Some Sore Throats Require Evaluation

It's that time of year: People are suffering from respiratory tract infections more than usual, especially children. A common symptom in these infections is sore throat.

Sore throats, like head colds, seem more prominent in the fall and winter, possibly because people are concentrated in enclosed spaces, making it easier to transmit their germs, says William F. Prudlow, MD, Associate Professor of Otolaryngology and Communication Sciences at the Medical College of Wisconsin. He also notes that recent epidemiological studies suggest that a relative deficiency of vitamin D, the "sunshine vitamin," could be a significant factor.

"A sore throat is a symptom, not a disease by itself, and it's often associated with a runny nose or other symptoms," he says.

But not all sore throats are benign, Dr. Prudlow notes. Some are long-lasting, and might indicate a more serious underlying condition. It's useful to begin by understanding the four types of underlying causes for sore throats - viral, bacterial, neoplastic, and irritant.

Viral
Because most sore throats and common colds are infections caused by viruses, antibiotics are not effective. This type of illness typically lasts less than two weeks.

"An exception is mononucleosis, most commonly found among adolescents," Dr. Prudlow says. Infectious mononucleosis, or "mono," "is a viral infection characterized by a severe sore throat with a visible membrane on the throat and tonsils, plus enlarged neck glands, accompanied by severe fatigue." Symptoms last from two to six weeks, he says, and as with colds, treatment is purely supportive, since antibiotics don't kill viruses. The body builds antibodies that eventually destroy the virus.

Like colds, mononucleosis is a contagious illness and can be transmitted through saliva, from mouth to hand, from hand to mouth or nose, and by sharing items like towels and eating utensils. In the most severe cases, mononucleosis can cause breathing difficulties and jaundice.

Bacterial
Strep throat is the most common bacterial infection, Dr. Prudlow says. It's caused by a strain of Streptococcus bacteria. Unlike a sore throat accompanied by a cold, strep is usually localized to the throat, but it might be accompanied by headache, fever, and nausea. Although the throat often appears obviously red or patchy with pus, most physicians prefer to diagnose it with a culture or a chemical test called a rapid strep test to definitively identify it as a strep infection.

Because it is a bacterial infection, a strep throat should be treated with antibiotics such as penicillin, or a similar drug if the patient is allergic to penicillin.

"Strep throats can become chronic," Dr. Prudlow says, "especially if they are severe and not treated." A complication in some cases is the development of a peritonsillar abscess, also called "quinsy." Patients with this disorder suffer severe pain on one side of the throat, have extreme difficult swallowing, and usually have difficulty opening their mouth. This usually requires surgical drainage of the abscess.

Patients who experience repeated bouts of strep throat or experience an abscess are often advised to have their tonsils removed, he says, especially if the tonsils remain large and obstructive.

If left untreated, strep throat can lead to more serious conditions, including rheumatic fever, or kidney or muscular disorders. These complications are rare in the United States.

The Medical College is engaged in research involving biofilm, a collection of bacterial organisms encased in a polysaccharide matrix that adhere to the surface of affected tissues and are highly resistant to antibiotic penetration. "It's one of the most exciting areas of study right now," Dr. Prudlow says. "It probably explains why surgical removal of tonsils is the better option for recurring strep throat."

Neoplastic
Neoplasms are tumors or uncontrolled growth of abnormal tissue. Frequently, these growths indicate cancer. "Patients whose sore throats may be mild or severe but last for weeks or months should be examined by a physician to determine the cause of their discomfort," Dr. Prudlow says.

Because this process often involves areas of the throat that can only be visualized with a mirror exam or endoscope, the exam is usually performed by an otolaryngologist (ear, nose and throat specialist). Other associated symptoms can include hoarseness, difficulty swallowing, localized pain, ear pain and perhaps a lump in the neck.

"Smoking and alcohol are the primary risk factors in cancers of the mouth, pharynx, and larynx," he notes. (The pharynx extends from the mouth and nasal cavities to the larynx, which contains the vocal cords.)

Irritants
Sore throats can also be caused by a broad variety of environmental irritants. "These include chemicals and cigarette smoke and allergies to pollen, pet danders, mold, or dust. They can make the nose dysfunctional so the throat has to overwork and becomes sore," says Dr. Prudlow.

"Another irritant, often overlooked, is acid reflux. Even patients whose heartburn is controlled through medication or diet still might experience throat irritation from gastric acid or pepsin because the throat is much more susceptible than the esophagus to these refluxed chemicals. Persistent hoarseness, a feeling of a lump in the throat and need to clear the throat frequently can be symptoms of this disorder."

Dr. Prudlow advises patients with persistent hoarseness lasting more than a few weeks to see an otolaryngologist for evaluation. In some cases, tests might be ordered to confirm the diagnosis.

Most Case are Uncomplicated
In most cases, sore throats and colds are mild, and will resolve on their own after a week or two. Patients, and parents of young patients, can help hasten their recovery and boost their immune systems with simple supportive treatments like getting more rest, increasing fluid intake, and consuming soothing foods and beverages like chicken soup and warm tea with honey. A healthy diet and possibly supplements of vitamins C and D might also offer some help. Sometimes, a salt-water gargle or inhaling moist air from a vaporizer can make a scratchy throat feel better.

Barbara Abel
HealthLink Contributing Writer

Dr. Prudlow practices at the Froedtert & The Medical College of Wisconsin Otolaryngology and Communication Sciences Clinic.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.