What causes sore throat?
Sore throat or pharyngitis has a variety of causes:
Dry Air: This is a very common cause of throat discomfort and morning complaints. In the fall and winter, the humidity level in the home drops to less than half the summer level. This is mostly due to the effects of dry heat. Humidifiers built into forced air heating systems only partly correct this dryness. Steam heat is associated with the driest form of heat. The dehumidified air causes the nasal passages and throat to become dry and uncomfortable. Anyone with nasal congestion caused by a cold, will breathe through their mouth all night which will make things even worse.
- To help, a humidifier in the bedroom will increase sleep (and morning) comfort through the entire winter. For an early morning sore throat, try something to drink (especially warm drinks) and a steamy shower. Usually this will bring moisture to these areas and kids will note a significant improvement. Adding a humidifier to the furnace will help the entire house. There is no need to miss school if the sore throat improves this easily as this type of sore throat is not contagious.
Post Nasal Drip: The congestion and mucous from either a cold or from seasonal allergies can cause a sore throat. The mucous relentlessly drips down the back of the throat, causing both discomfort and a cough. A cough causes mechanical irritation to the throat. Nasal congestion causes mouth breathing, which makes the sore throat worse. And none of these are a reason to miss school (unless there is a fever).
- Since the problem is caused from constant nasal dripping, treatment for this type of sore throat should focus on soothing the throat by using hard candy, lozenges, tea with honey and a humidifier. When allergies contribute to the post nasal drip, they can be managed with antihistamines such as generic Zyrtec or Benadryl. Once again, there is no reason to miss school unless the cold that caused the post nasal drip is making your child miserable.
Viruses: There are many viruses that cause sore throats. The most common are: adenovirus, influenza, Para influenza, enterovirus, and the Epstein-Barr virus. Many of these have hundreds of sub-groups. As a result, each season and even within a season, a child can have multiple viral infections. Each infection is a new learning lesson for the immune system. There is no treatment for a viral infection. The key to treatment is to help the child’s symptoms improve which can include acetaminophen or ibuprofen (Tylenol or Motrin). Children with viruses may return to school as long as they are feeling up to it and do not have a fever.
- Enterovirus. Also known as “Coxackie” or “ Hand-Foot-Mouth virus. The classic symptoms are painful viral blisters (sores) in the mouth, with a sore red throat. There is almost always fever the first few days (this is the contagious period). A few scattered red spots may appear on the body and in some cases blistery bumps will appear on the palms of the hands and soles of the feet. If you see blisters on the tongue, lips or throat, it is safe to say that it is enterovirus and not strep. Therefore, an office visit is usually not needed. The onset is usually in early spring or late summer. Treatment focuses on comfort. No antibiotics will cure a virus. Controlling the fever and pain with ibuprofen and acetaminophen are the first steps. Cold milk, ice cream, ice, and other soft cold items are also helpful avoid sweet foods like apple juice as well as acidic foods like orange and cranberry products. Focus on taking in enough fluids (ice cream counts).
- Influenza. (“The Flu”). The word “flu” is used for many things, but the real thing is an illness caused by the influenza viruses. Onset of the flu is usually fairly sudden, and occurs from late January to April. In addition to a very sore throat with large red tonsils, there is a combination of fever, headache, congestion, cough, stomach pain, body aches, nausea and vomiting. These symptoms last for 5-10 days. It is normal for flu fevers to last 1 week. Treatment again focuses on support and comfort. Kids need a lot of rest, fever medicine, and fluids. A strep test is not necessary.
- Mono. This is the most common term for “Infectious Mononucleosis,” which is caused by the Epstein-Barr virus. This illness typically shows a fever for 1-2 weeks, general malaise, an inflamed sore throat, and enlarged spleen. It occurs sporadically throughout the year. Although it used to be called the “kissing disease”, it is now more typically spread by the close contact found in schools as well as by not having good hand washing. Blood-work is required for definitive diagnosis but is not done unless there is a prolonged unexplained illness. There is usually not a rush to make the diagnosis, since treatment only involves supportive care, rest, and avoidance of contact sports.
- Common Colds. These are also part of the jumble of viruses already mentioned, but it is important to point out that even a mild cold can have a few days of sore throat.
What is Strep Throat?
With strep throat or strep pharyngitis, these sore throats are caused by an infection with the streptococcal bacteria. When trying to distinguish bacterial infections such as strep throat which will respond to antibiotics from viral infection which will have to get better on their own, there are 3 signs and 3 symptoms for which to look. Children with 5 of 6 signs and symptoms should be checked for strep.
- The signs to look for include: fever greater than 102, swollen neck glands and pus on the tonsils. The symptoms to look for are headache, sore throat and abdominal pain.
- The diagnosis must be done in the office. Children must see a provider for an evaluation and a throat swab. Fortunately in our office we have an advanced rapid diagnostic system, which will give you the results within 10 minutes. This system is so accurate there is usually no need to wait for overnight testing.
- Treatment of strep throat requires antibiotics, and will only be given for positive lab results! Please finish the entire treatment to avoid recurrences. Amoxicillin is the most commonly used first line of treatment for a strep throat. Typically, one requires 24 hours of antibiotics before return. You have 9 days to treat a strep infection before worrying about complications such as rheumatic heart disease. Children under 3 years are very unlikely to get a strep infection and children under 2 years even more unlikely. When completing treatment, please replace the child’s toothbrush. Strep bacteria can remain on a toothbrush for almost 2 weeks, longer than the typical treatment.
So when do I need an office visit for a sore throat?
- When there is a strong possibility of a strep infection - see above for signs and symptoms
- When the symptoms have lasted for more than a week
- When there has been a fever for more than 5 days
- When the child is absolutely miserable
- When you are worried