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 not only be uncomfortable but cause difficulty with eating and drinking. 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 chicken pox.
• 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: Infections can be caused by different types of infections (bacteria, viruses, or even fungus). These conditions cause post-nasal drip. When infected mucous runs down the back of the throat a sore throat ensues.
• Allergies: Particularly to dust, mold, or dander, but allergies can be in response to a wide variety of substances. Post-nasal drip from allergies can contribute 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, individuals who use their voice as part of their occupation, and more recently voice boxing. 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.

In the case of an infection causing your throat pain, you will likely have other symptoms such as a fever, cough, fatigue, or sore muscles. Some of the other causes of throat pain may be a bit more difficult to sort out. You may need to see a doctor who can help you determine the root cause of your throat pain.

Some key differences between strep throat and viral infections are that strep throat is often accompanied by a high fever and strep throat rarely is accompanied by symptoms such as a cough, runny nose or sneezing. You may have white patches on the back of your throat.

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 and should be evaluated by a doctor to determine if antibiotics are needed.

A sore throat accompanied by post-nasal drip (mucus running down the back of the throat) are 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 by 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 normal and doesn't need to be a 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.

While they may be swollen lymph nodes, any lumps or bumps, especially that are present for more than a week or so, should be evaluated by a physician.

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). 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 testing or skin tests to confirm this. Some family doctors will perform these tests while others may refer you to a more specialized doctor called an immunologist.

Skin testing involves making a tiny scratch in your skin and exposing you to an allergen (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 she may decide to refer you to a gastroenterologist for further testing or they may decide to trial you on an acid reflux medication to see if you respond first. This is also true with suspected allergies, your doctor may wish to trial you on an 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. They do this based on the location of the lump and by ruling out or confirming other infections. If your doctor can not determine that the lump is a lymph node they may order further testing such as a biopsy.

Rapid strep tests can be falsely negative. 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. These are also options to help prevent some forms of throat pain from occurring.

Stay Hydrated: If you become dehydrated, you may experience worsening throat pain for many underlying causes. Ensuring that you are drinking enough fluid will help to reduce the amount of pain you are having in your throat. You will likely find that you have a preference for frozen liquids like popsicles or warmed drink like tea or broth as opposed to refrigerated liquid.

Avoid Smoke: If you are a smoker, stopping will help reduce the amount of pain you have from smoking. Smoking cessation may cause you to experience other symptoms, so you can try a nicotine patch or other smoking cessation technique during this time. If you are a non-smoker, avoiding areas with smoke will help reduce your risk of worsening your symptoms.

Humidification: Humidifying your air is another way to reduce dryness in your throat, which can worsen your sore throat. However, you must be sure to clean your humidifier regularly to prevent the harmful spread of molds or bacteria. You can follow your humidifier manufacturer's instructions or ensure to clean it good weekly if you no longer have the instructions.

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

Viral Infection: Your doctor should not treat your viral infection with an antibiotic. Inappropriate prescribing of an antibiotic can lead to drug-resistant bacteria (superbugs) or cause other problems like a c-diff infection.

Bacterial Infection: 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.

Allergies: 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: Treatment of acid-reflux can take time, however, the sooner you are diagnosed and treatment started, 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 receive relief from your pain. Common active ingredients of sprays include phenol and benzocaine.

Not wanting to use conventional western medicine? Or are you wanting to try to add something to your current treatment options? Some Complimentary and Alternative Medicine (also known as CAM) may be helpful.

In order to stay hydrated, you may want to try some warm caffeine-free tea. Some may advertise that they help treat sore throat. 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 creates a soothing film in your mouth.

There is a commercial product known as Throat Coat, which 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 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.

Preventing a sore throat from occurring can be difficult to impossible. However, there are some general things that you can do to help prevent you from getting a sore throat.

The most effective means for preventing a sore throat caused by a viral or bacterial cause is hand washing. Thorough hand washing for 15–30 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 of your acid reflux. 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 allergy oral or nasal medications. Immunotherapy may also be an option that you can evaluate with your doctor.

Proper hydration is important regardless of the cause and is particularly important if you talk or sing frequently. Make sure that you drink plenty of water throughout your day to help prevent or reduce the amount of throat pain you experience.

A sore throat can make your life miserable. You are not alone. Millions of people visit their doctor each year because of having a sore throat. Getting care is easy as urgent care offices, your primary care office, and emergency departments can quickly check you for common causes of throat pain.

While it may be okay to delay slightly, any throat pain that goes unresolved should be seen by a doctor to prevent further complications. Regardless of how long you have had a sore throat, try some of the over-the-counter and at home treatments listed above and improve your day a little.