Sore throat

Sore throat
Viral pharyngitis, the most common cause of a sore throat.
SpecialtyEar, nose and throat
SymptomsPain, irritation or a scratchy feeling in the throat[1]
DurationAround 7-days[2]
CausesVirus, bacteria (Strep sore throat),[3] allergies, smoking,[1] acid reflux[4]
PrognosisGood if no other problems[2]
FrequencyCommon[2]

A sore throat is pain, irritation or a scratchy feeling in the throat.[1] The throat may feel dry or it may hurt to swallow.[1] Other associated symptoms may include fever, headache, hoarse voice, muscle aches, stuffy nose or runny nose.[5] There may be swollen glands or large red tonsils with white patches.[5]

Typically, it is caused by a viral pharyngitis as part of a cold and less commonly a bacterial infection such as group A Streptococcus.[3] If it lasts longer than 2-weeks, the cause is more likely to be non-infectious.[2] Allergies and smoking can also cause a sore throat.[1] Acid reflux can cause the throat to become sore.[4] Unless there are other problems or a weakened immune system, a sore throat is generally a temporary mild condition which gets better on its own.[2]

Signs and symptoms

A sore throat is pain, irritation or scratchiness felt in the throat.[1] The throat may feel dry or it may hurt to swallow.[1] There may be discomfort while speaking, a burning sensation or swelling in the neck.[5]

  • Sore throat due to glandular fever
    Sore throat due to glandular fever
  • Streptococcal sore throat
    Streptococcal sore throat
  • Vocal cord ulcer
    Vocal cord ulcer
  • Laryngopharyngeal reflux
    Laryngopharyngeal reflux

Causes

Usually, causes of sore throat include viral infections, group A streptococcal infection (GAS) bacterial infection,[3] pharyngitis (inflammation of the throat), tonsillitis (inflammation of the tonsils), or dehydration, which leads to the throat drying up.

The most common cause (80%) is acute viral pharyngitis, a viral infection of the throat.[6] Other causes include other bacterial infections (such as group A streptococcus or streptococcal pharyngitis), trauma, and tumors.[6] Gastroesophageal (acid) reflux disease can cause stomach acid to back up into the throat and also cause the throat to become sore.[4] In children, streptococcal pharyngitis is the cause of 35–37% of sore throats.[7][3]

Diagnosis

The symptoms of a viral infection and a bacterial infection may be very similar. Some clinical guidelines suggest that the cause of a sore throat is confirmed prior to prescribing antibiotic therapy and only recommend antibiotics for children who are at high risk of non-suppurative complications.[8][9] A group A streptococcus infection can be diagnosed by throat culture or a rapid test. In order to perform a throat culture, a sample from the throat (obtained by swabbing) is cultured (grown) on a blood agar plate to confirm the presence of group A streptococcus.[3] Throat cultures are effective for people who have a low bacterial count (high sensitivity), however, throat cultures usually take about 48 hours to obtain the results.[3]

Clinicians often also make treatment decisions based on the person's signs and symptoms alone. In the US, approximately 2/3rd of adults and half of children with sore throat are diagnosed based on symptoms and do not have testing for the presence of GAS to confirm a bacterial infection.[3]

Rapid tests to detect GAS (bacteria) give a positive or negative result that is usually based on a colour change on a test strip that contains a throat swab (sample). Test strips detect a cell wall carbohydrate that is specific to GAS by using an immunologic reaction.[3] Rapid testing can be performed in the doctors office and usually takes 5–10 minutes for the test strip to indicate the result. Specificity for most rapid tests is approximately 95%, however sensitivity is about 85%.[3] Although the use of rapid testing has been linked with an overall reduction in antibiotic prescriptions, further research is necessary to understand other outcomes such as safety, and when the person starts to feel better.[3]

Numerous clinical scoring systems (decision tools) have also been developed to support clinical decisions. Scoring systems that have been proposed include Centor's, McIsaac's, and the feverPAIN.[3] A clinical scoring system is often used along with a rapid test.[3] The scoring systems use observed signs and symptoms in order to determine the likelihood of a bacterial infection.[3]

Management

Sore or scratchy throat can temporarily be relieved by gargling with a solution of 1/4 to 1/2 teaspoon salt dissolved in an 8 ounces in 230 ml glass of warm water.[10]

The majority of sore throats are caused by a virus, for which antibiotics are not helpful.[3] A strong association between antibiotic misuse and antibiotic resistance has been shown.[11]

For sore throat caused by bacteria (GAS), treatment with antibiotics may help the person get better faster, reduce the risk that the bacterial infection spreads, prevent retropharyngeal abscesses and quinsy, and reduce the risk of other complications such as rheumatic fever and rheumatic heart disease.[3] In most developed countries, post-streptococcal diseases have become far less common. For this reason, awareness and public health initiatives to promote minimizing the use of antibiotics for viral infections has become the focus.[3]

Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help in the management of pain.[12][13] The use of corticosteroids seems to increase slightly the likelihood of resolution and the reduction of pain, but more analysis is necessary to ensure that this minimal benefit outweighs the risks.[14][15] Antibiotics probably reduce pain, diminish headaches and could prevent some sore throat complications; but, since these effects are small, they must be balanced with the threat of antimicrobial resistance.[16] It is not known whether antibiotics are effective for preventing recurrent sore throat.[17]

There is an old wives tale that having a hot drink can help with common cold and influenza symptoms, including sore throat, but there is only limited evidence to support this idea.[18] If the sore throat is unrelated to a cold and is caused by for example tonsillitis, a cold drink may be helpful.[19]

There are also other medications like lozenges which can help people to cope with a sore throat.

