SORE THROAT


DEFINITION

Sore throat is a painful inflammation of the pharynx. The pharynx (pronounced FAAR-ingks) is the part of the throat that lies between the mouth and the larynx (pronounced LAAR-ingks), or voice box. It is associated most commonly with the common cold (see common cold entry) or influenza (the flu; see influenza entry). While most sore throats heal without complications, in some cases, they develop into a serious illness.

DESCRIPTION

Almost everyone gets a sore throat at one time or another. Children tend to have them more often than adolescents or adults. Sore throats are most common during the winter months. Infections of the upper respiratory (breathing) tract are more common then and these infections can cause a sore throat.

Sore throats can be either acute or chronic. An acute sore throat comes on suddenly and usually lasts three to seven days while a chronic sore throat lasts much longer.

CAUSES AND SYMPTOMS

Sore throats have many different causes. Proper treatment depends on understanding the cause of the sore throat.

Viral Sore Throat

Viruses cause 90 to 95 percent of all sore throats. Cold and flu viruses are usually responsible for the condition. These viruses cause an inflammation of the throat and sometimes the tonsils. Symptoms of a viral infection include a runny nose, cough, congestion, hoarseness, and fever. The level of pain varies considerably. It may be quite mild or very severe. In the worst cases, a patient may not be able to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses (pronounced AD-nn-oh-VY-russ-ez). The adenoviruses usually cause infections of the lungs and ears. In addition to those symptoms described above, adenoviruses may cause white bumps on the tonsils and throat, diarrhea, vomiting, and a rash. Sore throats caused by these viruses last about a week.

A third type of virus responsible for causing sore throat is the coxsackie virus. This virus causes a disease known as herpangina (pronounced hurpan-JI-nuh). Herpangina occurs most commonly among children under the age of ten. The disease is most common during the summer. It is sometimes called summer sore throat.

Summer sore throat can be quite severe. Symptoms include a high fever and the presence of tiny grayish-white blisters on the throat and mouth. These blisters break open and become very painful. People with this form of sore throat may vomit, have abdominal pain, and, generally, feel very sick.

A fourth type of virus that causes sore throat is the Epstein-Barr virus, (EHP-stine BAR) which also causes mononucleosis (see infectious mononucleosis entry). Mononucleosis is a very common disease. About 80 to 95 percent of all Americans have had the disease by age forty. Symptoms are mild and the disease usually clears up quickly. It can, however, produce a very painful sore throat.

There is no simple way to distinguish a viral sore throat from a bacterial sore throat. Viral sore throats are quite contagious. They can be spread by personal contact and by coughing or sneezing.

Bacterial Sore Throat

About 5 to 10 percent of all sore throats are caused by bacteria. The most common bacterial sore throat is caused by a bacterium called group A Streptococcus (pronounced strep-tuh-KOK-us). This type of sore throat is usually called strep throat (see strep throat entry). Bacterial sore throats can also be caused by the Gonococcus bacterium (pronounced GAHN-uh-KOCK-us). This bacterium also causes the sexually transmitted disease gonorrhea (see sexually transmitted diseases entry). Bacterial sore throats are also contagious.

Sore Throat: Words to Know

Adenoviruses:
A group of viruses that usually cause infections of the lungs and ears.
Antibiotic:
A substance derived from bacteria or other organisms that fights the growth of other bacteria or organisms. Useful in treating bacterial sore throats, antibiotics are not effective against viral sore throats.
Coxsackie virus:
A virus that causes a disease known as herpangina.
Gonorrhea:
A sexually transmitted disease caused by the Gonococcus bacterium.
Larynx:
The voice box.
Lymph nodes:
Small round or oval bodies within the immune system. Lymph nodes provide materials that fight disease and help remove bacteria and other foreign material from the body.
Mononucleosis:
A highly infectious disease caused by Epstein-Barr virus. Characterized by fever, swollen lymph nodes and sore throat.
Pharynx:
The part of the throat that lies between the mouth and the larynx, or voice box.

Noninfectious Sore Throat

Not all sore throats are caused by infection. For example, people with allergies often have sore throats. The sore throat is caused by fluids dripping from the back of the person's nose into the throat. These fluids irritate the pharynx.

Many materials in the environment can also irritate the pharynx. Such irritants include cigarette smoke, polluted air, chemical fumes, and dry air. These forms of sore throat are not contagious.

DIAGNOSIS

Sore throats are easy to diagnose from a patient's symptoms. However, the type of sore throat is usually difficult to diagnose. Most sore throats clear up quickly on their own, so a detailed diagnosis as to exact cause is usually not necessary. However, sore throats can sometimes continue for a relatively long time. In that case, medical advice should be sought. Some types of sore throat can develop into serious diseases.

Diagnosis of sore throat begins with a medical history and a physical examination. In the medical history, the doctor will try to find out if the patient has been near someone with a cold or the flu. If so, the patient may have contracted the sore throat by way of that contact.

COUGH DROPS

Coughing serves an important function in the human body. It provides a way of expelling (getting rid of) harmful materials that get into the body. But coughing is an annoying, and sometimes crippling, pattern.

Throughout history, humans have used all kinds of natural products to relieve coughing. Today, one of the most popular cough treatments is the cough drop. The cough drop is similar to liquid cough medicine, except that it is prepared in a more convenient form.

