Chronic sore throat: potential causes & concerns
Dear Friends,
Welcome back to TGIF Dr Euan's Blogpost!
Today, we will look at a very common problem that affects millions of people worldwide: Chronic or Persistent Sore Throat.
Chronic pharyngitis is a recurrent or persistent sore throat that lingers for a few weeks or returns frequently. Chronic pharyngitis may be caused by infection, environmental pollutants, allergies, or acid reflux.
Correct and accurate Diagnosis will lead to appropriate treatment to address the underlying cause.
Q: What are the signs and symptoms of chronic pharyngitis?
Chronic pharyngitis symptoms are similar to acute pharyngitis symptoms. Generally, the condition is considered to be chronic if symptoms linger for longer than 10 days. Common warning signs include:
Pain or scratchiness in your throat.
Swollen lymph glands in your neck.
Hoarseness.
Difficulty swallowing.
A ticklish sensation in your throat.
A tired voice.
A sensation that something is stuck at the back of your throat.
If you have an infection as well as having a sore throat, you may also experience:
Fever.
Headaches.
Nausea and vomiting.
Coughing.
Sneezing.
Q: What’s the most common cause of a sore throat?
Infections are still the most common cause of both acute and chronic pharyngitis.
However, a number of other factors can result in chronic pharyngitis, including:
Persistent tonsillitis, a condition in which your tonsils become chronically inflamed and infected.
Environmental pollutants, such as cigarette smoke and chemicals.
Allergic reactions to pollen, mold, and pet dander.
Laryngo-pharyngeal reflux (LPR), where stomach acid goes back up into your throat and causes irritation.
Very rarely, throat cancer can cause chronic sore throat. This type of cancer starts in your pharynx or larynx (voice box). The resulting throat pain may be accompanied by shortness of breath, lumps in your neck, or bleeding from your nose or mouth.
Q: How is chronic pharyngitis diagnosed?
Your GP will begin with a physical examination. He / She may also recommend a throat culture or rapid antigen detection testing for strep throat — especially if they think your pharyngitis is due to something other than a virus.
If needed, your GP may refer you to see an ENT Specialist for a more detailed examination, including a flexible, fiber-optic Naso-endoscopy.
Photo showing nasoendoscopy in clinic
Q: How is chronic pharyngitis treated?
Treatment for chronic pharyngitis depends on the underlying cause. Once your healthcare provider determines what led to your sore throat, they’ll recommend an appropriate course of action.
Tonsillitis
In most cases, tonsillitis is treated with antibiotics. If the condition returns frequently, then your healthcare provider may recommend a tonsillectomy.
Environmental pollutants
Sometimes smoke, chemicals or other environmental pollutants can cause chronic pharyngitis. In these cases, you must avoid all situations in which you’re exposed to these triggers. This should promote healing and reduce symptoms.
An image of a pack of cigarettes warning of the increased risk of cancer from smoking
Allergic reactions
Oftentimes, nasal sprays and other over-the-counter medications can effectively treat chronic pharyngitis caused by allergies. In severe cases, you may need to schedule an appointment with an ear, nose, and throat (ENT) specialist.
Acid reflux
People with laryngo-pharyngeal reflux (LPR) may benefit from certain lifestyle changes, such as stress reduction, losing weight, and altering their diet. Proton-pump inhibitors (medication) can also help reduce symptoms eg Nexium / Pariet
Photo from scope of swollen larynx affected by GERD
Throat cancer
If you have throat cancer, you will need to undergo staging scans followed by definitive treatment, such as surgery, chemotherapy or radiation therapy, or a combination of these modalities. Ultimately, the specific treatment will depend on the type, stage, and location of the cancer.
Q: Doc, how can I manage symptoms of chronic pharyngitis?Are there any home remedies I can try?
Addressing the underlying cause is the only way to treat chronic pharyngitis. However, there are a few chronic pharyngitis home remedies you can try to ease your sore throat symptoms:
Drink lots of water.
Take over-the-counter pain relievers, such as acetaminophen, naproxen sodium, or ibuprofen.
Gargle with warm salt water a few times a day.
STOP smoking.
Q: What happens if chronic pharyngitis is left untreated?
In some cases, a chronic sore throat can have serious health consequences. So, it is vitally important to schedule a visit with your GP right away if your symptoms do not go away after 2 weeks. If needed, your GP may recommend you see an ENT Specialist for further evaluation.
If you would are experiencing symptoms of sinusitis, laryngitis, or prolonged sore throat, please feel free to make an appointment with us today.
