Throat pain can be a very irritating factor in a person’s life. It can hinder a person’s ability to talk, swallow, concentrate on work, and be just about a nuisance in daily activities. Everyone experiences throat pain now and then. It can be either a generalized throat pain or can be localized to specific structures such as tonsils, larynx, pharynx etc. in fact infection of these structures such as pharyngitis, tonsillitis, laryngitis is one of the main reasons for pain in the throat. Sometimes soreness or irritation at the back of the tongue can also cause throat pain and in rare cases, throat cancer may also cause throat pain. A person’s throat can also become irritated or sore due to allergies, straining of voice, vomiting, or gastric reflux (where stomach acids flow upward into the throat), tobacco usage, being exposed to toxic materials or injuries. Inflammation of throat is commonly caused by viral or bacterial infections. Streptococcus pyogenes or group A Streptococcus is responsible for causing the most common bacterial infection of the throat, also known as strep throat. Infectious mononucleosis is a type of viral infection that also produces throat pain.
Throat pain on its own is not life threatening and may resolve on its own. However, if the pain in throat lasts more than several days and is accompanied by other symptoms, then immediate medical attention is required to find out the cause, especially if there are serious symptoms like choking or severe difficulty breathing, which may be combined with pale or blue lips and high fever (higher than 101 degrees Fahrenheit), fast heart rate (tachycardia), sudden swelling of tongue or throat structures, change in level of consciousness, or change in mental status, persistent or mucus-producing cough with sore throat, white patches and redness in the mouth or throat, or a persistent feeling of something stuck in the throat.
Classification and Types of Throat Pain
Throat pain is classified depending on severity and cause. Sore throat can be of two types depending on severity.
- Acute Throat Pain: This is generally caused due to bacteria or virus and is sudden in onset usually lasting for a couple of weeks. Symptoms of acute throat pain are redness, pain, dryness of throat, and then onset of chills, fever, and hoarseness of voice.
- Chronic Throat Pain: Recurrent episodes of acute sore throat lead to chronic form of sore throat. This lasts for a prolonged period of time and because of it, it is an advanced stage of chronic inflammation of throat. Chronicity can also be from persistent irritation due to smoking, drinking hot drinks, or eating spicy foods. Overstraining of voice can also result in chronic sore throat. Symptoms of chronic sore throat are sensation of a knot in upper part of throat resulting in a hacking cough representing laryngeal complications.
- Throat Pain on the Basis of Infection: This form of sore throat is highly contagious and occurs as a result of bacterial or viral infections.
- Bacterial Sore Throat: Group A Streptococcus is the cause for about 15% of cases causing sore throat by bacteria resulting in pain in throat. This is commonly called strep throat. Symptoms are swelling of tonsils occurring with high fever. If untreated, this can lead to rheumatic fever damaging valves of heart. Another infection leading to throat pain is called epiglottitis is also a potentially serious bacterial throat infection warranting instant medical attention.
- Throat Pain as a Result of Viral Sore Throat: This is also highly contagious and spreads immediately. This is responsible for more than 95% of sore throats. Symptoms are cough, sneezing, nose congestion, generalized aches and pains. There is no clear cut treatment for viral sore throat and it generally runs its course for about a week and resolves by itself. Viral sore throat is generally caused due to adenoviruses, coxsackie virus, or mononucleosis.
- Throat Pain as a Result of Non-Infectious Sore Throat: This type of sore throat is as a result of allergies and environmental conditions. This is not contagious. People allergic to dust, pollen, pet dander etc. can suffer from this. The symptoms are swelling of eyes, runny nose, sneezing. Other than this, cigarette smoke, chemical fumes, and polluted air can also result in sore throat.
Pathophysiology of Throat Pain
Throat pain is commonly caused due to infections of the throat, especially pharyngitis. It usually occurs when bacteria or viruses from a cold, flu, or sinus infection involve the throat. This leads to inflammation, edema, redness, and swelling of lymph nodes in the throat. If this condition persists, antibiotics are required. Antibiotics have no effect on viral infections. Viral infections usually run their course and subside on their own. In case of throat pain from GERD, the acid pushes back into the throat leading to scratchiness and pain in the throat which is relieved with the treatment of GERD.
What Can Cause Pain in The Throat?
As mentioned above, throat pain is a symptom of an underlying condition and is caused by a number of factors such as infection of throat structures (tonsillitis, pharyngitis, and laryngitis), throat cancer (rare), voice straining, tobacco use, and exposure to toxic chemicals, allergies, gastric reflux and other injuries or irritants.
Throat Pain Caused Due To Infectious Processes Including
- The common cold
- Viral as well as bacterial infections
- Abscess of throat
- Other viral infections, such as mumps, herpangina, or influenza.
- Inflammation of the epiglottis (epiglottitis).
- Inflammation of the uvula (uvulitis).
- Inflammation of the adenoids (adenoiditis)
- Rarely due to STDs, such as gonorrhea or chlamydia.
