Sore Throat

Sore throat

Viruses cause the majority of sore throats. Bacteria cause 5-15% of sore throats, but those between the ages of 5-15-years-old have a higher incidence of bacterial causes of sore throat. In this group, 15-30 percent of sore throats may be caused by Group A Beta Hemolytic Streptococcus (GABHS) better known as strep throat.

Certain factors can help determine if the sore throat is caused by a bacterium or a virus. Viruses that cause sore throat are more commonly accompanied by cough, stuffy nose, red eyes and fatigue.

Possible diagnoses

Viral sore throat – there are over 200 viruses that cause the common cold and each presentation may be a little different. Many of these viruses are linked to sore throat. Below some specific viruses that cause sore throat will be discussed.

Hand-foot and mouth disease. This is caused by a virus that is called the Coxsackie virus. It causes blisters on the hands and feet as well as in the mouth or throat.

Infectious mononucleosis can also cause sore throat. This sore throat is typically severe and associated with pus (white patches) in the throat. This disease is associated with swollen lymph nodes – particularly the glands on the back of the neck. It sometimes comes with stomach pain due to an enlarged liver or spleen. Those who are treated with penicillin will usually develop a rash (90% of the time). It is most common in those who are 10-25 years old and is accompanied by fatigue and a lingering sore throat.

HIV is a rare cause of sore throat. Individuals who have risk factors for HIV (multiple sexual partners, men who have sex with men, intravenous drug users) who present with a sore throat should have this diagnosis considered.

Bacterial sore throat. The most common cause of bacterial sore throat is GABHS. Other bacteria can sometimes cause sore throat.

Fungal infections rarely cause sore throats. Candida infections are a common cause of fungal sore throat. The individual will have a sore throat with a white coat on the tongue and in the oral cavity that looks like cottage cheese. The white coating will bleed if it is scraped off.

Peritonsillar abscess is a serious cause of sore throat and presents with fever, feeling wiped out, a hot potato voice, difficulty swallowing, painful swallowing, ear pain and difficulty opening the mouth.

Miscellaneous causes of sore throat include: persistent cough, smoking, gastroesophageal reflux, postnasal drip secondary to runny nose, allergies, foreign body and thyroiditis (inflamed thyroid gland).

Complications

Most sore throats are caused by a virus and go away on their own. It is important that all health care consumers are aware of when sore throats can be serious and when they are likely self-limiting.

Some serious complications include:

Throat abscess (pus filled infection in the throat) may lead to breathing problems as the swelling in the throat reduces the ability to breath.
Diphtheria (a rare bacterial infection that can cause sore throat) can lead to respiratory failure.
Untreated GABHS can affect the heart valves and has the potential to lead to heart failure.
Peritonsillar abscess (pus behind the tonsils) can cause sore throat or can be a complication of GABHS.
Streptococcal infections have the potential to attack the kidneys.

Red flags

High fever

Drooling

Difficult time opening the mouth

Hot potato voice (muffled voice, sounds like you have a mouthful of hot potatoes)

Uvula (piece of tissue that hangs down in the back of the throat) deviating to one side

One swollen tonsil

Difficulty breathing

Treatment

Most cases of sore throat are either caused by a virus or GABHS. If strep throat is present treatment with antibiotics is important and if it is not present treatment of the symptoms is all that is necessary. Treatment of strep throat will reduce rheumatic fever, abscess formation, transmission and improve comfort.

Treatment of strep throat is with penicillin. Children sometimes receive amoxicillin, as its suspension tastes better. There are multiple other options for those allergic to penicillin.

Sore throat pain can be quite debilitating – whether it is caused by a virus or bacteria - and managing that pain is a critical part of treatment.

Oral medications used to treat the pain include ibuprofen, acetaminophen, naproxen or acetaminophen/codeine (in severe cases). The use of medications to reduce pain and fever, in addition to reducing symptoms, may help shorten the course of disease by one to two days.

Topical medications are available in many over-the-counter formulations (see table below) and some can be made at home. Most OTC products are very similar, but there is some evidence that the medication Dyclonine is most effective in relieving pain. This is the active ingredient in the product Sucrets.

To purchase products discussed in this chapter visit The Drug Store.

