Pharyngitis

Signs and Symptoms

The symptoms that accompany a sore throat can vary, depending on what's causing it.

Sore throat with cold:

• Sneezing
• Cough
• A low fever (less than 102°F/38.9°C)
• Mild headache

Sore throat with flu:

• Fatigue
• Body aches
• Chills
• Fever higher than 102°F/38.9°C

Sore throat with mononucleosis:

• Enlarged lymph nodes in neck and armpits
• Swollen tonsils
• Headache
• Loss of appetite
• Swollen spleen
• Liver inflammation

Causes

Most sore throats are caused by viruses, although a few are due to bacterial infections. You can breathe in bacteria or a virus from air that has been contaminated when someone sneezes or coughs, or you can transfer the organisms to your mouth or nose by touching a surface with germs on them. Viruses that can cause sore throat include the common cold, the flu, and mononucleosis (often called "mono"). Bacteria like Group A streptococcus, commonly known as strep throat, can also cause pharyngitis. An estimated 30% of childhood pharyngitis is caused by Group A streptococcus.

Risk Factors

Risk factors for pharyngitis include:

• Cold and flu seasons
• Having close contact with someone who has a sore throat or cold
• Smoking or exposure to secondhand smoke
• Frequent sinus infections
• Allergies
• Attending daycare or crowded schools

Diagnosis

Your doctor will check your temperature and examine your throat, sinuses, ears, nose, lungs, and neck, including feeling for swollen lymph nodes that may indicate strep throat. He or she may take a throat culture or do a rapid strep test by taking a swab from your throat. Your provider may also order a blood test to check for mononucleosis.

Preventive Care

You should:

• Avoid kissing or sharing cups and eating utensils with anyone who has a sore throat, a cold, flu, mononucleosis, or bacterial infection.
• Wash your hands frequently.
• Not smoke, and avoid exposure to secondhand smoke.
• Use a humidifier if the air in your home is dry.

Treatment Approach

If your doctor suspects that you have a sore throat caused by bacteria, such as strep throat, he or she will prescribe an antibiotic. But if your sore throat is caused by a virus, antibiotics won't help. It will go away on its own.

Cool air and humidity may help relieve symptoms. In the meantime, your doctor may recommend gargling with salt water and taking an over-the-counter pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Children under 19 should not take aspirin, because of the risk of a rare but serious illness called Reye's syndrome.

Lifestyle

• Rest.
• Drink lots of fluid. Water and warm broths are better than soft drinks.
• Avoid drinking alcohol.
• Gargle several times per day with ½ tsp. of salt in a glass of warm water.
• Try throat lozenges, but do not give them to a child under 3 years old due to choking hazard.

Medications

If your sore throat is caused by a bacterial infection, your doctor will prescribe an antibiotic. Doctors commonly prescribe penicillin or, if you have an allergy to penicillin, erythromycin. In severe cases of group A streptococcus, a single dose of steroids may result in a faster onset of pain relief and reduced suffering.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

There is not much scientific evidence about which supplements might help treat a sore throat, or reduce your chances of getting a cold of flu. However, a few supplements and nutrients may be helpful:

