Why is your throat sore?

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An antifungal agent such as nystatin mouthwash or amphotericin lozenges can clear the fungal infections within days.

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London - Most adults will suffer two or three sore throats a year. Here, with the help of Dr Adam Frosh, a consultant ear, nose and throat specialist at the Lister Hospital, Hertfordshire, we look at what might have triggered that croaky frog in the throat feeling, and how best to tackle it …

PAIN AT BACK OF THE THROAT, HUSKY VOICE

Other symptoms: May be accompanied by a high temperature that comes on quickly; a cough.

Possible cause: Viral pharyngitis - this is the most common cause of a sore throat, which is typically the first sign of a cold or flu, as the virus tends to replicate and gather in the throat before triggering other symptoms in the body. The husky voice is caused by the virus affecting the tissue around the voice box; the cough is triggered by general inflammation in the throat.

Treatment: Gargling with soluble aspirin will help reduce inflammation locally in the throat and after you swallow, the aspirin will help with the rest of the cold-like symptoms affecting the body.

Alternatively, gargling for 30 seconds with salt water (add two teaspoons of salt to a pint of lukewarm water) can help, as salt water helps draw fluid out and so takes some of the swelling down, says Dr Frosh. But don’t swallow the salt solution, as it can make you feel sick.

Drink plenty of fluids - with a sore throat it is easy to become dehydrated because you are inclined to drink less than normal. Medications containing aspirin, non-steroidal, anti-inflammatory drugs such as ibuprofen and paracetamol usually help to ease the soreness and flu-like symptoms.

Throat lozenges containing glycerin - which is often added to products as a lubricant - will ease a scratchy sore throat; lozenges with menthol have a cooling effect and will also make your nose feel less blocked up. Some contain local anaesthetic to ease pain, but others are largely sugar-based.

SLIGHTLY SORE THROAT, SORE TONGUE

Other symptoms: White coating on the tongue.

Possible cause: Thrush - this can be triggered by a recent course of antibiotics, which kills off healthy bacteria that prevent fungal thrush infections taking hold. However, steroid treatments and chemotherapy can also weaken the body’s resistance to fungal infections such as thrush.

Treatment: An antifungal agent such as nystatin mouthwash or amphotericin lozenges can clear the fungal infections within days. Both are available only on prescription. More resistant forms will require an oral antifungal medication.

THROAT FEELS 'COATED', INTENSE PAIN

Other symptoms: Temperature above 38degC; sometimes accompanied by headache, nausea and tummy pain; the back of the throat may be covered with a creamy coating of pus. However, no cough or runny nose and voice is unaffected.

Possible cause: Streptococcal infection - this is a bacterial infection and is a common cause of sore throat. It is typically diagnosed by taking a swab of the back of the throat.

Treatment: This needs antibiotics and the earlier the better, says Dr Frosh, as streptococcal sore throat can cause problems with the heart and kidneys - see the doctor if you have a raging sore throat that feels as if there is a film coating to it, and a high temperature.

CONSTANT FEELING OF PHLEGM IN THROAT

Other symptoms: You feel the need to keep clearing your throat.

Possible cause: Globus pharyngeus - a little-known but surprisingly common condition that in its most minor form has been experienced by almost half of the population. It is characterised by feeling as if you have persistent phlegm or a tightness in your throat.

Although you feel the regular need to clear their throat of phlegm, an examination will find nothing physically wrong. ‘Some say it’s like having irritable bowel syndrome in the throat,’ says Dr Frosh.

‘It’s a reflex action which people can have when they are under stress - it’s common among young entrepreneurs, carers of sick relatives or anyone living with constant pressure in their lives.’

Although there is no actual build up of phlegm, the constant throat clearing can inflame the throat and so increases the need to clear it. It then becomes a vicious circle.

Treatment: Distraction techniques and relaxation can help. So, too, can sipping water throughout the day - this helps prevent the dry sensation in the throat that can increase the urge to clear it.

RAGING PAIN, TROUBLE SWALLOWING

Other symptoms: High temperature, possibly voice sounds more muffled than usual, bad breath, general malaise and the glands in the neck may feel enlarged.

Possible causes: Tonsillitis or glandular fever - tonsillitis is the second most common cause of a sore throat and is most often caused by a bacterial infection of the tonsils (although sometimes a virus triggers this.) Symptoms are caused by swelling of the tonsils and the body fighting off the infection.

However, this kind of sore throat can be a sign of the viral condition glandular fever. This typically affects teenagers and will also cause general malaise and fatigue - with glandular fever, the swelling of the tonsils will be severe and they will often have a white coating.

Treatment: Hydration with plenty of non-alcoholic drinks is important, as dehydration can set in very quickly. Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can bring down a temperature and reduce throat pain.

Gargling with a glass of soluble aspirin or salt water can help reduce swelling. Antibiotics are also needed to control the infection - so if you have a raging sore throat, fever and film at the back of your throat, see your GP.

PAIN ON ONLY ONE SIDE OF THE THROAT

Other symptoms: A temperature in excess of 39degC; difficulty swallowing and feels difficult to open the mouth.

Possible cause: Quinsy - this is an abscess caused by a bacterial infection behind one tonsil. Pus collects in the space behind the tonsil, causing pain and inflammation and pushes the tonsil forward, making it hard to swallow. Affects all ages.

Treatment: The abscess can be drained with a needle. This is done under local anaesthetic in hospital, although in extreme cases it may require the tonsils to be removed under general anaesthetic. Quinsy needs prompt medical treatment, as left untreated the infection can spread down the throat.

SORE THROAT, WEAK OR RASPY VOICE

Other symptoms: Often accompanied by a cough and voice can be reduced to a whisper.

Possible cause: Viral laryngitis - this is a viral infection of the larynx (or voice box), which sits at the top of the windpipe. The swelling makes it harder for the vocal cords to vibrate, which is why it affects the voice.

Treatment: Antibiotics will not help, as this is a viral infection. Gargling (see viral pharyngitis, left) can help reduce inflammation. Normally it will clear up within several days. However, if the voice continues to be raspy for six weeks or more, see your doctor.

RAW AND DRY THROAT

Other symptoms: Problem is worse on waking; possibly a raspy voice; night-time cough.

Possible cause: Acid reflux - this is a common complaint that affects 12 million Britons - brought on by gastro-oesophageal reflux disease (GORD) or laryngopharyngeal reflux (LPR).

With GORD, stomach contents leak up into the gullet, typically causing indigestion, heartburn and burping - with LPR the reflux goes to the voice box at the top of the windpipe. ‘Sometimes a sore throat or a cough can be the only symptom of LPR and people are often surprised to know their sore throat is due to reflux,’ says Dr Frosh.

Treatment: Avoid eating late at night, as when you lie down in bed with a full stomach it puts extra pressure on the valve that closes the stomach, making reflux more likely. Also large meals, alcohol and acidic and fatty foods can make the symptoms worse.

Sleeping propped up on a pillow can reduce reflux. Antacids such as Rennies can also help. If symptoms persist for six weeks, visit the doctor. More severe cases may require stronger medication from the doctor such as omeprazole, which significantly reduces the amount of acid produced by the stomach.

CHRONIC SORE THROAT

Very occasionally a sore throat can be a sign of a more serious underlying condition such as throat cancer. The typical symptoms include a persistent sore throat, a croaky voice or a change to the voice, as well as unexplained weight loss.

Any case of sore throat or hoarse voice that lasts longer than six weeks should be checked by an ear, nose and throat surgeon. This is especially true of anyone who has any of the risk factors for cancer, such as being a smoker or heavy drinker, and if aged over 45. - Daily Mail

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