Most people have experienced episodes of sore throat, that manifest as pain especially on swallowing, hoarseness, or an itchy/unpleasant feeling in the throat. The most common cause is an infection, though non-infectious causes may also be present.
In 90% of adults and 60% of children, throat infections (pharyngitis) are caused by viruses, the rest being due to bacteria. The spread is through air droplets especially in poorly ventilated/crowded areas from coughing and sneezing, or by unwashed hands.
Viral sore throat is more commonly associated with a dry cough, hoarseness and symptoms of cold like sneezing, runny nose and nasal congestion. Fever and headache may be present in some cases. Viruses causing sore throat are mainly those of common cold, Flu (Influenza) and COVID-19. Sore throat may sometimes also be part of the symptoms of other viral infections like measles, mumps and infectious mononucleosis.
Bacterial sore throat is most commonly caused by Streptococcus pyogenes, also called Group A beta-hemolytic Streptococcus (Strept sore throat). This is seen more commonly in children. There is usually significant throat pain and difficulty in swallowing, and many children have trouble eating due to this. Accompanying fever, body ache and malaise (discomfort and weakness) is common. Vomiting, diarrhea and abdominal pain may also be present in children. There can be enlargement of the tonsils and the lymph nodes of the neck.
A clinical examination can usually differentiate a bacterial sore throat from a viral one, as in bacterial infections there is significant redness and swelling in the back of the mouth, and enlarged tonsils (tonsillitis) often with visible pus or white spots. The swollen lymph nodes can also be felt and maybe tender (painful to touch). However, if the diagnosis is in doubt, rapid antigen tests with throat swabs can be done for Strept, Flu and COVID to get a confirmed diagnosis.
Strept sore throat can sometimes lead to complications in other parts of the body like glomerulonephritis (kidney inflammation) and rheumatic fever (can damage heart valves). It can also cause pus pockets called abscesses in the throat and tonsils. Therefore, it should be diagnosed promptly and treated with appropriate antibiotics. Some other bacteria like Streptococcus pneumoniae, Moraxella and Hemophilus can also cause sore throat along with ear infection and pain.
Rarely, a fungus called Candida can cause sore throat in people who have compromised immunity. Characteristic white patches (thrush) are seen on examination.
Observing proper hygiene like washing/sanitizing hands regularly, covering mouth while sneezing/coughing, and wearing a mask in public places during a pandemic like COVID, can decrease transmission of such infections.
Strept/bacterial sore throat should be diagnosed and treated promptly with appropriate antibiotics in the recommended dose and duration, prescribed and monitored by the physician. In most cases, viral sore throat resolves on its own, and antibiotics have no role.
Supportive and symptomatic treatment for sore throat is given to improve comfort, which includes:
- Warm fluids and soft diet
- Medications for fever, inflammation and pain (NSAIDs- Paracetamol combinations with Ibuprofen or Diclofenac)
- Soothing and anesthetizing lozenges for sucking and soothing effect.
- Gargling with salt water, or anti-inflammatory/antiseptic agents like benzydamine, menthol, chlorhexidine, povidone-iodine, etc. (some of these agents are also available as throat spray and in combinations).
- Natural substances like turmeric, ginger, honey, Indian gooseberry (amla) and Indian basil (tulsi) are soothing, and also good for general health and immunity. They can be consumed by soaking in warm water, or as market preparation of herbal tea.
- Vitamin-Mineral supplements (containing vitamin C and zinc) may be given for general health and immunity
- Medicines for nasal congestion, sneezing/irritation, and cough may be added when present in required cases to enable good sleep and rest. (These include antihistamines, decongestants, mucolytics, and antitussives)
- Antibiotics, as mentioned are to be given in bacterial sore throat
COVID-19 or Flu (Influenza) may require hospitalization in cases where the symptoms are severe, there is accompanying breathlessness, or presence of co-morbidities like increased age, diabetes, cardiovascular disease (CVD), high BP, kidney or liver problems, asthma or chronic bronchitis, or conditions causing low immunity.
Prompt medical consultation should be taken if the sore throat is accompanied by any of the following
- Difficulty in eating or drinking,
- Drooling of saliva
- Breathlessness (Difficulty in breathing or noisy breathing)
- Fever above 101 F/ 38.3 C, or presence of chills
- Disorientation or confusion
- Ear pain
NON-INFECTIOUS CAUSES OF SORE THROAT
- Allergies to substances like pollen, dust mites, fungal molds or animal hair – These can cause nasal symptoms (allergic rhinitis), red eyes, as well as sore throat due to direct inflammation or backward dripping of mucus from the nose (postnasal drip).
- Tobacco smoke (active and passive) and other environmental irritants like exhaust, and chemicals.
- Acidity due to acid reflux or eating very spicy foods.
- Mouth breathing and snoring causing dryness of the throat.
- Intense screaming, shouting and throat strain.
- Throat cancers (rare).
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