Sore Throat - How & Why

SORE THROAT – How And Why?

Causes of Sore Throat:

Acute inflammation of the throat due to infection is called as Acute Pharyngitis (Sore Throat).

Sore throat is one symptom of an array of different medical disorders. Infections are responsible for the majority of sore throats, and these are the sore throats that are contagious (can be passed from one person to another). Infections are caused by either viruses (such as the flu, the common cold, mononucleosis), or bacteria (such as strep, mycoplasma, or hemophilus).

The most important difference between viruses and bacteria is that bacteria respond well to antibiotic treatment, but viruses do not.

Viruses: Most viral sore throats accompany the flu or a cold. When a stuffy-runny nose, sneezing, and generalized aches and pains accompany the sore throat, it is probably caused by viruses. These are highly contagious and spread quickly in a community, especially in the winter. The body cures itself of a viral infection by building antibodies that destroy the virus, a process that takes about a week.

Causes: Viruses- Epstein-Barr virus (infectious mononucleosis).

Other viral infections such as measles, chicken pox, whooping cough, and croup are accompanied by sore throat. Canker sores and fever blisters in the throat are also very painful.

One special virus infection takes much longer than a week to be cured: – infectious mononucleosis or “mono”. This virus lodges in the lymph system, causing massive enlargement of the tonsils (with white patches on their surface) and swollen glands in the neck, armpits and groin. It creates a severe sore throat, sometimes causes serious difficulties in breathing, and can affect the liver, leading to jaundice (yellow skin and eyes). It causes extreme fatigue that can last six weeks or more.

“Mono” is a severe illness in a teenager or young adult, but it is less severe in a child. Since it can be transmitted by saliva, it has been nicknamed the “kissing disease”. However, it can be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.

Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can cause damage to the heart valves (rheumatic fever) and kidneys (nephritis). Streptococcal infections can cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.
Cause: Bacteria- Streptococcus pneumonia
Streptococcus pyogens (Strep throat) (group A beta-hemolytic)

Because of these possible complications, a strep throat should be treated with an antibiotic. It is not always detected by examination, and a throat culture may be needed.

A newly developed strep test detects a streptococcal infection in about 15 minutes. These tests, when positive, influence the physician to prescribe antibiotics. Strep tests might not detect a number of other bacteria that can also cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection with strep culture tests.

Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues “catch” infections, sampling the child’s environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest that the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as 3 to 4 times each year for several years) were healthier after their tonsils were surgically removed.

Infections in the nose and sinuses can cause sore throats because mucus from the nose drains down into the throat and carries the infection with it.

The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that obstructs the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffeled, and when breathing becomes difficult. A strep test may miss this infection and be negative.

Allergy : Hayfever and allergy sufferers can get an irritated throat during an allergy attack the same way they get a stuffy, itchy nose, sneezing, and post nasal drip. The same pollens and molds that irritate the nose when they are inhaled also irritate the throat. Cat and dog danders and house dust are common things that can cause sore throats for people with allergies to them.

Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose.

An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat where they are extremely irritating. This can be avoided if the head end of the cot is elevated 4-6 inches higher than the foot. You should also avoid eating and drinking for one to two hours before retiring. One might find antacids helpful. If these fail, see your doctor.

Industrial pollutants and chemicals in the air can irritate the nose and throat, but by far the most common and pervasive air pollutant is tobacco smoke. Many persons who are either allergic or sensitive to its contents cannot tolerate it. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods.

A person who strains his voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain, but also from the rough treatment of the throat membranes. Well-trained, experienced public speakers and singers learn to produce loud voices by taking deep breaths and using their chest and abdominal muscles.

Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long term use of tobacco and alcohol. Sore throat and difficulty in swallowing – sometimes with pain radiating to the ear – may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.


A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:

  • Increase your liquid intake (Warm tea with honey is a favorite home remedy.)
  • Use a steamer or humidifier in your bedroom.
  • Gargle with warm salt waters several times daily: 1/4-tsp. salt to 1/2-cup water.
  • Take mild pain relievers such as Paracetamol (Crocin, Metacin, Calpol), Ibubrofen (Brofen) etc.

When should I see a Doctor?

Whenever a sore throat is severe, persists longer than the usual five to seven day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, one should seek medical attention. The following signs and symptoms should alert to see a physician:

  • Severe and prolonged sore throat
  • Difficulty in breathing
  • Difficulty in swallowing
  • Difficulty in opening the mouth
  • Joint pain
  • Earache
  • Rash
  • Fever (over 101 degree)
  • Blood in saliva or phlegm
  • Frequently recurring sore throat’
  • Lump in neck
  • Hoarseness lasting over 2 weeks


Antibiotics are drugs that kill or impair bacteria. Pencillin or erythromycin (well known antibiotics) is prescribed when the physician suspects streptococcal or other bacterial infection that will respond to them. However, a number of bacterial throat infections do not respond to pencillin, but require other categories of antibiotics instead. Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When such a combined infection occurs, antibiotics may become necessary.

When an antibiotic is prescribed, it should be taken – as the physician directs – for the full course (usually 7-10 days). Otherwise the infection will probably be suppressed rather than eliminated, and it can return.

What If My Throat Culture Is Negative?

A strep culture tests only for the presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative culture and sometimes so does a streptococcal infection. Therefore, when culture is negative, the physician will base his decision for treatment on the severity of symptoms and the appearance of the throat on examination. Do not discontinue the medications unless the physician instructs.

Should Other Family Members Be Treated Or Cultured?

When strep throat is proven by test or culture, many experts recommend treatment of other family members, because streptococcal infections are so highly contagious. Others recommend treating only the family members with sore throats and culturing the others. So be sure to tell the physician how other family members are feeling. Practice good sanitary habits: avoid close physical contact and sharing of napkins, towels and utensils with the infected person. Hand washing makes good sense.