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Sore Throat

Definition :
The dry scratchiness and painful swallowing that are the hallmarks of a sore throat — known medically as pharyngitis — can be miserable. Yet a sore throat isn't a disease. Most often, it's a symptom of another illness — usually a viral infection such as a cold or the flu (influenza). In many cases, a sore throat is the first indication that you're getting sick.

Sore throats are so common they're one of the main reasons Americans see a doctor. But many of those office visits aren't necessary. Most sore throats are caused by a virus and go away on their own in about a week. Only a small percentage are bacterial infections that may require medical care.

Bacterial infections are sometimes treated with antibiotics, although drugs don't always speed healing or prevent infections from recurring. And antibiotics aren't effective against viruses, which respond best to self-care measures such as resting and drinking plenty of fluids. Until you're feeling better, salt-water gargles, throat lozenges or warm water with honey and lemon can help make having a sore throat easier to swallow.

Causes :
Most sore throats are caused by viruses — the same germs that cause colds and flu. A much smaller number are due to bacterial infections. Viruses and bacteria both enter your body through your mouth or nose — either because you breathe in particles that are released into the air when someone coughs or sneezes, or because you have hand-to-hand contact with an infected person or use shared objects such as utensils, towels, toys, doorknobs or a telephone. Touch your eyes or nose after such contact and you're likely to become sick yourself.

Because the germs that cause sore throats are contagious, they can spread easily wherever large numbers of people congregate: schools, child care centers, offices and yes, your own home. Even so, not all sore throats result from viral or bacterial infections. Other common causes of sore throat include :

  • Allergies. The same pet dander, molds and pollens that trigger allergic reactions such as red, swollen eyes and a runny nose can also cause a sore throat.
  • Dryness. Dry indoor air, especially in winter when rooms tend to be overheated, can make your throat feel rough and scratchy, particularly in the morning when you first wake up. Breathing through your mouth — often because of chronic nasal congestion — can also cause a dry, sore throat.
  • Pollution and other irritants. Outdoor air pollution can cause ongoing throat irritation. But indoor pollution — especially tobacco smoke — is an even greater cause of chronic sore throat. What's more, inhaling secondhand smoke is often just as damaging as smoking itself. Smokeless tobacco, alcohol and spicy foods can also inflame your throat.
  • Muscle strain. You can strain muscles in your throat just as you can strain them in your arms or legs. If you've ever gotten a sore throat after yelling at a concert or sporting event, you've likely strained your throat muscles.
  • Acid (gastroesophageal) reflux disease (GERD). This occurs when stomach acid backs up into your food pipe (esophagus). Normally, a circular band of muscle (lower esophageal sphincter) blocks acid from coming up into the esophagus. But if the sphincter relaxes abnormally or weakens, stomach acid can back up, irritating your throat as well as your esophagus. Throat irritation caused by GERD doesn't occur with other symptoms of a viral illness, and it tends to be persistent, rather than lasting just a few days. It's also far more common in adults than in children. In many cases, you can prevent or reduce acid reflux with simple lifestyle changes — losing weight, avoiding foods that cause you discomfort and not eating right before bed, for example. When these aren't effective, over-the-counter or prescription medications may offer some relief.
  • HIV infection. HIV-positive people with low CD4 counts sometimes develop a chronic sore throat. This isn't due to HIV itself but to a secondary infection such as oral thrush or cytomegalovirus, a common viral infection that can be extremely serious in immunocompromised people.
  • Tumors. If you smoke or abuse alcohol, you're at high risk of tumors of the throat, tongue and voice box. In some people these tumors cause few, if any, signs and symptoms. In others, they can lead to hoarseness, difficulty swallowing and sore throat.