A common home remedy is salt-water gargles, which can be made by adding one-fourth of a teaspoon of salt to 6-8 ounces of warm water. This concoction can be gargled and spit out every 3-4 hours. Sugar-free or regular Popsicles can help ease the discomfort of a sore throat.

Multiple over-the-counter medications are available for treating sore throat. They come in sprays and drops (see chart at end of the chapter).

Certain foods can help the throat feel better. For example, warm or cool liquids soothe and moisturize the throat. Nasal saline can moisturize the nasal passages and clean mucus out of the nose. This will reduce the amount of post-nasal drip, which will help reduce throat discomfort. Herbal teas may be helpful in the treatment of sore throat. Throat coat – a herbal tea - has a demulcent that is more effective at providing relief than regular tea.

Certain prescription medications have the potential to aid a sore throat. Viscous lidocaine is a medications that comes as a thick liquid that the health care provider can prescribe that will numb the throat. It can also be mixed with other liquid medications such as liquid Benadryl and/or Maalox to ease the discomfort.

Steroids are used in some patients with sore throats. This is a prescription given by the doctor and can be given by mouth or as a shot. Steroids reduce the inflammation of a severely inflamed throat.

Home remedies for a sore throat:

Salt water gargles as outlined above.
A cool mist humidifier should be used. Many sore throats are caused by or exacerbated by dryness; the moisture that a cool mist humidifier provides can improve symptoms.
Suck on a sour drop. Lemon drops or another type of drop will stimulate saliva and reduce throat pain.
Drink tea with honey as this will coat the throat.

Natural Product for Sore throat

For a natural treatment for sore throat and tonsillitis not caused by strep throat, check out Banish Tonsillitis.

Follow up

Improvement in the sore throat caused by a bacteria or virus is typically noted in 2-3 days. When there is no improvement or a worsening of symptoms noted a follow up with your health care provider should be attained to rule out a more serious (cellulitis or abscess) or another underlying condition (mononucleosis or chronic post-nasal drip). What you need to know

If you are diagnosed with strep throat:

Do not infect others. Do not come in close contact with others for 24 hours after starting antibiotics.
Removable oral appliances (e.g. retainers) should be cleaned completely.
A new toothbrush should be used after 24 hours.
Complete the entire course of antibiotics or resistance to that antibiotic may occur.
Symptoms that do not improve by 72 hours or get worse after 48 hours require a medical evaluation.
Do not take any antibiotics that are lying around the house for a sore throat without visiting the health care provider. Antibiotics may invalidate a throat culture.

Over-the-counter products for sore throat

Chloraseptic spray	Phenol 1.4% spray can be used for those 3 and older. It is to be sprayed and held in place for 15 seconds and then spit out every 2 hours. Five sprays for those 12-years-old and older and three sprays for those 3-11-years old.
Chloraseptic max	Phenol 1.5% (slightly higher level) and glycerin 33% which is a demulcent.
Halls (Halls-Plus)	Menthol 7 mg – marketed as a cough suppressant/oral anesthetic
Halls Breezers	Pectin throat drops – 7 mg of pectin, which is an oral demulcent. They are meant for those five and older
Sucrets	Dyclonine hydrochloride 2.0 mg which is a sore throat/oral anesthetic. It is indicated for those 6 and older and can be repeated every 2 hours, no more than 10 per day
Luden’s	Pectin 2.8 mg marketed as a oral demulcent
Ricola	Menthol 4.8 mg marketed as a cough suppressant and oral pain reliever
Cepacol	Benzocaine 15 mg (oral anesthetic) plus menthol 3.6 mg oral analgesic. Can be give to those five and older and repeated every 2 hours
Cepacol (sore throat and cough)	Benzocaine 7.5 mg and 5.0 mg of dextromethorphan (cough suppressant). Individuals 12 and over should take 2 lozenges every 4 hours (max 12 in 24 hours), Individuals 6-12 should take one every four hours (max 6 in 24). It should not be used n those under 6
Cepacol (Sore throat and Coating relief)	Combines benzocaine 15 mg and pectin 5.0 mg and can be used every 2 hours in those over the age of 5.
Tylenol cough and sore throat	An oral liquid that contains acetaminophen (Tylenol and Dextromethorphan). Nothing in the medication directly works on the throat, but acetaminophen is a general pain reliever that will provide some relief and the liquid may provide an very temporary rush of relief.

Bonus: How To Evaluate a Sore Throat