Sore Throat

Symptoms

Sore throat symptoms can differ based on the underlying cause. Common signs and symptoms include:

• Throat pain or a scratchy feeling
• Aggravated pain when swallowing or speaking
• Trouble swallowing
• Tender, swollen jaw or neck glands
• Enlarged, red tonsils
• White spots or pus on the tonsils
• Hoarseness or a muffled voice

Throat Anatomy

The throat comprises the oesophagus, trachea (windpipe), larynx (voice box), tonsils, and epiglottis.

Infections that lead to a sore throat may contribute to additional signs and symptoms such as:

• Fever
• Coughing
• Runny nose
• Sneezing
• Headache
• Body aches
• Nausea or vomiting

Causes

The viruses causing flu and the common cold are also responsible for many cases of sore throat. Rarely, bacterial infections can also lead to sore throats.

Viral infections Some of the viral disorders that lead to a sore throat include:

• Flu (influenza)
• Common cold
• Mononucleosis (mono)
• Chickenpox
• Measles
• COVID-19 (coronavirus disease 2019)
• Croup, a common childhood disease that presents with a harsh, barking cough

Bacterial infections Most bacterial infections can result in a sore throat. Streptococcus pyogenes (group A streptococcus) is the most prevalent and leads to strep throat.

Additional causes

Sore throats can also be triggered by:

• Allergies: Allergens such as pet dander, dust, mould, and pollen may contribute to sore throats. This may come with postnasal drip, potentially causing inflammation and irritation of the throat.
• Dryness: Dry indoor air can cause a scratchy and rough feeling in the throat. Additionally, breathing through the mouth, often due to chronic nasal congestion, can lead to dryness and sore throat.
• Irritants: Both outdoor and indoor air pollutants, including chemicals or tobacco smoke, may result in prolonged sore throat. Furthermore, consuming alcohol, chewing tobacco, or eating spicy foods could irritate the throat.
• Muscle strain: Excessive strain on the throat muscles from yelling, speaking loudly, or talking for extended periods without a break can lead to a sore throat.
• Gastroesophageal reflux disease (GERD): This digestive disorder causes stomach acid to flow back into the oesophagus (food pipe). Other possible symptoms include hoarseness, heartburn, regurgitation of stomach contents, and a sensation of swelling in the throat.
• HIV infection: A sore throat, along with some flu-like symptoms, may occur shortly after contracting HIV. Those with HIV may also experience chronic or persistent sore throats due to fungal infections known as oral thrush or viral infections like cytomegalovirus (CMV). These infections can be severe in individuals with weakened immune systems.
• Tumours: Malignant tumours affecting the throat, larynx, or tongue can result in sore throats. Other likely associated symptoms include hoarseness, noisy breathing, difficulty swallowing, swelling in the neck, and bloody saliva or phlegm.

In rare cases, a sore throat can occur due to an abscess (infected tissue area) in the throat or epiglottitis, which is the inflammation of a small cartilage flap covering the windpipe. These conditions can obstruct the airway, leading to a medical emergency.

Risk Factors

While sore throats can affect anyone, certain factors increase susceptibility. These include:

• Age: Children and teenagers are most prone to sore throats. Kids aged 3 to 15 years are at a higher risk of developing strep throat, the well-known bacterial infection linked to sore throat.
• Tobacco smoke exposure: Smoking or inhaling second-hand smoke may irritate the throat. Additionally, using tobacco products raises the risk of developing throat, mouth, and voice box cancers.
• Allergies: Individuals with seasonal allergies or persistent allergic responses to dust, pet dander, or moulds are more prone to sore throats.
• Chemical irritants exposure: Air particles from household chemicals and burning fossil fuels can lead to throat irritation.
• Chronic or recurrent sinus infections: Nasal drainage can cause throat irritation or spread infection.
• Close quarters: Both viral and bacterial infections can be easily transmitted in crowded places such as daycare centres, offices, classrooms, or even airplanes.
• Weakened immune system: Having a compromised immune system makes you more vulnerable to infections. Common reasons for reduced immunity include diabetes, HIV, steroid or chemotherapy treatments, fatigue, poor diet, and stress.

Prevention

The best preventive measures for sore throats involve avoiding triggering germs and practising proper hygiene. Encourage your child to adhere to the following guidelines:

• Frequently and thoroughly wash hands for about 20 seconds, particularly after visiting the lavatory, before and after meals, and after coughing or sneezing.
• Avoid touching the face, especially the eyes, mouth, and nose.
• Do not share food, utensils, or drinking glasses with others.
• Use a tissue when coughing or sneezing and dispose of it properly. Wash hands afterwards. Sneezing into the elbow is also a good alternative.
• If soap and water aren’t accessible, consider using alcohol-based hand sanitiser.
• Avoid touching public phones or using your mouth to drink from fountains.
• Frequently clean and disinfect doorknobs, phones, light switches, computer keyboards, and remotes. When travelling, disinfect phones, remotes, and light switches in your hotel room.
• Maintain a safe distance from those who are ill or displaying symptoms.

Diagnosis

When diagnosing a sore throat, your doctor will likely review your or your child's symptoms and ask about medical history. They may also perform a physical examination, which may include:

• Examining the throat and possibly the nasal passages and ears with a lighted device.
• Gently touching the neck to check for enlarged lymph nodes (glands).
• Using a stethoscope to listen to your or your child's breathing.