Without active treatment, symptoms usually last two to seven days.[20]

Epidemiology

Approximately 35% of childhood sore throats and 5-25% of adults sore throats are caused by a bacterial infection from group A streptococcus.[3] Sore throats that are "non-group A streptococcus" are assumed to be caused by a viral infection. Sore throat is a common reason for people to visit their primary care doctors and the top reason for antibiotic prescriptions by primary care practitioners such as family doctors.[3] In the United States, about 1% of all visits to the hospital emergency department, physician office and medical clinics, and outpatient clinics are for sore throat (over 7 million visits for adults and 7 million visits for children per year).[3]

In the United States, there are about 2.4 million emergency department visits with throat-related complaints per year.[6]

References

  1. 1 2 3 4 5 6 7 "Suffering from a sore throat?". Centers for Disease Control and Prevention. 3 January 2022. Archived from the original on 1 April 2022. Retrieved 29 April 2022.
  2. 1 2 3 4 5 Krüger, K; Töpfner, N; Berner, R; Windfuhr, J; Oltrogge, JH; Guideline, group. (19 March 2021). "Clinical Practice Guideline: Sore Throat". Deutsches Arzteblatt international. 118 (Forthcoming). doi:10.3238/arztebl.m2021.0121. PMID 33602392. Archived from the original on 29 April 2022. Retrieved 28 April 2022.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Cohen, Jérémie F.; Pauchard, Jean-Yves; Hjelm, Nils; Cohen, Robert; Chalumeau, Martin (June 2020). "Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat". The Cochrane Database of Systematic Reviews. 6: CD012431. doi:10.1002/14651858.CD012431.pub2. ISSN 1469-493X. PMC 7271976. PMID 32497279.
  4. 1 2 3 "Sore Throat and Other Throat Problems-Topic Overview". Archived from the original on 2017-11-11. Retrieved 2022-04-28.
  5. 1 2 3 "Sore throat - Symptoms and causes". Mayo Clinic. Archived from the original on 13 April 2022. Retrieved 28 April 2022.
  6. 1 2 3 Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 30. ISBN 978-0-323-05472-0.
  7. ↑ Shaikh N, Leonard E, Martin JM (September 2010). "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics. 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID 20696723. S2CID 8625679.
  8. ↑ "Group A Strep | Strep Throat | For Clinicians | GAS | CDC". www.cdc.gov. 2019-04-19. Archived from the original on 2020-10-27. Retrieved 2020-09-18.
  9. ↑ "Clinical Practice Guidelines : Sore throat". www.rch.org.au. Archived from the original on 2020-10-07. Retrieved 2020-09-18.
  10. ↑ "Does Gargling Wlth Salt Water Ease a Sore Throat?". WebMD. Archived from the original on 2021-03-29. Retrieved 2022-04-28.
  11. ↑ "Antibiotic resistance". www.who.int. Archived from the original on 2021-05-21. Retrieved 2020-09-18.
  12. ↑ Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMC 1313826. PMID 11127175.
  13. ↑ de Cassan, Simone; Thompson, Matthew J.; Perera, Rafael; Glasziou, Paul P.; Del Mar, Chris B.; Heneghan, Carl J.; Hayward, Gail (1 May 2020). "Corticosteroids as standalone or add-on treatment for sore throat". The Cochrane Database of Systematic Reviews. 2020 (5): CD008268. doi:10.1002/14651858.CD008268.pub3. ISSN 1469-493X. PMC 7193118. PMID 32356360.
  14. ↑ de Cassan S, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ (May 1, 2020). "Corticosteroids as standalone or add-on treatment for sore throat". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008268.pub3. PMID 32356360.
  15. ↑ Sadeghirad, Behnam; Siemieniuk, Reed A C; Brignardello-Petersen, Romina; Papola, Davide; Lytvyn, Lyubov; Vandvik, Per Olav; Merglen, Arnaud; Guyatt, Gordon H; Agoritsas, Thomas (20 September 2017). "Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials". BMJ. 358: j3887. doi:10.1136/bmj.j3887. PMC 5605780. PMID 28931508.
  16. ↑ Spinks A, Glasziou PP, Del Mar CB (Dec 9, 2021). "Antibiotics for treatment of sore throat in children and adults". Cochrane Database Syst Rev. doi:10.1002/14651858.CD000023.pub5. PMID 34881426.
  17. ↑ Ng, Gareth JY; Tan, Stephanie; Vu, Anh N; Del Mar, Chris B; van Driel, Mieke L (2015-07-14). Cochrane ENT Group (ed.). "Antibiotics for preventing recurrent sore throat". Cochrane Database of Systematic Reviews (7): CD008911. doi:10.1002/14651858.CD008911.pub2. PMID 26171901.
  18. ↑ "Hot drinks ease cold and flu". National Health Service. 10 December 2008. Archived from the original on 8 August 2020. Retrieved 28 April 2022.
  19. ↑ Bathala S, Eccles R (March 2013). "A review on the mechanism of sore throat in tonsillitis". J Laryngol Otol (Review). 127 (3): 227–32. doi:10.1017/S0022215112003003. PMID 23317998. S2CID 20563591.
  20. ↑ Thompson, M; Vodicka, TA; Blair, PS; Buckley, DI; Heneghan, C; Hay, AD; TARGET Programme, Team (Dec 11, 2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ (Clinical Research Ed.). 347: f7027. doi:10.1136/bmj.f7027. PMC 3898587. PMID 24335668.
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