Sore throat

Definition

A sore throat is pain, scratchiness or irritation of the throat that often worsens when you swallow.

A sore throat is the primary symptom of pharyngitis — inflammation of the throat (pharynx). But the terms "sore throat" and "pharyngitis" are often used interchangeably.

The most common cause of a sore throat is a viral infection, such as a cold or the flu. A sore throat caused by a virus resolves on its own with at-home care. Strep throat (streptococcal infection), a less common type of sore throat caused by bacteria, requires additional treatment with antibiotic drugs to prevent complications.

Other less common causes of sore throat may require more complex treatment.

Symptoms

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  Throat anatomy

Symptoms of a sore throat may vary depending on the cause. Signs and symptoms may include:

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Dry throat
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• Hoarse or muffled voice

Common infections causing a sore throat may result in other signs and symptoms, as well. They may include:

• Fever
• Chills
• Cough
• Runny nose
• Sneezing
• Body aches
• Headache
• Nausea or vomiting

When to see a doctor

Take your child to a doctor if your child's sore throat doesn't go away with the first drink in the morning, recommends the American Academy of Pediatrics.

Get immediate care if your child has severe signs such as:

• Difficulty breathing
• Difficulty swallowing
• Unusual drooling, which may indicate an inability to swallow

If you're an adult, see your doctor if you have a sore throat and any of the following associated problems occur, according to the American Academy of Otolaryngology:

• A sore throat that is severe or lasts longer than a week
• Difficulty swallowing
• Difficulty breathing
• Difficulty opening your mouth
• Joint pain
• Earache
• Rash
• Fever higher than 101 F (38.3 C)
• Blood in saliva or phlegm
• Frequently recurring sore throats
• A lump in your neck
• Hoarseness lasting more than two weeks

Causes

Most sore throats are caused by viruses that cause the common cold and flu (influenza). Less often, sore throats are due to bacterial infections.

Viral infections

Viral illnesses that cause a sore throat include:

• Common cold
• Flu (influenza)
• Mononucleosis (mono)
• Measles
• Chickenpox
• Croup — a common childhood illness characterized by a harsh, barking cough

Bacterial infections

Bacterial infections that can cause a sore throat include:

• Strep throat, which is caused by a bacterium known as Streptococcus pyogenes, or group A streptococcus
• Whooping cough, a highly contagious respiratory tract infection
• Diphtheria, a serious respiratory illness that's rare in industrialized nations, but is more common in developing countries

Other causes

Other causes of sore throat include:

• Allergies. Allergies to pet dander, molds, dust and pollen can cause a sore throat. The problem may be complicated by postnasal drip, which can irritate and inflame the throat.
• Dryness. Dry indoor air, especially in winter when buildings are heated, can make your throat feel rough and scratchy, particularly in the morning when you first wake up. Breathing through your mouth — often because of chronic nasal congestion — also can cause a dry, sore throat.
• Irritants. Outdoor air pollution can cause ongoing throat irritation. Indoor pollution — tobacco smoke or chemicals — also can cause chronic sore throat. Chewing tobacco, drinking alcohol and eating spicy foods also can irritate your throat.
• Muscle strain. You can strain muscles in your throat just as you can strain them in your arms or legs. Yelling at a sporting event, trying to talk to someone in a noisy environment or talking for long periods without rest can result in a sore throat and hoarseness.
• Gastroesophageal reflux disease (GERD). GERD is a digestive system disorder in which stomach acids or other contents of the stomach back up in the food pipe (esophagus). Other signs or symptoms may include heartburn, hoarseness, regurgitation of stomach contents and the sensation of a lump in your throat.
• HIV infection. A sore throat and other flu-like symptoms sometimes appear early after someone is infected with HIV. Also, a person who is HIV-positive may have a chronic or recurring sore throat due to a secondary infection. Common problems include a fungal infection called oral thrush and cytomegalovirus infection, a common viral infection that can be serious in people with compromised immune systems.
• Tumors. Cancerous tumors of the throat, tongue or voice box (larynx) can cause a sore throat. Other signs or symptoms may include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, and blood in saliva or phlegm.