Throat swab

Doctors often recommend a simple test to check for the presence of streptococcal bacteria, which contributes to strep throat. This involves rubbing a sterile swab at the back of your throat to collect a secretion sample, which is then sent to the lab for further analysis.

Some clinics have labs that can quickly perform a rapid antigen test and provide results within minutes. Nonetheless, a throat culture, which is the second most reliable test, may be sent to the laboratory, and it usually takes 24 to 48 hours for the results to return.

While antigen tests are generally less sensitive, they can rapidly identify strep bacteria. Therefore, if the antigen test is negative, the doctor may suggest sending the throat culture to the lab for strep throat testing.

Sometimes, the doctor might check for streptococcal bacteria using a molecular test. This test also involves swabbing the back of the throat to obtain a secretion sample, which is then sent to the lab for testing. Accurate results will typically be available within minutes.

Treatment

A viral-induced sore throat normally resolves within 5 to 7 days without the need for any treatment. Antibiotics are generally not effective against viral infections.

To manage discomfort and fever, most individuals opt for acetaminophen (paracetamol) or other mild painkillers.

Give children non-prescription medications, such as paracetamol (Children's FeverAll, Calpol) or ibuprofen (Children's Motrin, Nurofen), to help alleviate symptoms.

Do not give your child or teenager aspirin, as it has been associated with an increased risk of Reye's syndrome. Although rare, this is a potentially fatal condition causing brain and liver swelling.

Bacterial infections treatment

If a bacterial infection is the cause of your or your child's sore throat, a physician or paediatrician will recommend antibiotics. It’s important to complete the entire course of prescribed antibiotics, even if symptoms improve. Not doing so could worsen the infection or allow it to spread to other body parts.

Additionally, failing to take all the medications for strep throat might increase the child’s risk of developing rheumatic fever or severe kidney inflammation.

If you miss or forget a dose, consult your healthcare provider or pharmacist on how to proceed.

Other treatments

If a sore throat is due to something other than a viral or bacterial infection, additional treatment options will probably be recommended based on the specific diagnosis.

Self-care

Regardless of the cause of the sore throat, the following at-home remedies can help alleviate signs and symptoms:

• Resting: Ensure you get enough sleep and give your voice a break.
• Staying hydrated: Drink fluids to moisturise your throat and avoid dehydration. Limit caffeine and alcohol intake, as they can contribute to dehydration.
• Consuming soothing foods and drinks: Warm liquids, such as broth, warm water with honey, or caffeine-free tea, as well as cold treats like ice pops, help soothe a sore throat. Avoid giving honey to minors under the age of one.
• Gargling with salt water: Gargling with a saltwater solution (a quarter to half a teaspoon of table salt dissolved in four to eight ounces of warm water) can help ease a sore throat. Children over 6 years old and adults can gargle the mixture and then spit it out.
• Air humidification: To avoid further irritation of a sore throat, consider using a cool-air humidifier. Ensure that you clean your humidifier regularly to prevent mould or bacterial growth. Alternatively, you can sit in a steamy bathroom for a few minutes.
• Opting for lozenges or hard candy: These can help soothe a sore throat. However, avoid giving them to children aged 4 years and below due to the risk of choking.
• Staying away from irritants: Ensure your living space is free from harsh cleaning solutions and cigarette smoke, as these can contribute to throat irritation.
• Staying home until you’re well: This helps prevent other people from contracting colds or other illnesses.

Alternative Medication

Various alternative medications are available to soothe sore throats. However, evidence supporting their effectiveness is limited. Therefore, do not rely on alternative options if you or your child has a bacterial infection that requires antibiotics.

Always consult your provider before trying any herbal solutions, as they may interact with prescription drugs and could be unsafe for children, pregnant or breastfeeding mothers, or individuals with particular health conditions.

Common herbal and alternative remedies for sore throats are usually available in teas, lozenges, or sprays. They include:

• Slippery elm
• Marshmallow root
• Liquorice root

Preparing for Your Appointment

Schedule an appointment with a paediatrician or family doctor if you or your child develops a sore throat. Sometimes, you may be referred to an ENT (ear, nose, and throat) specialist or an allergist (allergy doctor).

What to do

Write a list that includes:

• Symptoms you or your child are experiencing and their duration
• Important personal information, such as recent exposure to a sick person
• All medications, vitamins, or supplements that you or your child are taking, along with the dosages
• Relevant questions you intend to ask

Basic questions about a sore throat to ask during your visit include:

• What could be causing these symptoms?
• Are there other potential causes?
• Which tests will be needed?
• What course of action would you recommend?
• How soon will my symptoms improve with treatment?
• How long will my condition remain contagious? When is it safe to return to school or work?
• What self-care measures will be helpful?

Feel free to ask any additional questions that come to mind.

What to expect from your doctor:

Your doctor will likely ask the following about you or your child’s condition:

• Do you have any other symptoms besides a sore throat?
• Has there been a fever alongside the symptoms? If yes, how high?
• Have you experienced difficulty breathing?
• Does swallowing aggravate the sore throat?
• Does anything help improve the symptoms?
• Has anyone else in the household been ill?
• Is your sore throat a recurrent issue?
• Are you a smoker? Do you or your child often get exposed to second-hand smoke?