• Warm liquids, such as soup or broth. Soup, broth, and tea can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.
• Probiotics (Lactobacillus). So called "good" bacteria or probiotics help prevent infections in the intestines. Preliminary evidence suggests they might help prevent colds, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Another study of children in daycare found those who took a specific combination of Lactobacillus and Bifidobacterium had fewer flu-like symptoms. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it is not possible to say whether the vitamins, minerals, or probiotics were most responsible for the fewer colds. People with weakened immune systems, or those who take drugs to suppress their immune systems, should not take probiotics without their doctor's supervision.
• Honey. Honey is a traditional remedy for sore throat and cough. A 2007 study found that honey given to children before bedtime did a better job of suppressing night time cough than dextromethorphan, a cough suppressant found in many over-the-counter cough syrups. Never give honey to an infant under the age of 1.
• Vitamin C. Research does not support the popular belief that vitamin C can cure the common cold. Scientists have found only a small reduction in the duration of a cold (about 1 day) when people take vitamin C supplements regularly, not just at the beginning of a cold. The only other piece of evidence supporting vitamin C for preventing colds comes from studies looking at people who exercise in extreme environments, athletes such as skiers and marathon runners, and soldiers in the Arctic. In these studies, vitamin C seemed to reduce the risk of getting a cold. Talk to your doctor about any pros and cons with using vitamin C during cold and flu season. Some people believe that you have to take very high doses of vitamin C to get any benefit, but you should only take high doses of vitamin C under your doctor's supervision.
• Zinc. Your body needs zinc for its immune system to function properly, so it has long been thought that zinc could help protect against catching a cold. But the evidence has been decidedly mixed, with some studies finding a benefit from zinc lozenges and others showing no effect. Recently, a review of studies that compared zinc to placebo found that most of them had flaws that made any positive results unreliable. Only four studies were deemed reliable, and three found no benefit from zinc lozenges. The remaining study suggested that zinc nasal sprays might help reduce nasal stuffiness, but zinc nasal sprays have been reported to cause permanent loss of smell and are not recommended. If you do decide to try zinc lozenges for a cold, remember that getting too much zinc (more than 50 mg per day over a long period of time) can be dangerous. People taking cisplatin, penicillamine, and quinolone, or tetracycline antibiotics should not take zinc.
• Vitamin D. Preliminary studies suggest optimal vitamin D stores may reduce the risk of developing pharyngitis. More research is needed.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Before giving any herbs to a child to treat a cold, talk to your pediatrician.

To prevent colds and flu:

• Echinacea (Echinacea purpurea). Although evidence on whether echinacea works to prevent or treat colds has gone back and forth, recent evidence is encouraging. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58 percent and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it is impossible to say which one was responsible for the benefit. Women who are pregnant or breastfeeding, or people taking drugs that suppress the immune system (such as corticosteroids or methotrexate), people with autoimmune disease, or who are prone to allergies, should not take echinacea without first asking their doctor. If you are allergic to ragweed, you may be allergic to echinacea. Echinacea can potentially interact with several medications. Speak with your physician if you are taking any medications.
• Andrographis (Andrographic paniculata). One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero or Siberian ginseng (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms. Pregnant or breastfeeding women should not take andrographis. People who are trying to get pregnant should not take andrographis. People with diabetes, or those who take blood-thinners or blood pressure medications should not take andrographis without first asking their doctor.
• Garlic (Allium sativum). In one study, people who took garlic for 12 weeks between November and February had 63 percent fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take bloodthinners, such as aspirin or warfarin (Coumadin), should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements. Garlic can potentially interfere with several medications, including drugs used to treat HIV/AIDS. Speak with your physician.
• Ginseng (Panax quinquefolius). At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds and the severity of symptoms. Ginseng interacts with a number of medications, so ask your doctor before taking it. Pregnant or breastfeeding women should not take ginseng.

There are not many scientific studies that have examined which herbs might work to treat sore throat. These herbs have been used traditionally to relieve sore throat pain:

• Eucalyptus (Eucalyptus globulus). Eucalyptus is used in many remedies to treat cold symptoms, particularly cough, but it may also help soothe a sore or irritated throat. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. You can also use fresh leaves in teas and gargles to soothe sore throats. DO NOT take eucalyptus oil by mouth.
• Licorice (Glycyrrhiza glabra). Licorice root is a traditional treatment for sore throat, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure, kidney disease, liver disease, or heart disease, women who are pregnant or breastfeeding, and those who take bloodthinners, such as aspirin or warfarin (Coumadin), should not take licorice.
• Marshmallow (Althea officinalis). Although there is not any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough. It contains mucilage, which coats the throat and may help relieve irritation.
• Peppermint (Mentha x piperita). Like eucalyptus, peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant, but peppermint is also soothing for sore throats and dry coughs. You should not use peppermint or menthol on infants. DO NOT take peppermint oil by mouth.
• Slippery elm (Ulmus fulva). Slippery elm as a tea or in lozenges may help ease a sore throat and has been used traditionally for this purpose, although scientific evidence is lacking. Like marshmallow, it contains mucilage, which coats the throat and relieves irritation. Pregnant or breastfeeding women should avoid slippery elm. Slippery elm can affect how your body absorbs some medications, so you should wait at least one hour before and at least two hours after taking medication before taking slippery elm.

