Causes of Throat Pain and Treatment Options

Throat pain is extremely common and can be caused by a variety of ailments that affect most of us at some point in our lifetime. Some of the most prevalent causes of a sore throat may include a cold virus, acid reflux, or allergies.

Throat pain can also make it difficult to eat and drink. If severe enough, swallowing problems can lead to weight loss or other complications. This article will cover the different causes of throat pain, explain when you should see a doctor, and what you can do to ease your sore throat.

Some of the most common causes of throat pain include:

• Viral infections: The flu, cold viruses, croup, mononucleosis, and—less commonly—herpangina, measles, and chickenpox.
• Bacterial infections: Strep throat can cause severe throat pain and difficulty swallowing. The tonsils may also become very swollen. Another bacteria called Arcanobacterium haemolyticum can also cause throat pain as well as a rash. Bacterial causes of throat pain need to be treated with antibiotics. Strep throat can lead to serious complications such as heart or kidney damage if left untreated.
• Infections of the nasal passageways or sinuses: Bacteria, viruses, and even fungus can cause post-nasal drip. The resulting infected mucus that runs down the back of the throat can cause a sore throat.
• Allergies: Dust, mold, or dander allergies, in particular, can cause the post-nasal drip that contributes to your sore throat.
• Acid reflux: A sore throat caused by acid reflux is often worse in the morning since acid from the stomach can enter the esophagus, back of the throat, and mouth (contributing to tooth erosion) during the night while you are sleeping.

• Irritation from dry air, chemicals or cigarette smoke: This may be exacerbated by breathing with your mouth open.
• Laryngitis from overusing your voice: This is often a problem for singers and individuals who use their voice as part of their occupation. Laryngitis usually causes hoarseness and pain when talking as well.
• Post-intubation: You can develop throat pain if you have had a breathing tube inserted during surgery or due to illness or injury. This is temporary and will usually subside in a day or two after the tube is removed.
• Surgery: Surgeries such as a thyroidectomy can also cause throat pain. Other procedures such as an EGD (esophagogastroduodenoscopy) where an endoscope is inserted through the mouth and back of the throat can also cause this type of throat pain.
• Cancer: While very rare, tumors or other growths can lead to throat pain.

Persistent throat pain with unknown causes should be evaluated by a physician to rule out serious causes that can lead to dangerous health complications.

If an infection is causing your throat pain, you will likely have other symptoms such as a fever, cough, fatigue, or sore muscles.

Extreme pain or severe swelling of the tonsils are both reasons to see a doctor.

Throat pain accompanied by a rash is often bacterial in nature. A doctor should determine if antibiotics are needed.

A sore throat accompanied by post-nasal drip (mucus running down the back of the throat) is rarely associated with emergent or serious conditions. However, if this persists longer than a few weeks, you may need to see a doctor to determine the root cause. Your family doctor is a great place to start, but you may ultimately need to see an immunologist to be tested for allergies.

While not an emergency, throat pain that is worse in the morning or accompanied by symptoms such as stomach pain or heartburn should be evaluated by a doctor. Family doctors and general practitioners often diagnose acid reflux and are capable of performing diagnostic tests or referring you to a more specialized doctor if necessary.

There are many medications available, both over-the-counter and prescription, that can treat throat pain related to acid reflux. However, you should see a doctor for an initial diagnosis and to rule out any serious conditions.

If you experience throat pain immediately after having general anesthesia or having a breathing tube inserted for any reason it is probably no cause for concern. However, if throat pain does not subside within a few days, you may want to contact a physician. Some surgeries, such as a thyroidectomy can in and of themselves cause throat pain, so keep this in mind.

The following conditions are actual emergencies. You should call 911 or go to the emergency room if you experience throat pain accompanied by:

• Persistent drooling
• Inability to swallow
• Difficulty breathing

Diagnosing the source of throat pain can involve labs and tests, medical imaging, or differential diagnosis.

Throat culture: A throat culture is a test where the back of the throat is brushed with a long cotton swab. The cotton swab is then sent to the laboratory to be analyzed for bacteria. The swab can usually be evaluated for strep throat very quickly (this is called a rapid strep test). Additionally, sinusitis or infections of the nasal passageways may be diagnosed using cultures of your throat or your sputum.

Allergy Testing: If your doctor suspects allergies are the cause of your sore throat, they may perform blood tests or skin tests to confirm this.

Skin testing involves making a tiny scratch in your skin and exposing you to an allergen (a substance you are potentially allergic to) to see if you have a reaction. The results of skin testing are available immediately while blood test results may take a few days.

