Why do I have a Sore Throat?

A sore throat is a painful, dry, or itchy feeling in the throat. One of the most common symptoms felt in the sore throat is pain, and this is responsible for at least 13 million yearly visits to the doctor’s office (1).

A sore throat can be self-limiting, meaning it goes away on its own without any intervention. Most cases of sore throat result from an infection or environmental exposures.

A sore throat can be classified based on the region of the throat affected and they include:

  • When it affects the back of the mouth, it is called pharyngitis.
  • When it affects the tonsils, the soft tissue found at the back of the mouth, it is called tonsillitis.
  • When the voice box or larynx is affected, it is called laryngitis.

Symptoms of sore throat

Symptoms felt in the sore throat are dependent on the causative factor. They include throat dryness, itching, burning, pain, irritation, and rawness.

In some cases, there will be swallowing difficulty and the throat or tonsils may be inflamed.

Other times, there may be a collection of pus on the tonsils or even the presence of white patches on the tonsils, typically seen in the sore throat caused by strep.

Other associated symptoms include:

Causes of sore throat

The following are some of the few causes of sore throat:

Colds, flu and viral infection

Viruses are implicated in the causation of up to 90% of a sore throat (2). The common conditions here include:

  • Influenza virus which causes flu
  • Common cold
  • Chickenpox, caused by the varicella virus, typically manifests as a fever or an itchy, nodular rash
  • Mononucleosis, an infection spread through saliva. It also causes a sore throat.
  • Measles, caused by the rubeola virus, causes rash and fever too
  • Mumps, this causes the parotid gland situated in the neck to become swollen.

Bacterial infections

Other than viruses, bacteria have also been implicated in the causation of sore throat especially group A streptococcus bacteria which are known to cause strep throat.

Strep throat is very common in children, amounting to as much as 40% of cases of sore throat in them (3). A sore throat can also be caused by sexually transmitted infections such as gonorrhea and chlamydia.

Allergies

Allergy triggers such as pollen, dust, dander, grass cause the immune system to release chemicals that cause symptoms such as sneezing, coughing, watery eyes, nasal congestion, and throat irritation.

Postnasal drip which occurs when excessive mucus in the nose drips down the back of the throat can also cause sore throat.

Irritants such as smoke and chemicals

Some many environmental substances and chemicals serve as throat irritants. They include:

  • Cigarette and other tobacco smoke
  • Cleaning products and similar chemicals
  • Air pollution

Dry air

Dry air can draw moisture from the mouth and throat thus leaving them dry and itchy. Dry air usually occurs during winter.

Gastroesophageal reflux disease (GERD)

In GERD, acid from the stomach flows back up into the esophagus, a long tube that conveys food from the mouth to the stomach.

This acid causes the burning of the throat and esophagus and manifests as heartburn and acid reflux.

Injury

Trauma to the neck can cause throat pain. The throat also gets irritated when food is stuck in it.

A sore throat can also result from yelling, talking loudly, or singing for a prolonged period and is common in people whose profession demands such (4).

Tumor

A tumor of the throat, larynx, or tongue can cause sore throat which will not be self-limiting. This occurs very rarely.

Home remedies for sore throat

Most sore throat cases can be managed at home by relaxing and boosting the immune system to fight any infection.

The following can be done to reduce the pain associated with sore throat:

  • Soothe the throat by taking warm liquids such as warm water with lemon, hot tea with honey, herbal teas, soup broth (5)
  • Cold treats such as ice cream and popsicles can be used to cool the throat
  • Gargle with a mix of warm water and a teaspoon or half teaspoon of salt
  • Moisturize the throat by turning on a humidifier
  • Suck on hard candy or lozenges

Buy cool mist humidifiers online

When to see a doctor

A sore throat caused by viruses usually goes on its own within a week (6). The following are indications to see a doctor when you have sore throat:

  • Difficulty in swallowing
  • Severe sore throat
  • Difficulty in breathing
  • Pain on breathing
  • Joint ache
  • Persistent fever
  • Neck pain or stiffness
  • Ear pain
  • Presence of blood or phlegm in saliva
  • Soreness of the throat that extends beyond one week

Making a diagnosis of sore throat

To effectively make a diagnosis, the doctor will take a history of the symptoms and will use a light source to examine the back of the throat for any inflammatory signs such as redness, swelling. The doctor may also palpate the sides of the neck for swollen glands or lymph nodes.

When a strep throat is suspected, a culture of a throat swab would be done. The swab sample is taken by running a swab piece over the back of the throat. The sample is taken to the laboratory for a confirmatory test although there is provision for a rapid strep test.

Additional tests may be required to make a diagnosis. You may need to see an ear, nose, and throat (ENT) doctor or otolaryngologist for further evaluation.

Medications

Medications can be used to either treat or relieve the symptoms of throat soreness.

Pain due to the soreness of the throat can be relieved with over-the-counter drugs such as ibuprofen, acetaminophen, and aspirin.

Aspirin is contraindicated in children and teenagers as it is linked to a serious condition known as Reye’s syndrome.

Sore throat specific remedies include:

  • Sore throat spray which contains an anesthetic antiseptic such as phenol or a cooling substance such as menthol
  • Throat lozenges
  • Cough syrup

Shop for cough syrup and throat lozenges

Some herbal preparations such as licorice root, marshmallow root, and slippery elm are sold as sore throat remedies though there’s not much proof that they work (7).

Shop for throat coat herbal tea

Soreness of the throat caused by GERD can be relieved by medications that reduce stomach acid. These include:

  • Antacids: such as Mylanta, Maalox, and tums which neutralize stomach acid
  • H2 blockers such as cimetidine, ranitidine, and famotidine which reduce the acid produced by the stomach
  • Proton pump inhibitors(PPI’s): such as omeprazole, lansoprazole, and esomeprazole which block acid production

Shop for antacids

Corticosteroids given in low doses can also help with throat soreness without causing major side effects (8).

When is an antibiotic indicated?

Antibiotics are useful for the treatment of this condition caused by bacteria such as strep throat.

If strep throat is left untreated, it would result in complications such as pneumonia, bronchitis, and rheumatic fever. Antibiotics can ease throat soreness by 24 hours, and reduce the risk of rheumatic fever by two-thirds (9).

Antibiotics are usually prescribed for about ten days (10), and compliance is key as the premature stopping of antibiotics as one begins to feel better can leave some bacteria alive which can make one sick again.

Summary

The majority of the throat soreness is caused by viruses, bacteria, irritants, and injuries. Most sore throats are self-limiting and resolve within a few days.

Home remedies for this condition include rest, taking warm liquids, gargling with salt water, and using over-the-counter pain relievers.

Bacterial causes of throat soreness such as strep throat is treated with antibiotics and a swab test can be done to check if you have strep throat. You need to see a doctor if you experience symptoms such as difficulty in swallowing or breathing, or neck stiffness.