Alternate Names: Sore throat; Burning in the throat; Pain - throat

Considerations: Frequent and recurrent sore throats are common, especially in children between the ages of 5 and 10. There is no evidence that removing the tonsils decreases this frequency; therefore, tonsillectomy surgery is performed less commonly than in the past.

Sore throats can be caused by either viruses or bacteria. The majority of sore throats are caused by viruses; therefore, treating all sore throats with antibiotics (which can’t cure viruses and can be unnecessarily expensive) would needlessly expose people to the risks of adverse reaction to the drugs.

Strep throat is a primary concern because it can occasionally lead to rheumatic fever. Strep should be treated with antibiotics. Strep throat often presents with a fever (greater than 101 degrees Fahrenheit), white draining patches on the throat, and swollen or tender lymph glands in the neck, along with headache and stomach pain in children. Rheumatic fever is very rare in children under 3 and in adults.

Strep throat is very common in children under 3 years old and is much less common in adults. Strep throat is not likely if the sore throat is a minor part of a typical cold (with runny nose, stuffy ears, cough, and similar symptoms).

Common Causes:

• breathing through the mouth (can cause drying and irritation of the throat)
• common cold
• viral pharyngitis
• influenza
• strep throat (caused by the streptococcal bacteria)
• infectious mononucleosis
• fish, chicken bone, or other foreign substance stuck in the throat. (For emergency actions, see CPR)
• endotracheal intubation (tube insertion)
• local surgery such as tonsillectomy and adenoidectomy

Home Care: Time is the most important healer for sore throat pain. If the sore throat is caused by a virus, it will clear up on its own.

Cold liquids and over-the-counter pain medications are effective in treating the pain. Aspirin should be avoided in children under 15 years old (because of the risk of Reye’s syndrome). Home remedies such as gargling salt water, or drinking honey or lemon tea may help. Analgesic sprays and lozenges may be administered; however, they may make the pain of strep throat worse instead of better.

Call If:

• there is severe difficulty in swallowing, difficulty in breathing, or excessive drooling in a young child.
• there is a temperature of 101 degrees Fahrenheit or greater.
• there are tender or swollen lymph glands in the neck.
• there is pus in the back of the throat.
• there is a fever, a red rash that feels rough, and increased redness in the skin folds.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting sore throat in detail may include:

• time pattern
  • How long has the sore throat been present?
  • Have you had a sore throat before?
  • What was the cause?
  • Have other family members had recent sore throats?
• quality
  • Is the pain increasing, staying the same, or decreasing?
  • Are you able to swallow saliva, fluids, and food?
  • Is there excessive drooling (infants)?
  • Is the person able to talk?
  • Is the person hoarse?
  • Is the person able to sleep?
• aggravating factors
  • Worse at night?
  • Breathing through mouth?
• relieving factors
  • Is the soreness better in the morning?
  • Is the soreness better with moist air or mist?
  • Is the soreness better with medications?
• other
  • What other symptoms are also present?
    • noisy breathing
    • fever
    • wheezing
    • recent choking
    • allergies
    • rash
  • Has there been a recent injury?
  • Has there been a recent surgery?
  • Are there swollen lymph glands in the neck?
  • Are there sores or pus in back of throat?
  • Is there a sensation of gagging?
  • What medications are being taken?
  • What is the typical daily diet?

• complete blood count
• monospot test (to rule out mononucleosis)
• throat culture or rapid strep test