Throat Pain Caused Due To Injury or Irritants:
- Being exposed to chemicals
- Recurrent throat clearing
- Tobacco usage
- Straining of voice
- Mouth breathing as a result of allergies or congested nose.
- Acid reflux
- Injury to back of throat.
Throat Pain Due To Serious Conditions Include
- Cancer of throat and/or esophagus
- Being exposed to toxic chemicals
Signs and Symptoms of Throat Pain
Throat pain itself is a symptom of an underlying disorder.
Throat pain symptoms are variable in character and severity and are dependent on underlying disease.
Common Symptoms of Throat Pain
- Alteration in voice for example muffled speech.
- Dryness of throat
- Feelings of itchiness or tickling in throat
- Development of phlegm as a result of postnasal drip, infection etc.
- Sore throat
- Dysphagia or odynophagia
- Throat lump
- Throat pain
- White patches on tonsils and throat
Symptoms of Throat Pain Along With Respiratory Disorders are
- Cough with yellow, brown, or greenish phlegm
- Throat dryness
- Enlargement of lymph nodes
- Hoarseness of voice
- White patches covering tonsils or throat
- White patches on tongue or mucus membranes of mouth
Symptoms of Throat Pain Along With Gastrointestinal Disorders Are
Other General Symptoms That Accompanies Throat Pain Are
- Fever and chills
- Body aches
Serious Symptoms of Throat Pain Indicating A Potentially Life Threatening Problem:
- Alteration of consciousness like confusion, passing out etc.
- Unconsciousness even for a very small period of time
- Acute pain
- Sudden swelling of tongue or throat
- High fever
- Joint pain or jerking movements
- Severe dyspnea with blue lips and tachycardia.
- Anxiety or panic attacks
Treatment for Throat Pain
Treatment of throat pain depends upon the cause of the throat pain. Usually the milder form of throat pain can be treated with some simple home remedies.
Home Remedies for Mild Throat Pain
- Gargling with warm salt water helps in reducing swelling, postnasal drip and relieves discomfort associated with throat pain.
- Drinking lots of fluids helps in thinning the secretions and soothing irritated throat especially hot fluids like tea, coffee, or soup are very helpful home remedies to soothe the pain in throat.
- Using a vaporizer or humidifier in the bedroom also helps comfort the throat pain discomfort.
- Avoiding smoking and second-hand smoke and other throat irritants like toxic chemical fumes, traffic pollution etc.
- Treating throat pain using non-prescription medicines such as throat lozenges, cough drops, and use of decongestants (either oral or nasal) help by shrinking the swollen mucous membranes in the nose and allowing air to pass through thus make breathing easier. They also help in relieving runny nose and postnasal drip, which can also cause sore throat.
Treatment For Throat Pain Caused By Infections:
- There is no specific treatment for throat pain caused due to viral infections. They will run their own course and the infection usually resolves when the body fights them off.
- For treating throat pain caused due to bacterial infections such as tonsillitis; analgesics, anti-inflammatory, antipyretics such as acetaminophen/paracetamol and/or ibuprofen are used.
- Antibiotics like penicillin or amoxicillin are the first choice for treating pain in the throat. Other antibiotics like cephalosporin and macrolides are good alternatives to penicillin especially for those patients who are allergic to penicillin. Clindamycin and amoxicillin-clavulanate are also used. In chronic cases of tonsillitis or in cases with recurrent episodes of tonsillitis, tonsillectomy (surgical removal of tonsils) is the choice of treatment.
- In case of throat pain due to pharyngitis, treating it with analgesics like NSAIDs along with acetaminophen reduce pain. Steroids like dexamethasone are found to be beneficial for acute cases of pharyngitis.
- Viscous lidocaine improves throat pain by numbing mucus membranes. Antibiotics are helpful in bacterial infections causing throat pain but in cases of viral infections they are deemed ineffective.
- In case of throat pain due to laryngitis, if it is due to a bacterial or fungal infection then the patient may be prescribed a course of antibiotics or anti-fungal medications. Patient may be instructed to drink lot of fluids if he has a cold. Antibiotics are almost never needed because most cases of laryngitis are caused by a virus. If laryngitis is due to GERD then antacids are prescribed.
- Mouth breathing or smoking causes a dry mouth, which is treated by changing habits (quit smoking) or by changing sleeping positions. Mouth breathing at night may be a sign of other respiratory problems and needs medical attention.
Investigations for Throat Pain
- Infections like tonsillitis, pharyngitis etc. can be diagnosed by doing a throat swab culture. Samples are obtained by swabbing tonsillar surfaces and the posterior pharyngeal wall.
- Diagnosis of infectious mononucleosis is done through blood test. The presence of 50% lymphocytes with at least 10% atypical lymphocytes is the usual criteria. It can also be confirmed by a serological test.
- Biopsy confirms the presence of cancer in the throat.