The first commercial cough drops were prepared by James Smith, of Poughkeepsie, New York, in the mid-1850s. Smith made his cough drops in a pot on his kitchen stove. He then began selling them as the James Smith and Sons Compound of Wild Cherry Cough Candy in 1852. He claimed that the product would relieve coughs, colds, hoarseness, and sore throat.

Later, Smith's sons joined their father in the business. When other companies also began to make cough drops, the Smiths decided they needed to make their product distinctive. They began to package their cough drops in boxes with pictures of the two sons on the front. They also protected the name of their product by putting the words "Trade Mark" on the package. The two words, "Trade" and "Mark," appeared below the pictures of the two sons. Very soon, people who bought cough drops began to think of the two boys as "Trade" and "Mark." Many never knew that their real names were William and Andrew.

The physical examination may provide further information. The doctor may discover a sinus infection, bronchitis, or some other infection of the upper respiratory tract. Any one of these infections could be the cause of the sore throat. If the doctor suspects strep throat, laboratory tests may be ordered. These tests will tell whether the Streptococcus bacterium is present or not.

A simple, quick, and inexpensive test is available for mononucleosis. If the doctor suspects that the patient has this disease, the test can be performed in the office.

TREATMENT

For the vast majority of sore throats, there are no treatments to cure the disease. These cases of sore throat are caused by viruses, against which there are few medications. Antibiotics may be prescribed for bacterial sore throats. But they will have no effect on viral sore throats.

The usual medication prescribed for bacterial sore throats is penicillin. Penicillin can be given either as a single injection or a series of pills. The pills must be taken for ten days. If a patient does not take the full course of pills the infection may return.

A number of treatments are available for the symptoms of sore throat. These include rest, a healthy diet, plenty of fluids, restrictions on heavy exercise, and a variety of drugs. The drugs that are usually recommended are aspirin, acetaminophen (trade name Tylenol), or ibuprofen (trade names Advil, Motrin). These medications reduce pain and fever that accompany a sore throat.

Chronic sore throat requires a somewhat different treatment. In many cases, the sore throat is not caused by an infection. Instead, it may be produced by some environmental condition. People who work around chemicals, for example, may have chronic sore throats. In such cases, it may be necessary to change the patient's working conditions in order to provide relief for the sore throat.

Viruses cause 90 to 95 percent of all sore throats which cause an inflammation of the throat and sometimes the tonsils. (Reproduced by permission of Custom Medical Stock Photo)
Viruses cause 90 to 95 percent of all sore throats which cause an inflammation of the throat and sometimes the tonsils. (Reproduced by permission of
Custom Medical Stock Photo
)

Home Care for Sore Throat

Sore throat is usually not a very serious disease. It can be treated most effectively with some simple remedies available in the home, including:

  • Taking aspirin, acetaminophen, or ibuprofen for pain. But children should not be given aspirin because of the risk of Reye's syndrome (see Reye's syndrome entry).
  • Gargling with warm tea or warm salt water
  • Drinking plenty of fluids but avoiding fruit juices
  • Eating soft, nutritious foods, such as noodle soup, and avoiding spicy foods
  • Refraining from smoking
  • Resting until the fever is gone
  • Increasing the humidity of a room with a room humidifier
  • Avoiding the use of antiseptic lozenges and sprays, which are likely to make the condition more uncomfortable

Alternative Treatment

Alternative practitioners recommend a variety of natural products for the treatment of sore throat. For example, aromatherapists recommend inhaling the fragrances of lavender, thyme, eucalyptus, sage, and sandalwood. Herbalists recommend taking osha root, ginger, or slippery elm. Some practitioners suggest gargling with a mixture of water, salt, and tumeric. Homeopathic practitioners treat sore throats with very dilute solutions of Lachesis, Belladonna, Phytolacca, yellow jasmine, or mercury. Nutritionists recommend vitamins and minerals such as vitamins A or C and the mineral zinc.

PROGNOSIS

Sore throat caused by a viral infection usually clears up on its own within one week with no complications. The one exception is mononucleosis. Most cases of mononucleosis also clear up on their own but the recovery period may be much longer. Among adults, it may take up to six months to recover completely from mononucleosis. In rare cases, mononucleosis may lead to complications, such as swollen tonsils, adenoids, and lymph nodes. Lymph nodes are small round or oval bodies that are part of the body's immune system. If this happens, the patient should seek emergency medical care.

Patients with bacterial sore throat usually begin to feel better about 24 hours after starting on antibiotics. An antibiotic is a substance derived from bacteria or other organisms that fights the growth of other bacteria or organisms. Strep throat is the most serious form of sore throat since it can lead to serious complications. These complications include scarlet fever (see scarlet fever entry), kidney damage, and rheumatic fever. Treatment with antibiotics during the early stages of sore throat can usually avoid these complications.

PREVENTION

It is difficult to avoid getting a sore throat. People carrying the viruses and bacteria that cause the disease are all around us. The chance of being infected can be reduced, however. Some simple rules to follow include the following:

  • Wash hands frequently and well.
  • Avoid close contact with someone who has a sore throat.
  • Do not share food and eating utensils with anyone.
  • Do not smoke.
  • Stay out of polluted air.

FOR MORE INFORMATION

Web sites

"Ask NOAH About: Pain." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/pain/pain.html#S (accessed on October 31, 1999).

National Institute of Allergy and Infectious Diseases. "Infectious Mononucleosis Fact Sheet." [Online] http://www.niaid.nih.gov/factsheets/infmono.htm (accessed September 1, 1997).