Symptoms
Sore throat manifests as an inflamed and irritated throat lining and pain when swallowing or at rest. The palatine tonsils may also be inflamed, swollen, and coated. Possible accompanying symptoms include mucus production, cough, hoarseness, fever, headache, runny nose, eye irritation, feeling sick, and fatigue.
Causes
The most common cause of sore throat is a viral infection as part of a cold. Possible causative agents include rhinoviruses, parainfluenza viruses, coronaviruses, RSV, adenoviruses, and enteroviruses. The illness is self-limiting and usually lasts 5 to 10 days. Other viruses that cause serious illness are also possible causes of sore throat. These include herpes viruses such as Epstein-Barr virus (mononucleosis), herpes simplex virus, measles virus, and cytomegalovirus. A few days to weeks after infection with the HI virus (HIV), sore throat may occur along with other symptoms. Especially in children, β-hemolytic group A streptococci are a common trigger. Streptococcal angina manifests itself, among other things, in swollen and clogged tonsils, fever and absence of cough. Other bacilli such as , , chlamydia and mycoplasma can cause the symptoms. In addition to infectious causes, gastroesophageal reflux (heartburn), allergic diseases, smoking, foreign bodies such as fish bones, chemical burns, irritating substances, environmental pollution, muscle strain, and tumors can also trigger sore throats. Another possible trigger is dry air and inflammation of the nasal mucosa in winter.
Transmission
Depending on the infectious agent, transmission occurs as a droplet infection or via contaminated surfaces, through kissing (mononucleosis) or sexually (HIV, gonorrhea, chlamydia).
Diagnosis
Often, the cause of sore throat is trivial, i.e., it is due to a cold and the symptoms disappear on their own after a few days. The diagnosis should exclude more serious causes such as streptococcal angina, mononucleosis, or HIV. Reddened and coated tonsils, pharyngitis, fever, enlarged cervical lymph nodes and absence of cough indicate streptococcus, but the diagnosis cannot be made on the basis of symptoms alone (throat swab). Especially in case of long duration, severe discomfort, concomitant symptoms, and occupied and swollen tonsils, medical clarification is urgent.
Nonpharmacologic treatment
- Drink plenty of warm teas, e.g. chamomile tea, sage tea.
- Heat treatment: wear scarves, wraps
- Keep throat moist with mild lozenges, bronchial pastilles or sage pastilles
- Semi-solid, liquid, warm and spice-free foods irritate the throat less
Drug treatment
Topical local anesthetics:
- Such as lidocaine or ambroxol are analgesic and are used locally in the form of sprays, gargles, and lozenges. Possible adverse effects include hypersensitivity reactions.
Analgesics:
- Such as non-steroidal anti-inflammatory drugs are effective against pain, fever and inflammation (eg, ibuprofen, naproxen, acetylsalicylic acid). Paracetamol is effective against pain and fever. Opioids such as codeine may also be indicated for very severe pain. NSAIDs are also used topically, such as flurbiprofen lozenges.
Systemic antibiotics:
- Antibiotics are used exclusively for the less common bacterial infections. Agents of 1st choice for streptococcal angina are penicillins. In case of penicillin allergy, macrolides or cephalosporins or clindamycin are also used. They shorten the duration of the disease, prevent complications, and reduce contagiousness. For other causes, the use of antibiotics is not indicated.
Herbal medicines:
- Many herbal medicines are used locally for sore throat and pharyngitis. These include local analgesic preparations with cloves, sage, sage pastilles, mucilage drugs for irritation relief such as marshmallow, Iceland moss or immunostimulant echinacea preparations. Menthol is analgesic. Bronchial pastilles contain various herbal ingredients.
Topical disinfectants:
- Are applied against microorganisms and have a partially local anesthetic effect.Among others, hexetidine, cetylpyridinium chloride, cetrimonium bromide, chlorquinaldol, dichlorobenzyl alcohol, iodine, amylmetacresol, 2,4-dichlorobenzyl alcohol and chlorhexidine are used.
Topical antibiotics:
- Such as the polypeptide antibiotics tyrothricin and bacitracin are also controversial. For streptococcal angina, oral, not topical, antibiotics are used. Antibiotics are ineffective for viral infections.
Probiotics lozenges:
- Probiotics lozenges provide the mucous membrane of the oral cavity with “good” bacteria, which settle and multiply. The treatment is considered well tolerated.