How to deal with a sore throat

You have experienced that moment when you come to sudden realization that you may be getting a cold. It usually begins with an itch or tingling in the throat. You shrug it off. Maybe drinking more water will make it go away. You briefly consider running to the store to purchase the latest cold remedy you heard about from a friend. For the next few days you toy with the idea of paying a visit to your doctor. You hold off in hopes that the worst has passed. Finally, you reach your pain threshold and begin the process of heading over to your local urgent care. Before leaving your residence, you make sure to pack your bag with your ipad, laptop, headphones and a portable battery just in case your wait outlasts the juice left on your devices. You pause at the door, realizing that you have been meaning to try the new Heal service that you saw on television. This is the perfect opportunity; a doctor in your home within an hour. Letting out a sigh of relief you quickly request a Heal visit. You sit back down on your couch and proceed to read the Heal blog post on sore throat, waiting comfortably for the doctor to arrive.

Sore throat or pharyngitis is a common ailment, especially in childhood, and it is usually part of a constellation of symptoms associated with the common cold. The symptom itself is not specific to any particular virus or bacteria. The soreness in your throat is a side effect of the war your immune system is waging with the pesky organism that chose to infect you. Viruses are by far the most common cause of sore throat, however sometimes bacteria can also cause this symptom. It is difficult to determine the cause of a sore throat based on symptoms alone. As physicians we actually act as detectives gathering clues from your history, vital signs, and physical exam. After collecting all of these clues, we build a case to identify the specific pathogen that is attempting to disrupt your health. As I mentioned before, the guilty culprit is usually a virus and not a bacteria. However, it is important to recognize and treat those patients with sore throat from Group A streptococcus (GAS) the bacteria that causes ‘strep throat.’ The reason we treat these bacterial infections with antibiotics is to prevent the spread of infection and also prevent potentially serious complications such as rheumatic fever, scarlet fever and glomerulonephritis (kidney issues), etc. Patients and parents are encouraged to seek medical attention if there is concern, especially if one or more of the following is present:

  • Temperature is > 101F or 38.3C
  • If there is absence of cough
  • Recent exposure to someone with strep throat
  • Difficulty breathing
  • Difficulty swallowing to point of dehydration
  • Muffled or ‘hot potato’ voice
  • Stiff neck or difficulty opening mouth
  • Tender or swollen neck glands/lymph nodes
  • Patches of pus in the back or sides of the throat
  • Small red spots on the roof of the mouth
  • Age is between 5–15 years (most of the cases of bacterial throat infections occur in this age group)

The history and physical examination will often suffice for diagnosis. Most physicians will use the Centor criteria as a clinical decision tool to determine what patients can be safely diagnosed without special testing. Therefore the majority of the time special testing is not required for patients presenting with this common symptom. Additionally, the majority of patients will not require antibiotics.

The treatment of sore throat depends upon the cause; viral pharyngitis is treated with rest, hydration, and pain relievers (motrin or tylenol). Do not give aspirin to children less than 18 years of age due to risk of a potentially serious condition known as Reye syndrome. Strep throat is treated with an antibiotic in addition to the aforementioned remedies. Salt-water rinses may help both, with most recipes suggesting ¼ to ½ teaspoon of salt per cup of warm water which is then gargled (not swallowed!). Sprays containing topical anesthetics are an option but studies have shown them to be no more effective than sucking on a hard candy (the same can be said for medicated throat lozenges). Other interventions include sipping warm beverages (ex, honey, tea, or chicken soup) or cold beverages (ex, eating ice cream or popsicles). It is important to monitor for symptoms of dehydration, especially in children. Symptoms of dehydration include slightly dry mouth, increased thirst, and decreased urine output (one wet diaper or urine void in six hours). Signs of moderate or severe dehydration include decreasing urine output (less than one wet diaper or urine void in six hours), lack of tears when crying, dry mouth, and sunken eyes. Children who are moderately or severely dehydrated should be evaluated by a physician as soon as possible.

Preventing the spread of pharyngitis revolves around good hand hygiene. Hand washing is essential and highly effective in preventing the spread of infection. Alcohol-based hand rubs are a good alternative if soap and water are not available. Hands should be washed after coughing, blowing the nose or sneezing. It may sometimes be impossible to avoid all contact with a person who is sick, the spread of infection can be prevented if touching the eyes, nose, or mouth are avoided. Tissues should be used to cover the mouth when sneezing or coughing. When tissues are unavailable, sneezing or coughing into the sleeve of one’s clothing (at the inner elbow) is another means of containing sprays of saliva and secretions.

The doorbell rings. The Heal team has arrived. As they settle into your living room, you clear your throat and tell the story of your symptomatology. Armed with a new understanding of pharyngitis, you now stand ready to make an informed shared medical decision with your Heal doctor.

Dr. Manuel Celedon is a San Diego native and completed his undergraduate at UC San Diego. He obtained his M.D. from the David Geffen School of Medicine at UCLA. He specializes in Emergency Medicine and trained at Harbor-UCLA Medical Center. He is committed to medical education and authored a chapter for the USMLE review book, Crush Step 1 and is a senior editor of WikEM.org.

Any views or opinions expressed in this blog post are solely those of the author, an independent physician, and do not necessarily represent those of Heal. You should not assume or construe that this blog post represents the opinion of Heal. In addition, although this blog post provides information concerning potential medical issues, it should not be relied upon as medical advice. It is not a substitute for consultation with a qualified, licensed physician and does not replace a physician’s independent judgment about any given patient’s condition or appropriateness or risks of any treatment or procedure. Rather, this blog post is solely for general educational and informational purposes. Your reading of this blog post does not create any physician-patient relationship between you and the author.


Originally published at blog.getheal.com.

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