Here are some useful references for more reading, if you are keen to learn more:
REFERENCES:
Feder HM, Jr, Gerber MA, Randolph MF. Once-daily therapy for streptococcal pharyngitis with amoxicillin. Pediatrics. 1999;103:47–51. [PubMed] [Google Scholar]
Markowitz M, Gerber MA, Kaplan EL. Treatment of streptococcal pharyngotonsillitis: Reports of penicillin's demise are premature. J Pediatr. 1993;123:679–685. [PubMed] [Google Scholar]
Massel BF, Chute CG, Walker AM. Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States. N Engl J Med. 1988;318:280–286. [PubMed] [Google Scholar]
Paradise JL, Bluestone CD, Bachman RZ. Efficacy of tonsillectomy for recurrent throat infection in severely affected children: Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310:674–683. [PubMed] [Google Scholar]
Randolph MF, Gerber MA, DeMeo KK. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr. 1985;106:870–875. [PubMed] [Google Scholar]
Seppala H, Nissinen A, Jarvinen H. Resistance to erythromycin in group A streptococci. N Engl J Med. 1992;326:292–297. [PubMed] [Google Scholar]
Shulman ST, Gerber MA, Tanz RR. Streptococcal pharyngitis: The case for penicillin therapy. Pediatr Infect Dis J. 1994;13:1–7. [PubMed] [Google Scholar]
Snellman LW, Stang HJ, Stang JM. Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics. 1993;91:116–117. [PubMed] [Google Scholar]
Tanz RR, Poncher JR, Corydon KE. Clindamycin treatment of chronic pharyngeal carriers of group A streptococci. J Pediatr. 1991;119:123–128. [PubMed] [Google Scholar]
Tanz RR, Shulman ST, Shortridge VD. and the North American Streptococcal Pharyngitis Surveillance Group. U.S. community-based surveillance of macrolide-resistant pharyngeal group A streptococci during three respiratory disease seasons. Clin Infect Dis. 2004;39:1794–1801. [PubMed] [Google Scholar]
Chow AW. Life-threatening infections of the head and neck. Clin Infect Dis. 1992;14:991–1004. [PubMed] [Google Scholar]
de Marie S, Tham RT, van der Mey AGL. Clinical infections and nonsurgical treatment of parapharyngeal space infections complicating throat infection. Rev Infect Dis. 1989;11:975–982. [PubMed] [Google Scholar]
Fiesseler FW, Riggs RL. Pharyngitis followed by hypoxia and sepsis: Lemierre syndrome. Am J Emerg Med. 2001;19:320–322. [PubMed] [Google Scholar]
Savolainen S, Jousimies-Somer HR, Makitie AA. Peritonsillar abscess: Clinical and microbiologic aspects and treatment regimens. Arch Otolaryngol Head Neck Surg. 1993;119:521–524. [PubMed] [Google Scholar]
Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: Duration of and frequency of complications. Pediatrics. 1991;87:129–133. [PubMed] [Google Scholar]
White B. Deep neck infections and respiratory distress in children. Ear Nose Throat J. 1985;64:30–38. [PubMed] [Google Scholar]
Centor RM, Arkinson TP, Ratliff AE. The clinical presentation of Fusobacterium-positive pharyngitis at a university health clinic: A cross-sectional study. Ann Intern Med. 2015;162:241–247. [PubMed] [Google Scholar]
Feder HM., Jr Periodic fever, aphthous stomatitis, pharyngitis, adenitis: clinical review of a new syndrome. Curr Opin Pediatr. 2000;12:253–256. [PubMed] [Google Scholar]
Gerber MA, Randolph MF, Martin NJ. Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics. 1991;87:598–603. [PubMed] [Google Scholar]
Karpathios T, Drakonaki S, Zervoudaki A. Arcanobacterium haemolyticum in children with presumed streptococcal pharyngotonsillitis or scarlet fever. J Pediatr. 1992;121:735–737. [PubMed] [Google Scholar]
Komaroff AL, Branch WT, Aronson MD. Chlamydial pharyngitis. Ann Intern Med. 1989;111:537–538. [PubMed] [Google Scholar]
Lajo A, Borque C, Del Castillo F. Mononucleosis caused by Epstein-Barr virus and cytomegalovirus in children: A comparative study of 124 cases. Pediatr Infect Dis J. 1994;13:56–60. [PubMed] [Google Scholar]
McMillan JA, Weiner LB, Higgins AM. Pharyngitis associated with herpes simplex virus in college students. Pediatr Infect Dis J. 1993;12:280–284. [PubMed] [Google Scholar]
Nakayama M, Miyazaki C, Ueda K. Pharyngoconjunctival fever caused by adenovirus type 11. Pediatr Infect Dis J. 1992;11:6–9. [PubMed] [Google Scholar]
Straus SE, Cohen JI, Tosato G. Epstein-Barr virus infections: Biology, pathogenesis, and management. Ann Intern Med. 1993;118:45–58. [PubMed] [Google Scholar]
Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children: I. Clinical and general laboratory findings. Pediatrics. 1985;75:1003–1010. [PubMed] [Google Scholar]
Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children: II. Heterophil antibody and viral-specific responses. Pediatrics. 1985;75:1011–1019. [PubMed] [Google Scholar]
Waagner DC. Arcanobacterium haemolyticum: Biology of the organism and diseases in man. Pediatr Infect Dis J. 1991;10:933–939. [PubMed] [Google Scholar]
Wurster VM, Carlucci JG, Feder HM., Jr Long-term follow-up of children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome. J Pediatr. 2011;159:958–964. [PubMed] [Google Scholar]
