Symptoms
Since sore throats can have a wide variety of causes, the symptoms and complaints are also very diverse. In the case of tonsillitis, sore throats are usually accompanied by severe difficulty swallowing, bad breath, and a strong feeling of illness. Eating and drinking are almost impossible in the advanced stage, resulting in weight loss and an increased susceptibility to infection by other pathogens.
An acute tonsillitis can potentially also change into a chronic tonsillitis, and cause a rheumatic fever. Sore throat can also be an expression of vocal gang inflammation and be accompanied by hoarseness and breathing difficulties. This is particularly the case with singers and long-time smokers.
In these cases, it is advisable to stop smoking and to protect the voice. One of the most typical diseases of adolescence – Pfeiffer’s glandular fever, also known as “kissing disease” – leads to a viral infection with the Epstein-Barr virus. It is transmitted by saliva and droplets, and is therefore more common in adolescents and young adults.
This leads to tonsillitis and pharyngitis, i.e. an inflammation of the mouth and nose. Although Pfeiffer’s glandular fever has similar symptoms to tonsillitis, it is more serious and, like bacterial angina, must never be treated with antibiotics. In addition to a general weakness in physical performance, in rare cases a splenic rupture or meningitis may also occur.
A peritonsillar abscess can also occur on the basis of tonsillitis. This additionally hinders food intake and breathing, and usually has to be surgically split. Diphtheria is a disease that occurs only rarely and leads to a so-called Caesar’s neck: This is the name given to the heavily swollen lymph nodes that are distributed over the entire neck and enlarge the entire neck.The larynx also swells, causing breathing difficulties when inhaled.
A pseudomembrane may form in the throat and pharynx. This is how white-brownish coatings on the throat are called, which bleed when touched lightly. In the western industrialized countries, people are vaccinated against diphtheria within the first year of life, but in developing countries, or with vaccination opponents, diphtheria can still occur.
In the context of an inflammation or an infection, earache can develop in addition to sore throat and cough. In many cases, ear pain is accompanied by other symptoms such as dizziness or hearing loss, since the ear contains both the hearing organ and the organ of balance. Infections often lead to a carry-over of pathogenic germs, which are located on the mucous membrane of the nose-throat area, into the middle ear.
This is possible because there is a connection between the human nasopharynx and the middle ear in the form of a tube, the so-called Eustachian tube (Tuba auditiva). This actually serves to equalize pressure. This connection allows germs to rise and trigger an inflammatory reaction in the middle ear (see: middle ear inflammation).
In their case, the connecting tube is even shorter than in adults and runs even more horizontally, so that inflammatory pathogens can rise more easily and attack the middle ear. In addition, children generally suffer more frequently from respiratory tract infections than adults. In the case of mild infections, it is usually sufficient to take it easy and rest for a few days so that the symptoms diminish.
Antibiotics are usually only used in somewhat more severe cases or when complications are expected. Since the nose is often blocked with secretions, especially in the case of respiratory tract infections, nose drops are often administered. They relieve the swelling of the mucous membrane, allowing the accumulated secretion to drain off more easily and preventing it from accumulating behind the eardrum.
Sore throat associated with difficulty swallowing can have many different causes and does not always have to be accompanied by tonsillitis. Infections in the mouth-throat area, both bacterial and viral, can lead to sore throats and difficulty swallowing, as the mouth and throat mucosa is usually irritated by the pathogens, causing it to undergo reactive inflammatory changes, acquire a reddish color, become sensitive to pain and often swell. The inflammation of the mucous membrane then leads to sore throat and – due to the simultaneous swelling of the mucous membrane – also to difficulty swallowing.
Such symptoms are found, for example, in tonsillitis, pharyngitis, laryngitis and viral, flu-like infections, but also in more rare infectious diseases such as scarlet fever, Pfeiffer’s glandular fever or diphtheria. In the case of laryngitis, it is not so much the mucous membrane of the mouth and throat that swells, but rather that of the larynx. This swelling inflammation can lead to sore throat, which is particularly severe when swallowed, and in the worst case to shortness of breath if the larynx swells as part of the airways.
In most cases, the entire throat is affected in the same way, but in certain cases the sore throat can be unilateral. This is typical, for example, in the case of a peritonsillar abscess. This is the result of tonsillitis, and refers to a pus-filled sac that also lies in the area of the tonsils.
Usually the pain can be limited relatively clearly to one area. In the case of angina plaut vincenti – a unilateral change in the palatine tonsil after mixed infection with fusobacteria and treponema – the sore throat also occurs only on one side. Characteristic here are strong bad breath and minor physical complaints.
Furthermore, tumorous processes in the area of the thyroid gland or the paranasal sinuses can cause unilateral sore throat. Tumors rarely grow over the entire neck, and usually grow out of a focus on one side. They also impress by an externally and internally visible swelling in the neck area.
Depending on the type of tumor, the growth can increase strongly within a few months or progress very slowly for years. However, they should not be confused with swollen lymph nodes, which typically increase in volume during an infection and can press on the neck. This can cause unilateral sore throat, but usually disappears when the infection ends.In addition to the usual patient survey (anamnesis), in which the doctor asks the patient about the type of complaints, the onset and accompanying symptoms, the inspection of the neck is one of the most important diagnostic criteria.
The doctor will inspect the patient’s throat with a flashlight and, in order to have a better insight, press down the patient’s tongue with a spatula. By being asked to say “A”, the doctor can see whether the uvula is being pulled to a certain side or whether it remains straight. Pulling to one side could confirm the suspicion of neurological involvement.
During the examination, the physician can see whether the throat is reddened or whether there are purulent coatings (so-called stippling) on the tonsils. Furthermore, the doctor will palpate the area around the neck to see if there is any swelling of the lymph nodes. A pathogen with a frequently complicated course is the bacterium Streptococcus pyogenes.
In order to be able to distinguish this pathogen from the other pathogens, the doctor should ask the patient the following questions: Are there any fever (higher than 38 degrees), is there no cough, are the frontal neck lymph nodes swollen, is there evidence on the tonsils? If all questions can be answered positively, the probability of a streptococcal pyogenic infection (also known as GAS pharyngitis) is 50-60%. If the symptoms are mild and there are no risk factors, no further diagnosis is necessary.
In other cases a blood test should be used. This, together with a smear from the almond region, may make the pathogen cultivable under certain circumstances. However, this procedure has some shortcomings.
On the one hand, the findings take 2-3 days, on the other hand, the absence of the pathogen in the cultivation does not exclude a pyogen disinfection one hundred percent. Furthermore, there are rapid tests that can diagnose streptococcal involvement. However, there is no hundred percent certainty.
Blood tests mainly measure the C-reactive protein (CRP) and the blood sedimentation rate, which is increased in the case of an infection (BSG). In the event of an infection, the CRP will also be well above the normal value. Furthermore, it is also possible to detect the antistreptolysin titer in the blood produced by streptococci.
The detection makes a streptococcal infection likely. When presenting the patient, the physician should also try to avert numerous severe and complicated courses of disease. For example, a diagnosed shortness of breath is an absolute emergency for the patient, as it is probably a co-participation of the epiglottis with swelling of the airways.
In this case immediate hospitalization is necessary. In addition, it must be checked whether the patient has difficulty swallowing or opening his mouth. This topic might also be of interest to you: Duration of sore throat