There are several possible causes of a sore throat. Pharyngitis can be bacterial or viral in origin, and it is not always easy to distinguish between the two clinically. Often the patient’s overall presentation helps with the diagnosis:
- Allergic rhinitis: The postnasal drip from allergic rhinitis can cause pharyngitis. The patient typically has an itchy, runny nose, sneezing, and sometimes itchy red eyes. Postnasal drip is also one of the most common causes of a cough that just won’t go away. The pharyngeal mucosa often has a granular appearance in these patients. Treatment with a topical antihistamine spray will help to control rhinitis. In more severe cases an oral antihistamine may be required to control symptoms. A topical steroid nasal spray may also be required.
- Viral pharyngitis: A patient with clear rhinitis, sneezing, a mild temperature, and sore throat, is more likely to be viral. Treat symptomatically with a topical decongestant or an oral antihistamine/decongestant combination, depending on the severity of the nasal symptoms. Gargling, which mechanically clears postnasal drip, inflammatory debris, etc. from the throat, is both soothing and therapeutic. A topical agent may be required if the throat is very painful.
- Bacterial pharyngitis: Usually due to a streptococcal infection, typical features would be fever, a very red, inflamed throat, and tender, enlarged lymph nodes in the head and neck area. Penicillin or cephalosporin antibiotic is usually prescribed by the doctor for this type of infection.
- Epstein-Barr Virus (glandular fever): Be aware of this as a possible cause of pharyngitis in teenagers and young adults, particularly if the sore throat has been present for several weeks and the lymph glands in the head and neck area, as well as the rest of the body, are enlarged. Glandular fever can present as a mild, subacute febrile illness in one of three ways: generalised lymphadenopathy, pharyngotonsillitis with regional lymphadenopathy and characteristic petechiae on the palate, and persistent fever. Being viral, it will not resolve with antibiotics. Treatment is symptomatic.
Other causes of a sore throat include:
- Dryness: Dry indoor air, especially in winter when buildings are heated, can make the throat feel rough and scratchy. Breathing through the mouth – often because of chronic nasal congestion – can also cause a dry, sore throat.
- Irritants: Outdoor air pollution can cause ongoing throat irritation as can drinking alcohol, eating spicy foods, and chewing tobacco.
- Muscle strain: Placing strain on the muscles in the throat when yelling at a sporting event, talking to someone in a noisy environment or talking/singing for long periods without rest can result in hoarseness and a sore throat.
- Gastroesophageal reflux disease (GERD): Stomach acids or other contents of the stomach back up in the oesophagus irritating the 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.
- Tumours: Cancerous tumours of the throat, tongue, or voice box 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.
The primary decision in patients presenting with a sore throat is whether they need antibiotics and to treat the specific underlying aetiology, e.g. reflux. If no antibiotics are given, treatment is symptomatic. Basic principles remain rest, adequate fluid intake, antipyretics, and pain management.
Systemic treatment options include antimicrobial agents, pain medication and possibly anti-inflammatory agents. The local or topical treatment options include lozenges, sprays, oral rinses (gargles), and alternative medicines.