Overview

Sore throats, medically termed pharyngitis, are a common complaint especially in children. They are commonly caused by viruses or bacteria. Other less common causes of sore throat are serious and some life-threatening. Although sore throats usually clear up on their own without complications, they sometimes need a prescription of antibiotics.

What are the common causes of sore throat?

Contagious viruses are the vast majority of causes of sore throat. Bacteria too are a common cause of sore throat.

Viruses and bacteria are spread from one person to another through hand contact. Hands get contaminated when the sick individual touches their nose or mouth and then touches another person directly (hand-to-hand contact) or indirectly (hand-to-object, such as doorknob, telephone, toys).

Viruses  — There are many viruses that can cause pain and swelling of the throat. The most common include viruses that cause sore throat as part of an upper respiratory infection, such as the common cold. Other viruses that cause sore throat include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms  — Symptoms that may occur with a viral infection can include a runny nose and congestion, irritation or redness of the eyes, cough, hoarseness, soreness in the roof of the mouth, a skin rash, or diarrhea. In addition, children with viral infections may have a fever and may feel miserable. A high fever does not necessarily mean that the child has a bacterial infection.

Group A streptococcus  — Group A streptococcus (GAS) is the name of the bacterium that causes strep throat. Although other bacteria can cause a sore throat, GAS is the most common bacterial cause. Strep throat usually occurs during the winter and early spring, and is most common in school-age children and their younger siblings.

Symptoms  — Symptoms of strep throat in children older than three years often develop suddenly and include fever (temperature> 38ºC), headache, abdominal pain, nausea, and vomiting. Other symptoms can include swollen glands in the neck, white patches of pus in the back or sides of the throat, small red spots on the roof of the mouth, and swelling of the uvula

What are other less common causes of sore throat?

Allergies to pollens and molds such as cat and dog dander and house dust are common causes of sore throats.

Irritation caused by dry heat, a chronic stuffy nose, pollutants and chemicals, and straining your voice can also irritate your throat.

Reflux, or a regurgitation of stomach acids up into the back of the throat, can cause you to wake up with a sore throat.

Tumors of the throat, tongue, and larynx (voice box) can cause a sore throat with pain radiating to the ear and/or difficulty swallowing. Other important symptoms can include hoarseness, noisy breathing, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

HIV infection can sometimes cause a chronic sore throat, due not to HIV itself but to a secondary infection that can be extremely serious.

When should I see a doctor?

Seek medical advice if any of the following occur:

• Severe and prolonged sore throat
• Difficulty breathing
• Difficulty swallowing
• Difficulty opening the mouth
• Joint pain
• Earache
• Rash
• Fever (over 38.3°C)
• Blood in saliva or phlegm
• Frequently recurring sore throat
• Lump in neck
• Hoarseness lasting over two weeks

What are my treatment options?

Treatment options depend on the cause. Bacterial infection are treated with antibiotics while viral infections require rest, hydration and pain killers.

Strep throat-this is usually treated with antibiotics. After completing 24 hours of antibiotics, the child is no longer contagious and may return to school. Symptoms usually improve within two to three days. However, it is important for the child to finish the entire course of treatment (usually 7-10 days). If a child does not begin to improve or worsens within three days, the child should be reevaluated.

Viral infections-Sore throat caused by viral infections usually last four to five days. During this time, treatments to reduce pain may be helpful but will not help to eliminate the virus. Antibiotics do not improve throat pain caused by a virus and are not recommended. A child with a viral infection is usually allowed to return to school when there has been no fever for 24 hours and the child feels well enough to pay attention.

Pain medication-commonly paracetamol or ibuprofen

Hydration-plenty of fluids and monitor for dehydration (lack of tears, dry mouth, wrinkled skin)

Oral rinses-dawa or salt water gargles help with relief of throat pain.

Lozenges- relieve dryness and pain but can be a choking hazard in young children.

Alternative treatment-diet changes, herbal medications, vitamins have not been scientifically proven to be safe or effective and more so may have mislabelling and wrong dosing information.

How can I prevent sore throats?

Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly, and dried with a single use towel.

Hands should be washed after coughing, blowing the nose or sneezing. While it is not always possible to limit contact with a person who is sick, the spread of infection can be prevented if touching of the eyes, nose or mouth are avoided.

In addition, tissues should be used to cover the mouth when sneezing or coughing. These used tissues should be disposed of promptly. Sneezing/coughing into the sleeve of one’s clothing (at the inner elbow) is another means of containing sprays of saliva and secretions and has the advantage of not contaminating the hands.

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

References

1. Shulman, Stanford T., et al. “Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America.” Clinical infectious diseases10 (2012): e86-e102.
2. Stelter, Klaus. “Tonsillitis and sore throat in children.” GMS current topics in otorhinolaryngology, head and neck surgery13 (2014).
3. Kenealy, Tim. “Sore throat.” BMJ clinical evidence2011 (2011).