Sore Throat

Sore throats happen to everyone on occasion and are usually due to viruses or bacteria. They typically resolve within 5 to 10 days. If you have a sore throat that persists longer than that, schedule an appointment with your physician.

Contact your doctor if you have a sore throat that lasts longer than 5-10 days and is associated with any of the following symptoms:

• Severe and prolonged pain
• Trouble breathing
• Trouble swallowing
• Trouble opening your mouth
• Facial or neck swelling
• Pain in the joints
• Ear pain
• Rash
• Temperature greater than 101F
• Coughing up blood
• Persistent hoarseness

Sore throats may be due to:

Viruses - There are several viruses that may involve a sore throat including the flu, colds, measles, chicken pox, whooping cough, or mononucleosis. Other accompanying symptoms may include fever, chills, headache, fatigue, nasal congestion, and swollen glands.

Bacterial Infections - Strep throat is due to the streptococcus bacteria. Symptoms include sudden sore throat, pain swallowing, fever greater than 101F, swollen tonsils with white patches, and swollen lymph glands in the neck.

Epiglottitis - This occurs when the flap of tissue that prevents food from going down the windpipe when swallowing becomes inflamed and infected. It is a very dangerous infection because the swelling of the epiglottis can close off the airway. In addition to infection, it can also be caused by chemicals (illicit drugs), severe heat damage, or trauma. Symptoms include severe pain with swallowing, drooling, muffled speech, and difficulty breathing. If you experience these symptoms, seek immediate medical attention.

Allergens and Irritants - Environmental allergies to pollens, molds, animal dander, or dust mites can cause throat soreness. In addition, environmental irritants such as dry heat, pollutants, car exhaust, and chemicals can lead to throat pain.

Acid Reflux - Gastroesophageal reflux (GERD) occurs when stomach contents come up into the throat. Symptoms include a feeling of a lump in the throat, sore throat, trouble swallowing, chest pain, bad breath, and frequent belching or regurgitation of food. It may be accompanied by a burning sensation in the chest or throat (heartburn), but not always.

Tumors - A sore throat with pain to the ear can be caused by a tumor of the throat, tongue, or voice box. Other symptoms include trouble swallowing, spitting up blood, voice changes, noisy breathing, a lump in the neck, and unintentional weight loss.

Tonsillitis

Tonsillitis is inflammation of the tonsils which are the lymph glands in the back of the throat on the sides of the tongue. The purpose of the tonsils are to prevent bacteria and viruses from entering the body. When the tonsils become infected, the back of the throat may appear red and swollen, and there may be white or yellow patches on the tonsils. Tonsillitis can either be acute, meaning it comes on suddenly, or it can be persistent (chronic).

Symptoms of acute tonsillitis include:

• Fever
• Chills
• Headache
• Throat pain
• Trouble swallowing
• Coughing
• White patches on the tonsils
• Fatigue
• Enlarged, painful lymph nodes in the neck

Symptoms of chronic tonsillitis include:

• Persistent sore throat
• Bad breath
• Tonsil stones (white particles in the tonsils)
• Persistent swollen lymph nodes in the neck

If tonsillitis is caused by a virus, it will typically resolve within four to seven days. If it is caused by a bacteria, such as strep, it is usually treated with an antibiotic. Chronic cases of repeated episodes of tonsillitis may require surgical removal of the tonsils and adenoids.

Hoarseness

Hoarseness is a change in the quality of the voice, making it sound raspy, strained, or a different pitch than usual. This usually occurs when there is a problem with the vocal cords of the voice box, which is called the larynx. There are several possible causes of hoarseness. Some of them include:

• Acute laryngitis- this is the most common cause for hoarseness and may be due to vocal cord swelling. This may be due to a virus or vocal strain.
• Vocal cord lesions- prolonged trauma to the voice box can lead to nodules, polyps, or cysts. Sometimes these lesions are benign, but other times they can be precancerous or cancerous. If you have hoarseness that lasts longer than four weeks and you are a tobacco user, you should have an evaluation by an ENT specialist.
• Neurological disorders- neurological disorders such as a stroke or Parkinson’s disease can cause hoarseness.
• Injury- a paralyzed vocal cord can occur after surgery, trauma, or illness.
• Vocal cord atrophy- aging can lead to a raspy voice that is not as powerful as it once was. This is because the vocal cords lose bulk and tone with age.

Factors that contribute to hoarseness and problems with the vocal cords include:

• Reflux- Heartburn and indigestion occur when acidic stomach contents move up from the stomach into the esophagus. If the stomach acid reaches the voice box, hoarseness and other throat symptoms can result.
• Smoking- Smoking can cause permanent changes to the vocal cords altering the quality of the voice. It significantly increases the risk of developing throat cancer.
• Allergies- Allergies resulting in post nasal drainage and throat irritation can contribute to hoarseness.
• Trauma- Trauma to the vocal cords from injury or surgery can affect the vocal cord function.
• Thyroid problems- The thyroid is located on the front of the neck near the larynx, and problems with the thyroid can contribute to voice problems.

If you have any of the following symptoms, schedule an appointment with an ENT specialist as soon as possible:

• Hoarseness lasting more than four weeks, especially if you are a tobacco user
• Difficulty breathing
• Pain with speaking
• Severe changes in voice lasting more than a few days
• Vocal professionals who cannot do their job (singers, public speakers, teachers, etc)

Trouble Swallowing

Swallowing is a complex process that is affected by aging and changes over time. Difficulty swallowing may be associated with:

• Trouble chewing
• Difficulty moving food and liquids from the mouth into the throat
• The feeling of food or pills getting stuck in the throat
• Food/liquids coming back up (regurgitation)
• Coughing or choking with swallowing
• Lung infections
• Weight loss

Some of the factors that contribute to trouble swallowing are:

• Aging
• Dry mouth
• Poor dentition
• Muscle atrophy of the tongue and upper throat
• Narrowing of the entrance to the esophagus
• Decreased feeling or sensitivity of the throat and voice box

When stomach acid repeatedly comes up from the stomach into the esophagus, it is called gastroesophageal reflux (GERD). When the stomach acid comes up to the point of the throat or voice box, it is called laryngopharyngeal reflux (LPR). Many patients with LPR do not have classic symptoms of heartburn. Sometimes they may have symptoms such as:

• Heartburn
• Belching
• Regurgitation of food and liquids
• Cough and throat clearing
• Trouble swallowing
• A feeling of something stuck in the throat
• Voice changes
• Post nasal drainage
• Episodes of choking

If you have symptoms of GERD or LPR twice per week or more, schedule an appointment with your physician.