Sore Throat

Introduction

Any part of the respiratory mucosa of the throat can exhibit symptoms of pain (range from irritation to severe pain).

  • This includes the pharynx (pharyngitis) and tonsils (tonsilitis), yet clinical distinction between pharyngitis and tonsilitis is unclear.

The majority of cases will be acute and self-limiting, whether viral or bacterial in origin.

  • 40% of people being symptom free after 3 days and 85% of people symptom free after 1 week.



Indications for Referral

Sore throat duration >2 weeks or hoarseness of longer than 3 weeks' duration
  • Suggests nonacute cause and require further investigation
Difficulty in swallowing (dysphagia)
  • Suggests sinister pathology
Patents taking medications that can interfere with the immune response (e.g. immunosuppressants, disease-modifying antirheumatics) or those known to cause agranulocytosis (e.g. carbimazole)
  • Requires doctor involvement to monitor.



Management

Because most sore throat are viral in origin and self-limiting, treatments aim at providing relief from discomfort and pain until the infection subsides can be offered.

Oral analgesics, e.g. paracetamol and NSAIDs (primarily ibuprofen).

Lozenges and pastilles have a soothing effect (higher initial deposition of active ingredient in the mouth and throat). Some are medicated

  • Analgesic - Amylmetacresol and 2,4-dichlorobenzylalcohol (AMC/DCBA), benzydamine
  • Antibacterial - Benzalkonium chloride, cetylpyridinium, dequalinium chloride, hexylresorcinol
  • Anti-inflammatories - Benzydamine, flurbiprofen
  • Cough suppressant - Pholcodine
  • Local anaesthetics - Ambroxol, benzocaine, benzydamine, hexylresorcinol, lidocaine
  • Mucolytics - Ambroxol
Throat spray
  • NSAIDs - Benzydamine, flurbiprofen
  • Disinfectant - Povidone-iodine
Gargle
  • Gargle is not recommended for use in children <6-8 years due to the risk of swallowing.
  • E.g. Benzydamine, hexetidine, povidone-iodine and thymol.
Other interventions: sipping warm fluids (e.g. honey, tea or soup)
  • Honey should be avoided in children younger than one year of age because of the contamination of the honey with Clostridium botulinum spores, potentially leading to infantile botulism.
  • Gargling with aspirin or salt water is a common lay remedy for sore throat. No trials appear to have been conducted on their effectiveness and until evidence becomes available, they should not be recommended.



Antibiotics?

In most cases, treatment with antibiotics is unnecessary.

  • Overuse of antibiotics contributes to antibiotic resistance and can cause side effects such as diarrhoea, nausea and vomiting.



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