Rarely, an infected area of tissue (abscess) in the throat causes a sore throat. Another rare cause of a sore throat is a condition that occurs when the small cartilage "lid" that covers the windpipe swells, blocking airflow (epiglottitis). Both causes can block the airway, creating a medical emergency.

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible. These factors include:

• Being a child or teenager. Children and teens are most likely to develop sore throats. Children are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.
• Being exposed to tobacco smoke. Smoking and secondhand smoke can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box.
• Having allergies. If you have seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, you're more likely to develop a sore throat than are people who don't have allergies.
• Being exposed to chemical irritants. Particulate matter in the air from the burning of fossil fuels, as well as common household chemicals, can cause throat irritation.
• Having chronic or frequent sinus infections. Chronic or frequent sinus infections increase the risk of sore throat because drainage from the nose can irritate the throat or spread infection.
• Living or working in close quarters. Viral and bacterial infections spread easily anywhere people gather — child care centers, classrooms, offices, prisons and military installations.
• Having decreased immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Tests and diagnosis

Your doctor will start with a physical exam that is generally the same for children and adults. The exam will include:

• Using a lighted instrument to look at your throat, and likely your ears and nasal passages
• Gently feeling (palpating) your neck to check for swollen glands (lymph nodes)
• Listening to your breathing with a stethoscope

Throat swab

With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of secretions. The sample will be checked in a lab for streptococcal bacteria, the cause of strep throat. Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can return results within 24 to 48 hours.

If the rapid, in-clinic test comes back positive, then you almost certainly have a bacterial infection. If the test comes back negative, then you likely have a viral infection. Your doctor will wait, however, for the more reliable, out-of-clinic lab test to determine the cause of the infection.

Other tests

• Complete blood count (CBC). Your doctor may order a CBC with a small sample of your blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent.
• Allergy tests. If your doctor suspects your sore throat is related to an allergy, you may be referred to an allergist for additional tests.

You may be referred to an ENT doctor or other specialist if you have chronic or frequent sore throat or if there are any signs or symptoms that suggest a serious condition other than a common viral or bacterial infection.

Lifestyle and home remedies

Regardless of the cause of your sore throat, at-home care strategies usually provide temporary relief. Try these strategies:

• Rest. Get plenty of sleep and rest your voice.
• Drink fluids. Drink plenty of water to keep the throat moist and prevent dehydration.
• Try comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats such as ice pops can soothe a sore throat.
• Gargle saltwater. A saltwater gargle of 1 teaspoon (5 grams) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Gargle the solution and then spit it out.
• Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat or sit for several minutes in a steamy bathroom.
• Consider lozenges. Lozenges can soothe a sore throat. Because lozenges are a choking hazard for young children, don't give them to children age 4 and younger.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
• Treat pain and fever. Ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may minimize throat pain. Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Prevention

The germs that cause viral and bacterial infections are contagious. Therefore, the best prevention is to practice good hygiene. Follow these tips and teach your child to do the same:

• Wash your hands thoroughly and frequently, especially after using the toilet, before eating, and after sneezing or coughing.
• Avoid sharing food, drinking glasses or utensils.
• Cough or sneeze into a tissue and throw it away. When necessary, sneeze into your elbow.
• Use alcohol-based hand sanitizers as an alternative to hand-washing when soap and water aren't available.
• Avoid touching public phones or drinking fountains with your mouth.
• Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. When you travel, clean phones and remotes in your hotel room.
• Avoid close contact with people who are sick.

Other tips to avoid sore throat include the following:

• Stay indoors as much as possible on high-pollution days.
• Wear a filtering mask when cleaning to avoid inhaling dust or airborne particles from cleaning products.
• If you smoke, quit. Talk to your doctor if you need help breaking a smoking habit.
• Avoid exposure to secondhand smoke.
• Humidify your home if the air is dry.