Risk Factor :
Although anyone can get a sore throat, some factors make you more susceptible to throat problems. These factors include :

  • Age. Children and teens are most likely to develop sore throats. In the United States, children between ages 5 and 18 may have as many as five sore throats a year, whereas adults have less than half that number. Children are also far more likely to have strep throat, the most common bacterial infection associated with a sore throat.
  • Smoking or exposure to secondhand smoke. Tobacco smoke, whether primary or secondary, contains hundreds of toxic chemicals that can irritate the throat lining.
  • Allergies. If you have seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, you're more likely to develop a sore throat than people who don't have allergies.
  • Exposure to chemical irritants. Particulate matter in the air from the burning of fossil fuels as well as common household chemicals can cause throat irritation.
  • Chronic or frequent sinus infections. Drainage from nose or sinus infections can cause throat infections as well.
  • Living or working in close quarters. Viral and bacterial infections spread easily anywhere people gather — child care centers, classrooms, offices, prisons and military installations.
  • Poor hygiene. Washing your hands carefully and often is the best way to prevent many viral and bacterial infections.
  • Lowered immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include diseases such as HIV and diabetes, treatment with steroids or chemotherapy drugs — even fatigue and poor diet.

When to seek medical advice :
Although uncomfortable, most sore throats aren't harmful and go away on their own in five to seven days. But sometimes they can signal a more serious condition. See your doctor if you or a child has any of the following :

  • A sore throat that is severe or lasts longer than a week
  • Severe difficulty swallowing or breathing
  • Excessive drooling in a young child
  • A temperature higher than 101 F in babies under age 6 months and 103 F in older children
  • Tender or swollen lymph glands in the neck
  • Pus at the back of the throat
  • Rash
  • Hoarseness that lasts longer than two weeks
  • Blood in saliva or phlegm
  • Symptoms of dehydration, such as sunken eyes, severe weakness and decreased urine output
  • Contact with someone who has been diagnosed with strep throat
  • Recurring sore throats

Symptoms :
A sore throat usually occurs with other signs and symptoms. These can vary considerably, depending on the type of infection you have. Most often, a sore throat accompanies a viral infection, such as a cold or the flu. You can usually distinguish between the two based on your symptoms. For example, in addition to a sore throat, a cold is likely to cause :

  • Sneezing
  • Watery eyes
  • Cough
  • A low fever — less than 102 F
  • Slight body aches or mild headache

Influenza, on the other hand, is usually marked by :

  • Fatigue
  • Body aches
  • Chills
  • Sweats
  • A fever over 102 F

Mononucleosis is another viral illness associated with a severe sore throat. Although signs and symptoms of the disease typically last about 10 days, it can take weeks to recover your strength after a bout of mono. In addition to a sore throat, mononucleosis may cause :

  • Swollen lymph nodes in your neck and armpits
  • Swollen tonsils
  • Headache
  • Skin rash
  • Loss of appetite
  • Soft, swollen spleen
  • Liver inflammation

A sore throat often occurs with other viral illnesses, including :

  • Measles
  • Chickenpox
  • Croup

Bacterial infections
Bacterial infections that can cause a severe sore throat include strep throat, tonsillitis and diphtheria — a serious respiratory illness that causes breathing difficulties and painful swallowing. Diphtheria is rare in industrialized nations but remains a threat in developing countries.

Most often, your doctor or your child's pediatrician will diagnose the cause of a sore throat on the basis of a physical exam and a throat culture. During the exam, your doctor is likely to check your throat for redness and swelling and for white streaks or pus on your tonsils. Although these signs indicate an infection, there's no accurate way to tell by looking if it's viral or bacterial.

For that reason, your doctor is likely to take a throat culture or perform a rapid strep test to check for the presence of bacteria that cause strep throat. In either case, your doctor will rub a sterile swab over the back of your throat and tonsils to get a sample of the secretions.

In the past, the only way to accurately diagnose strep throat was to have these secretions cultured in a laboratory — a procedure could take up to two days. Now, your doctor may use a rapid test that checks for bacterial infections within hours, but because rapid tests may miss a fair number of infections, your doctor may choose to have additional laboratory testing done as well.

