Sore throat

From Ganfyd

A symptom of discomfort or pain localised to the upper aerodigestive tract (usually the pharynx and larynx).

Primary Care

In the primary care setting, most cases are due to viral laryngitis, viral pharyngitis or tonsillitis. Almost all are minor, self-limiting illnesses whose best management is nothing but sympathy, symptomatic non-medical behaviour, or symptomatic treatment with a minor analgesic. Picking out the few different ones is the challenge.

In cases due to suspected Epstein-Barr virus infectious mononucleosis, amoxicillin and ampicillin should be avoided as patients can develop a specific rash.

Although a viral cause is most common, some cases can be due to streptococcal pharyngitis ('strep throat'). Antibiotics are throught to marginally shorten the course of the disease, but it can be difficult to differentiate a viral and bacterial cause on clinical alone. Certain features of history and examination are more useful than others^[1]. Bacterial serology often takes too long to usefully inform management.

A small proportion of strep throats are associated with rheumatic fever, although the disease became much rarer in the early part of the 20th century and remains very uncommon. This may have been an evolutionary change by selection in Streptococcus populations.

Secondary Care

Patients actually unable to swallow - who will therefore be drooling - may benefit from a single dose of a steroid^[2]. If the underlying problem is bacterial infection then antibiotics may be useful. Steroids may allow discharge, and avoid the need for intravenous fluids.

Post-operatively

Usually due to irritation of the upper airway tissue from laryngeal mask airway or endotracheal tube. A gargle with NSAID may ameloriate this. ^[3] Usually, self-limiting. Rarely, may signify inadvertent damage.

Relatively immunocompromised patients treated with broad spectrum antibiotics can sometimes develop oral candidiasis, which can also cause mouth and throat discomfort.

References