Sore Throat

• Sore Throat


  Any part of the respiratory mucosa of the throat can exhibit symptoms of pain, including the pharynx (pharyngitis) and tonsils (tonsillitis), but the clinical distinction between the two is unclear
• Sore Throat


  • Pain can range from irritation to severe pain
  • Often associated with the common cold
• Sore throats are extremely common (2 to 3 a year) and most prevalent in children and teenagers
• Sore throats are self-limiting, worsening over 2-3 days and gradually going within a week, however 1 in 10 can last longer than a week
• Viruses account for the majority of sore throat cases and 1 in 4 may be due to streptococcal (bacterial) infection
• Viral infection


  Accounts for between 70% and 90% of all sore throat infections
• Bacterial infection


  The most common one being group A beta-haemolytic Streptococcus (aka Streptococcus pyogenes)
• Acute pharyngitis


  • Characterised by rapid onset of sore throat and pharyngeal inflammation (with or without exudate)
• Symptoms of sore throat

  • Painful/tender feeling at the back of the throat
  • Discomfort when swallowing
  • Hoarse voice
  • Mild cough
  • Fever
  • Headache
  • Nausea
  • Tiredness
  • Swollen neck glands
  • Runny nose
• 40% of people are symptom free after 5 days and 85% of people are symptom free after a week
• Tonsillitis


  Inflammation of the tonsils, different to pharyngitis which is inflammation of the pharynx
• Symptoms of tonsillitis


  • Sore throat
  • Cough
  • Fever
  • Headache
  • Nausea
  • Tiredness
  • Painful to swallow
  • Swollen neck glands
  • Tonsils red and swollen
  • Pus - white spots on tonsils
• Tonsillitis symptoms worsen over 2-3 days and gradually go usually within a week
• Differential diagnosis of sore throat

  • Viral infection
  • Streptococcal (bacterial) infection
  • Glandular fever (Epstein-Barr virus)
  • Trauma-related sore throat
  • Medicine-induced sore throat
  • Laryngeal and tonsillar carcinoma
• Viral sore throat


  • Occurs at any age
  • Lasts for 3-7 days
  • Cervical glands normal
  • Cough is common
  • Low-grade fever
  • Headache
• Streptococcal (bacterial) sore throat

  • Most prevalent in school age children
  • Duration is more than a week
  • Marked tonsillar exudate
  • High-grade fever
  • Absence of cough/cold symptoms
  • Cervical glands swollen
  • Possible rash
• Glandular fever (Epstein-Barr virus)


  • Spread via shared items, e.g. cups, toothbrushes, towels
  • Most prevalent in teenagers and young adults
• Streptococcus is uncommon in those under 3 years old
• Streptococcal infections are more prevalent in people aged 3-30 years, particularly those of school age (5-10 years) and young adults (15-25 years)
• Glandular fever is most prevalent in adolescents
• Patients suffering from glandular fever and streptococcal sore throat often have markedly swollen glands, which is less so in viral sore throat
• Marked tonsillar exudate is more suggestive of a bacterial rather than a viral cause
• Herpetiform and herpes simplex ulcers can also cause soreness in the mouth, especially in the posterior part of the mouth
• Oral analgesia


  E.g. paracetamol, ibuprofen and aspirin - provide rapid and effective relief and have been proven effective at reducing the pain associated with sore throat
• Flurbiprofen lozenges


  Have also been shown to be effective in reducing pain
• Local anaesthetics


  E.g. lidocaine and benzocaine (for children) - proven efficient at helping to manage sore throats and include lozenges and sprays
• Local anaesthetics have an effect on local nerve endings, including numbing of the tongue and pain in the back of the throat, alleviating the symptoms
• A small number of patients may experience a hypersensitivity reaction with either lidocaine or benzocaine, although it appears to be more common with benzocaine
• Antibacterial and Antifungal Agents


  E.g. chlorhexidine, tyrothricin, dequalinium chloride and benzalkonium chloride - include lozenges and pastilles, but they shouldn't be routinely recommended as the vast majority of sore throats are caused by viral infections against which they have no action
• Anti-inflammatories


  Benzydamine is an anti-inflammatory that can be used as a spray or mouthwash - helps with the pain and inflammation
• Antiseptic Mouthwashes and Gargles

  E.g. gargling with aspirin or saltwater - a common lay remedy for sore throat
• Reasons for referral


  • Dysphagia (difficulty swallowing)
  • Swollen lymph glands
  • Tonsillar exudate (inflamed tonsils), accompanied with high temperature and swollen glands
  • Earache
  • Fever
  • Hoarseness
  • Mouth ulceration
  • Myalgia (muscle pain)
  • Severe malaise
  • Skin rash
  • Duration is more than 2 weeks
• People taking medications that can interfere with the immune response (e.g. immunosuppressants, disease-modifying antiheumatics etc) or those known to cause agranulocytosis require doctor involvement to monitor