Medication Trials: If your doctor suspects acid reflux is the cause of your sore throat, they may prescribe a trial of acid reflux medication to see if you respond. This is also true with suspected allergies; your doctor may prescribe a trial of antihistamine medication before completing allergy testing.

Medical imaging, specifically CT scans, ultrasounds, or MRIs can be used to diagnose throat pain if the suspected cause is due to a lump or growth, or sinusitis.

A common method of diagnosing acid reflux or similar problems is an esophagogastroduodenoscopy (EGD) (also sometimes called an upper endoscopy). This procedure involves inserting a small camera into the back of the throat and down the esophagus to visualize the tissue of the esophagus. Another test that can be used is a barium swallow.

If you have a lump or bump associated with your sore throat, your doctor will try to determine if it is a lymph node or something more concerning. If your doctor cannot determine that the lump is a lymph node, they may order a biopsy.

In the case of rapid strep tests, false negatives can occur. For this reason, after a rapid strep test is performed the throat culture is usually sent to the lab for further testing. You could still get a call back in the next day or two telling you if you actually do have strep throat.

There are a few options that you can start immediately to treat your sore throat.

• Stay hydrated
• Avoid smoke
• Use a humidifier

There are a variety of medication options to treat underlying causes of throat pain, as well as medications to treat the actual symptom of a sore throat.

Antibiotics: If you are diagnosed with a bacterial infection like strep throat, your doctor will start you on an antibiotic. This may include a one-time shot or oral antibiotics over a period of time. Make sure you tell your doctor about any allergies to medications, as there are many options that your doctor can choose from if you have an allergy to penicillin or other antibiotics.

Antihistamines: If you have allergies, you might want to try an antihistamine if you are not currently on one. Histamine is released as a result of your body coming into contact with a substance that you are allergic to (pollen, mold, dander, etc.). Histamine is a cause of pain sensation in your body, so taking an antihistamine like Zyrtec (cetirizine), Claritin (loratadine), or Allegra (fexofenadine) will help throat pain related to allergies.

Acid Reflux Medication: Treatment of acid reflux can take time. But the sooner you are diagnosed and treated, the sooner symptoms like a sore throat will resolve. Your physician will likely start you on a trial of an H2 blocker or a proton pump inhibitor (PPI). You may find both of these medications over the counter. Over-the-counter H2 blockers include Pepcid (famotidine) or Zantac (ranitidine). Over-the counter PPIs include Prilosec (omeprazole), Prevacid (lansoprazole), and Nexium (esomeprazole).

Regardless of the reason you are experiencing throat pain, there are several treatments that can help you control your level of pain. Aspirin, NSAIDs (like ibuprofen or naproxen), and Tylenol (acetominophen) all are very effective in controlling the pain associated with a sore throat. If you are having severe throat pain and/or you are having difficulty swallowing due to the severity of your pain, your doctor may prescribe glucocorticoids (like prednisone or dexamethasone).

You can also use any over-the-counter throat sprays or lozenges to help relieve your pain. Common active ingredients of sprays include phenol and benzocaine.

In order to stay hydrated, you may want to try some warm caffeine-free tea. While research is limited, you may try adding or buying tea that has honey, pectin, or glycerin. These ingredients are referred to as demulcents, which help relieve irritation in your oral mucous membranes and create a soothing film in your mouth.

There is a commercial product known as Throat Coat that contains licorice root, slippery elm bark, dry aqueous extract, and marshmallow root, as well as a proprietary blend of other organic substances. A small study showed a significant decrease in pain 30 minutes following the consumption of Throat Coat.

There are inconsistent findings related to a variety of Chinese herbs and acupuncture. As such, these are generally not recommended. You will, however, likely find many testimonials stating the contrary. You should discuss with your doctor before experimenting with any herbal medications, particularly if you would be mixing them with medications that your doctor has prescribed.

The most effective means for preventing a sore throat caused by a viral or bacterial cause is hand washing. Thorough hand washing for at least 20 seconds—ensuring that you clean your fingernails down to your wrists—can greatly reduce your risk for acquiring an infection. Hand sanitizing lotions are a good alternative means when you are not near a bathroom.

Acid Reflux: If you have acid reflux, you may want to discuss whether or not your weight is a potential cause. If it is, weight loss can be a great lifestyle adjustment to reduce your related symptoms and help prevent long-term throat pain.

Allergies: If you have allergies, you may discuss long-term use of oral or nasal allergy medications. Immunotherapy may also be an option.