections
  Infections such as common cold, influenza, measles, chickenpox, infectious mononucleosis, parainfluenza, and whooping cough are some of the commonest causes that lead to a sore throat. Symptoms of mononucleosis last for a very long time and the sore throat is accompanied by tremendous fatigue, which can last for many weeks. Enlarged lymph nodes in the armpits and neck along with fever and headache are some of the associated symptoms of mononucleosis.
• Bacterial infections
  A Strep throat is also a sore throat caused by the bacteria Group A Streptococci. This group of bacteria also causes other infections like tonsillitis, pneumonia, ear infections, and more. Along with a sore throat, streptococcal infections produce fever (over 101° F) and tender lymph nodes in the neck with reddish-white patches in the throat. In children, it may also be accompanied by a headache and stomach pain.
• Allergies
  Pollen, moulds, dust, animal hair and dander are some of the allergens that can cause a sore throat.
• Irritants
  Irritants such as dust particles, pollutants, tobacco, alcohol, spicy food, harmful gases, car smoke, exposure to chemicals, heat, or even excessive strain on the voice can irritate the throat causing the symptoms.
• Air Pollution
  Poor air quality can lead to an irritation and roughness in the throat, especially in the morning. Breathing through the mouth due to nasal polyps or congestion can also cause a sore throat.
• Gastrointestinal reflux disorder (GERD)
  In GERD, the contents of the stomach regurgitate or flow back into the throat via the food pipe (oesophagus). Symptoms of GERD also include acidity  (heartburn) and a sensation of a lump rising in the throat. Over a period of time, it can lead to a sore throat.
• HIV infection
  An HIV-positive person may show flu-like symptoms such as a sore throat, fatigue, and low-grade fever in the early stages of the infection. People with HIV-AIDS have severely compromised immune systems, hence, they may also complain of a sore throat due to secondary infections.
• Tumours
  Throat, tongue, and mouth cancers can often lead to a sore throat. Other symptoms include blood in the sputum, difficulty in breathing, hoarseness of voice, and a lump in the neck.
• Overuse of muscles
  The muscles of the throat get strained while yelling, talking loudly or speaking for a long period without any rest such as during public speeches, lectures, debates, singing, and other such events.
• Epiglottitis
  Epiglottitis is a rare condition where the epiglottis, a small muscle flap covering the windpipe, becomes inflamed and swollen obstructing the air flow and warranting immediate medical intervention. Individuals with this condition experience difficulty in breathing and extremely painful swallowing with drooling. Childhood epiglottitis has almost been eradicated owing to mass vaccination. Epiglottitis can be easily diagnosed by simply examining the mouth and throat.

Risk factors

Certain factors that increase an individual’s risk of contracting throat infections include:

• Age
  Sore throats are extremely common in children as their immune system is weak as compared to that of adults. Young children are commonly susceptible to developing streptococcus throat infections in particular. The incidence of infections decrease as children grow up, however, proper hygiene and sanitation are also essential to prevent contracting them.
• Exposure to irritants
  Exposure to smoke (directly or via passive smoking), consumption of tobacco and tobacco products, irritates the throat and increases the risk of various mouth (oral) and throat cancers. Chemical irritants like fuel and fossil fuels also can lead to throat irritation.
• Allergy
  Individuals who are sensitive to dust and pollens are more likely to develop a sore throat. People who have pets or who live in unhygienic living conditions may get a sore throat due to allergies to pet dander and moulds, respectively.
• Poor immunity
  Poor immune status is a major cause of recurrent infections. People who are HIV-positive, diabetic, undergoing chemotherapy for cancer, on steroid medications, and constantly fatigued due to poor diet and stress are highly susceptible to infections.
• Cramped areas
  Heavily populated areas with lack of space, such as slums, offices, and planes allow infections to multiply and spread faster.

Sore throat prevention involves taking measures to avoid the germs that cause infections along with maintaining good hygiene. The following tips can be adapted to keep microorganisms at bay:

• Wash hands
  Washing hands thoroughly, especially after using the toilet, before and after meals, after sneezing and coughing prevent the germs from entering the mouth.
• Use tissues
  Use tissues when sneezing and coughing, and throw them thereafter. By taking these precautions, the viruses and bacteria do not spread to other people. In case tissues are not available, sneezing into the elbow also prevents the infection from spreading.
• Use hand sanitizers
  Sanitizers offer a good alternative to soap. They are useful in areas with a scarcity of soap and water. Remember to rub your hands together while using a sanitizer as they help to get rid of the bacteria.
• Keep household items clean
  Use alcohol-based household cleansers to clean appliances like television, remote control device, doors, and telephones.
• Avoid public items
  It is highly advised not to use public telephones or vending machines without cleaning them first with a sanitizer. If that is not possible, use a tissue or a napkin while using them or rub your hands with a sanitizer right after. Also, avoid drinking water from drinking fountains directly.
• Avoid close contact with infected people
  Stay away from people who are unwell as they are a carrier of the infection. Also, avoid sharing food or drinks with them.