Some people may find relief gargling these teas:

• Chamomile (Matricaria recutita)
• Sage (Salvia officinalis)
• Blackberry (Rubus fruticosus)

Homeopathy

Few studies haved examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sore throat based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum. For sore throats that come on suddenly after exposure to cold and are accompanied by a high fever and thirst; this remedy works best if given immediately after symptoms begin.
• Apis mellifica. For shiny red, swollen throats with stinging, burning, and dry pains; this remedy is most appropriate for individuals who feel better with cold drinks but have little thirst; they may also have difficulty swallowing, and may have the sensation of a fishbone being stuck in the throat; they also tend to be bothered by anything around the neck.
• Arsenicum album. For a burning sensation in the throat accompanied by thirst, chills, and restlessness; symptoms are relieved by warm liquids; nasal discharge often occurs before the development of a sore throat.
• Belladonna. Usually the first homeopathic remedy considered for sore throats, particularly if there is sudden onset of intense pain on the right side of the throat along with redness, swelling, and a feeling of constriction; individuals also generally have a fever, may experience pain when swallowing (although the individual wants to drink despite the pain), and often describe a hot sensation in the throat; this remedy works best if used during the first 24 hours of throat soreness.
• Hepar sulphuricum. For stinging throat pain that is often described as a stick in the throat; throat pain is usually accompanied by enlarged tonsils; pain may extend to the ears and is generally better from warm drinks; individuals for whom this remedy is appropriate are often very irritable and sensitive to cold, touch, motion, noise, and light.
• Lachesis. For throat pain with swelling that is initially worse on the left side but may spread to the right; symptoms are worsened by warmth, warm liquids, swallowing (including saliva), and constrictive clothing.
• Lycopodium. For throat pain with a choking sensation, as if having a ball stuck in the throat; individuals for whom this remedy is appropriate often have pain that begins on the right side and may spread to the left; symptoms are relieved by warm drinks.
• Mercurius. For throat pain accompanied by fever, weakness, red spots on the tonsils, as well as possible pus, and bad breath; Mercurius is most appropriate for individuals who may be sensitive to both heat and cold and tend to salivate, drool, or perspire, particularly at night.
• Phytolacca. For a dark red, purple, or bluish swollen throat accompanied by excessive aching, fever, and pain with swallowing; individuals for whom this remedy is appropriate may also have a shooting pain that extends to the ears, and an acute pain at the base of the tongue when protruded; these symptoms are worsened by warm drinks and motion.
• Rhus toxicodendron. For throat pain accompanied by restlessness that is worse with initial swallowing, but is relieved by subsequent swallows, as well as warm liquids; symptoms may be initiated by cold air or straining the voice.
• Sulphur. For a burning, lingering sore throat; symptoms are worsened by warm drinks and food; tonsils tend to be swollen, breath may be foul, and gums and nasal passages are dry.

Other Considerations

Prognosis and Complications

A sore throat usually goes away quickly on its own. If you have had a sore throat for more than a week, or you have a fever, swollen lymph nodes, or a rash, you should call your doctor right away. Fever, swollen lymph nodes, or a rash may indicate strep throat or a complication, such as rheumatic fever. Strep throat requires antibiotics to prevent complications such as:

• Scarlet fever, which can cause fever and a bright red rash that begins on the neck and spreads to the trunk and extremities
• Rheumatic fever, which can cause joint inflammation or damage your heart valves
• Glomerulonephritis (kidney inflammation)
• Infection in the bloodstream
• Shock
• Respiratory arrest, particularly among children with croup

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