SORE THROAT

Anatomy of the throat

Technically the throat (pharynx) begins at the back of the mouth at the level of the tonsils. It ends where the oesophagus or gullet starts, and on the outside this is approximately at the lower end of the neck. The structures in the throat include tonsils, back of the tongue, voice box (larynx), and the lining of the pharynx.

What causes a sore throat?

Any reason that leads to an inflammation of the throat lining can cause a sore throat. This can be due to an infection, either viral or bacterial. Infection is a common cause of soreness. Most adults suffer from 2-3 viral sore throats a year. Children may have a few more episodes. These are self limiting, and tend to resolve within a week or so.

Tonsillitis is another cause of a sore throat. The pain is moderate to severe, and at its peak swallowing can be difficult. It is accompanied by fever, malaise, earache, and adults may take time off work to speed recovery and prevent spread amongst co-workers.

Pharyngitis or inflammation of the throat lining can be due to an infection. In most cases it is self limiting. However, in some cases it can be chronic. Here the soreness persists despite a lack of signs suggesting an infection. Several reasons can cause this chronic inflammation. A postnasal drip, acid regurgitation from the stomach, mouth breathing at night, and snoring are some causes.

Throat cancer can cause a sore throat. Fortunately, it is uncommon. The pain can be severe accompanied by an earache, and swallowing can be affected. Soreness usually gets worse with time.

Laryngitis or inflammation of the voice box can cause a sore throat. This is invariably accompanied by a change in voice. The need to constantly clear the throat can cause soreness.

How is it managed?

Most patients see their family doctor as a first step. Antibiotics are prescribed although their role remains controversial as most infections are viral. If the soreness persists for more than 2 weeks it is important to seek advice from an ENT specialist.

An ENT specialist will take a history which provides clues to the possible cause. A flexible endoscopy in the clinic is essential to view the throat.

What is a flexible endoscopy?

This is an examination using an endoscope housed in a flexible tube that can be manoeuvred through the nasal passage into the throat to get a panoramic view of the throat, and voice box. It is carried out in the clinic. To minimise discomfort a local anaesthetic is used. This can numb your throat (to a degree) for a few hours, and it is best to avoid a hot drink or food. All areas of the throat can be thoroughly examined with this endoscope.

What is the treatment for a sore throat?

As mentioned above there are several reasons for a sore throat. Hence, it is important to find a cause and treatment is tailored to the situation.

In patients with chronic pharyngitis a reason may not be obvious, and occasionally symptomatic treatment is the only recourse.