Complications :
Although most bacterial throat infections aren't dangerous, they can lead to serious complications. Strep throat, in particular, can cause other infections, such as tonsillitis, sinusitis, ear infections and scarlet fever — an illness marked by fever, severe sore throat and rash.

For reasons that aren't clear, two of the most serious sore throat complications — kidney damage (glomerulonephritis) and rheumatic fever — are less common than they once were, but they can cause real problems when they do occur. Rheumatic fever, for instance, causes inflammatory spots (nodes) to form in various tissues, including your joints, skin and muscles. These nodes also may form on the heart muscle, the lining of the heart and especially the heart valves, causing scarring that can interfere with the flow of blood inside the heart. Although surgery can sometimes repair scarred valves, the damage is often permanent.

Complications of viral infections
Although bacterial infections that cause sore throats are generally more serious than viral infections are, even viral infections aren't without risk. Infectious mononucleosis, for instance, can lead to an enlarged, and possibly ruptured, spleen. Other complications of mononucleosis include :

  • Liver inflammation (hepatitis)
  • Low levels of blood cells involved in clotting (platelets)
  • Anemia
  • Inflammation of the heart
  • Nerve damage, possibly leading to paralysis
  • Swollen tonsils, leading to obstructed breathing

Most sore throats go away without treatment, often within a week or so. That's a good thing, because no medical therapy exists for sore throats caused by viral infections. But increasing your fluid intake and getting extra sleep can help speed your recovery.

When you're sick, choose fluids such as water, soups and broths — not sodas or drinks that contain caffeine, which can dehydrate you further. If you find it extremely painful to swallow, try sipping warm broth through a straw or sucking on ice chips. You may also find that jello slides down easily.

Treating bacterial infections
At one time, doctors automatically treated all sore throats with antibiotics, both to cure the infection and to prevent dangerous complications such as rheumatic fever. Now, though, doctors are much less likely to prescribe medication because the overuse of antibiotics has led to an alarming increase in antibiotic-resistant strains of bacteria. What's more, antibiotics such as penicillin do little to hasten recovery from strep throat or to reduce signs and symptoms, and they don't prevent infections from recurring. Be sure your doctor performs a rapid strep test before prescribing any antibiotic for a sore throat.

If your doctor does recommend antibiotics for you or your child, take the entire course of medication, even if you feel better. This helps prevent the infection from coming back. It also prevents bacteria from becoming resistant to the medication. If children on antibiotic therapy feel well and don't have a fever, they often can return to school or child care when they're no longer contagious — usually 24 hours after beginning treatment.

The single best way to prevent illness is also one of the simplest: hand washing. Teach your children to wash their hands often — before eating and after using the bathroom, and after spending time in a crowded public space or touching animals. Show them how to wash their hands thoroughly, covering all hand surfaces — front and back — with soap and rubbing hands vigorously under warm running water. Teach young children to scrub their hands for as long as it takes them to sing the alphabet song or the "Happy Birthday to You" song — about 10 to 15 seconds.

Alcohol-based hand sanitizers are an excellent alternative to hand washing, particularly when soap and water aren't available. They're actually more effective than hand washing in killing bacteria and viruses that cause disease. And because hand sanitizers often contain moisturizing ingredients, they may cause less skin dryness and irritation. Not all hand sanitizers are created equal, however — avoid products that don't contain alcohol.

These measures may also help keep you and your children healthy :

  • Avoid sharing eating utensils, glasses, napkins, food or towels with others.
  • Avoid touching public phones or drinking fountains with your mouth.
  • Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. When you travel, clean phones and remotes in your hotel room.
  • Avoid close contact with people who are sick.
  • Stay indoors as much as possible on high pollution days.
  • Don't smoke, and avoid exposure to secondhand smoke.
  • Humidify your home if the air is dry.
  • Cough or sneeze into a tissue and then throw it away.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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