The diagnosis of a sore throat will depend on the following:

• Medical history
  A detailed medical history of the person including the duration and intensity of a sore throat is recorded by the doctor. Other details that your doctor may ask for include:
  • Associated complaints like a runny nose, cough, pain on swallowing, and difficulty breathing.
  • Certain symptoms before the onset of a sore throat, such as weakness and malaise as they are specific symptoms of certain illnesses like mononucleosis.
  • A history of mononucleosis, streptococcal infections, and pneumonia.
  • A history of close or sexual contact with HIV-positive individuals or those with sexually transmitted infections, and risk factors like unprotected sexual intercourse, multiple sexual partners, and intravenous drug use.
• Physical examination
  A general physical examination to check for fever, pulse, and signs of breathing issues may be performed. A complete throat examination is carried out to check for redness, inflammation, pus, and oedema. Swelling around the tonsils may also be looked for. The neck is also palpated to check for lymph node swellings. The lungs are also examined for any abnormal sounds or wheezing. The abdomen may also be palpated to rule out an enlargement of the spleen.
• Investigative Tests
  Blood count usually reveals an increase in the number of white blood cells denoting the presence of an infection. A throat culture is a more specific test performed to identify the bacteria or virus that has caused the infection. Some advanced tests to check for HIV and mononucleosis may also be performed as per the doctor’s discretion. Some cases may also require imaging studies like MRI and CT scan to check for lymph node abnormalities in the neck.

• Painkillers and antipyretics
  A sore throat caused by virus get better without any medication within 5 to 7 days. In some cases, acute symptoms like pain and fever can be managed by mild antipyretics (medicines used to treat fever) and pain relievers. In children, over-the-counter medicines may be given after consulting a doctor about their correct dosage that depends on the child’s age, weight and height. Medications like aspirin should not be given without a doctor’s prescription to teenagers with a sore throat or flu-like symptoms as it can cause severe complications.
• Antibiotics
  If a sore throat is caused by a bacterial infection, a course of antibiotics will be prescribed by the doctor. It is advised to complete the entire course of medicines even if all the symptoms have subsided. If the medicines are not taken as directed, the infection may recur or spread to other parts of the body. If the full antibiotic course is not taken for strep throat, especially in children, the risk of developing kidney disease or rheumatic fever increases.
• Other medications
  If a sore throat is caused by an underlying medical condition, the treatment varies and is disease-specific.

Lifestyle management

• Along with medications, these home care tips can be helpful in providing temporary relief from a sore throat:
• Take ample rest and give some rest to your voice as well.
• Drink plenty of fluids to keep the throat moist. Avoid coffee and alcohol as they dehydrate the throat.
• Drink warm liquids like soup, broth, and warm water with honey to soothe the throat.
• Gargling with lukewarm salt water 3 to 4 times a day is also helpful.
• Suck on throat lozenges to soothe symptoms but be careful while giving them to children as they pose a risk of choking.
• Avoid irritants like cigarette smoke, incense sticks, and strong-odour substances which can irritate the throat.
• Alternative treatments like herbal remedies, teas, liquorice, marshmallow root, and Chinese herbs may also be helpful. Consult a doctor before beginning an alternative treatment.

Prognosis

Prognosis of a sore throat depends on its underlying cause. Infections caused by viruses are self-limiting and such cases recover completely within a few days indicating excellent prognosis. Bacterial infections when treated with antibiotics also yield better results. When a sore throat is caused by serious infections such as HIV and gonorrhoea, the prognosis varies with every case depending upon the intensity and duration of the condition.

Complications

Complications of a sore throat are:

• Abscess (pus) formation.
• Otitis media (inflammation of the middle ear).
• Sinusitis.
• Cellulitis (infection and swelling of the deeper layers of the skin).
• Kidney diseases. (Read more - Chronic kidney disease treatment)
• Rheumatic heart disease - inflammation of the heart muscles due to an autoimmune reaction that may occur after a Strep throat.