Sore Throat




Introduction

The dry scratchiness and painful swallowing that are the hallmarks of a sore throat — known medically as pharyngitis — can be miserable. Yet a sore throat isn't a disease. Most often, it's a symptom of another illness — usually a viral infection such as a cold or the flu (influenza). In many cases, a sore throat is the first indication that you're getting sick.

Sore throats are so common they're one of the main reasons Americans see a doctor. But many of those office visits aren't necessary. Most sore throats are caused by a virus and go away on their own in about a week. Only a small percentage are bacterial infections that may require medical care.

Bacterial infections are sometimes treated with antibiotics, although drugs don't always speed healing or prevent infections from recurring. And antibiotics aren't effective against viruses, which respond best to self-care measures such as resting and drinking plenty of fluids. Until you're feeling better, salt-water gargles, throat lozenges or warm water with honey and lemon can help make having a sore throat easier to swallow.

Signs and Symptoms

A sore throat usually occurs with other signs and symptoms. These can vary considerably, depending on the type of infection you have. Most often, a sore throat accompanies a viral infection, such as a cold or the flu. You can usually distinguish between the two based on your symptoms. For example, in addition to a sore throat, a cold is likely to cause:
  • Sneezing
  • Watery eyes
  • Cough
  • A low fever — less than 102 F
  • Slight body aches or mild headache
Influenza, on the other hand, is usually marked by:
  • Fatigue
  • Body aches
  • Chills
  • Sweats
  • A fever over 102 F


Mononucleosis is another viral illness associated with a severe sore throat. Although signs and symptoms of the disease typically last about 10 days, it can take weeks to recover your strength after a bout of mono. In addition to a sore throat, mononucleosis may cause:
  • Swollen lymph nodes in your neck and armpits
  • Swollen tonsils
  • Headache
  • Skin rash
  • Loss of appetite
  • Soft, swollen spleen
  • Liver inflammation
A sore throat often occurs with other viral illnesses, including: Bacterial infections
Bacterial infections that can cause a severe sore throat include strep throat, tonsillitis and diphtheria — a serious respiratory illness that causes breathing difficulties and painful swallowing. Diphtheria is rare in industrialized nations but remains a threat in developing countries.

Causes

Most sore throats are caused by viruses — the same germs that cause colds and flu. A much smaller number are due to bacterial infections. Viruses and bacteria both enter your body through your mouth or nose — either because you breathe in particles that are released into the air when someone coughs or sneezes, or because you have hand-to-hand contact with an infected person or use shared objects such as utensils, towels, toys, doorknobs or a telephone. Touch your eyes or nose after such contact and you're likely to become sick yourself.

Because the germs that cause sore throats are contagious, they can spread easily wherever large numbers of people congregate: schools, child care centers, offices and yes, your own home. Even so, not all sore throats result from viral or bacterial infections. Other common causes of sore throat include:
  • Allergies. The same pet dander, molds and pollens that trigger allergic reactions such as red, swollen eyes and a runny nose can also cause a sore throat.
  • Dryness. Dry indoor air, especially in winter when rooms tend to be overheated, can make your throat feel rough and scratchy, particularly in the morning when you first wake up. Breathing through your mouth — often because of chronic nasal congestion — can also cause a dry, sore throat.
  • Pollution and other irritants. Outdoor air pollution can cause ongoing throat irritation. But indoor pollution — especially tobacco smoke — is an even greater cause of chronic sore throat. What's more, inhaling secondhand smoke is often just as damaging as smoking itself. Smokeless tobacco, alcohol and spicy foods can also inflame your throat.
  • Muscle strain. You can strain muscles in your throat just as you can strain them in your arms or legs. If you've ever gotten a sore throat after yelling at a concert or sporting event, you've likely strained your throat muscles.
  • Acid (gastroesophageal) reflux disease (GERD). This occurs when stomach acid backs up into your food pipe (esophagus). Normally, a circular band of muscle (lower esophageal sphincter) blocks acid from coming up into the esophagus. But if the sphincter relaxes abnormally or weakens, stomach acid can back up, irritating your throat as well as your esophagus. Throat irritation caused by GERD doesn't occur with other symptoms of a viral illness, and it tends to be persistent, rather than lasting just a few days. It's also far more common in adults than in children. In many cases, you can prevent or reduce acid reflux with simple lifestyle changes — losing weight, avoiding foods that cause you discomfort and not eating right before bed, for example. When these aren't effective, over-the-counter or prescription medications may offer some relief.
  • HIV infection. HIV-positive people with low CD4 counts sometimes develop a chronic sore throat. This isn't due to HIV itself but to a secondary infection such as oral thrush or cytomegalovirus, a common viral infection that can be extremely serious in immunocompromised people.
  • Tumors. If you smoke or abuse alcohol, you're at high risk of tumors of the throat, tongue and voice box. In some people these tumors cause few, if any, signs and symptoms. In others, they can lead to hoarseness, difficulty swallowing and sore throat.


Treatment

Most sore throats go away without treatment, often within a week or so. That's a good thing, because no medical therapy exists for sore throats caused by viral infections. But increasing your fluid intake and getting extra sleep can help speed your recovery.

When you're sick, choose fluids such as water, soups and broths — not sodas or drinks that contain caffeine, which can dehydrate you further. If you find it extremely painful to swallow, try sipping warm broth through a straw or sucking on ice chips. You may also find that jello slides down easily.

Treating bacterial infections
At one time, doctors automatically treated all sore throats with antibiotics, both to cure the infection and to prevent dangerous complications such as rheumatic fever. Now, though, doctors are much less likely to prescribe medication because the overuse of antibiotics has led to an alarming increase in antibiotic-resistant strains of bacteria. What's more, antibiotics such as penicillin do little to hasten recovery from strep throat or to reduce signs and symptoms, and they don't prevent infections from recurring. Be sure your doctor performs a rapid strep test before prescribing any antibiotic for a sore throat.

If your doctor does recommend antibiotics for you or your child, take the entire course of medication, even if you feel better. This helps prevent the infection from coming back. It also prevents bacteria from becoming resistant to the medication. If children on antibiotic therapy feel well and don't have a fever, they often can return to school or child care when they're no longer contagious — usually 24 hours after beginning treatment.

Prevention

The single best way to prevent illness is also one of the simplest: hand washing. Teach your children to wash their hands often — before eating and after using the bathroom, and after spending time in a crowded public space or touching animals. Show them how to wash their hands thoroughly, covering all hand surfaces — front and back — with soap and rubbing hands vigorously under warm running water. Teach young children to scrub their hands for as long as it takes them to sing the alphabet song or the "Happy Birthday to You" song — about 10 to 15 seconds.

Alcohol-based hand sanitizers are an excellent alternative to hand washing, particularly when soap and water aren't available. They're actually more effective than hand washing in killing bacteria and viruses that cause disease. And because hand sanitizers often contain moisturizing ingredients, they may cause less skin dryness and irritation. Not all hand sanitizers are created equal, however — avoid products that don't contain alcohol.

These measures may also help keep you and your children healthy:
  • Avoid sharing eating utensils, glasses, napkins, food or towels with others.
  • Avoid touching public phones or drinking fountains with your mouth.
  • Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. When you travel, clean phones and remotes in your hotel room.
  • Avoid close contact with people who are sick.
  • Stay indoors as much as possible on high pollution days.
  • Don't smoke, and avoid exposure to secondhand smoke.
  • Humidify your home if the air is dry.
  • Cough or sneeze into a tissue and then throw it away.


Credit: National Institute of Health.
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