Sore Throat

Question 1

Most likely cause of sore throat

Answer 1

Common cold, flu, viral pharyngitis or tonsillitis, smoking, post-nasal drip (rhinitis, rhino-sinusitis)

Question 2

Likely causes of sore throat

Answer 2

Bacterial pharyngitis or tonsillitis, hand foot and mouth disease

Question 3

Unlikely causes of sore throat

Answer 3

Scarlet fever, STI infection, oral mucocutaneous herpes

Question 4

What is acute pharyngitis?

Answer 4

Infection and inflammation of the pharynx (either viral or bacterial (A streptococcus))

Bacterial is more prevalent in winter, viral is most common generally (70%-90% cases)

Self limiting = 7-10days

Question 5

Name the symptoms of viral pharyngitis/tonsillitis

Answer 5

Cough, hoarse voice, conjunctivitis, nasal congestion, diarrhoea, absence of fever

Question 6

Common causes of viral pharyngitis/tonsillitis

Answer 6

Epstein-Barr (mononucleosis), adenovirus, enterovirus, influenza A and B

Question 7

Symptoms of bacterial pharyngitis/tonsillitis

Answer 7

Fever >38°c

Tender lymph nodes either side of neck

Tonsillar exudate (grey/white costing on tonsils)

Absence of cough, rhinorrhoea, nasal congestion

Question 8

In what age group is bacterial pharyngitis/tonsillitis more common?

Answer 8

School aged children and adolescents

Question 9

Questions you’d ask to investigate the sore throat

Answer 9

Age

What are symptoms? Any accompanying symptoms? (Fever)

Duration of symptoms/have they come back?

What have you tried?

Any other health conditions? Other medications?

Where have they been? Who have they been in contact with?

Question 10

Mention referral points for a sore throat

Answer 10

Dysphagia = painful swallowing (e.g. prevent you from drinking water)

Difficulty breathing through mouth, muffled voice

Noisy breathing or excessive drooling

Unilateral (one-sided) throat pain

Trismus = lock jaw (limited range of movement)

Respiratory distress - signs of airway compromise

No symptom improvement

Question 11

What are som differential diagnoses for a sore throat/pharyngitis/tonsillitis?

Answer 11

Cold, flu, rhinitis and rhino-sinusitis

Scarlet fever = children (5-15y/o), fever >38.5°C, red sandpaper rash, facial flushing, tongue discolouration (red + bumpy = strawberry like)

Epstein-Barr virus (glandular fever) = severe sore throat, nausea, enlarged lymph nodes, enlarged liver/spleen, fatigue, rash

Hand foot and mouth = mucosal ulcers around mouth/throat, loss of appetite, rash, skin lesions, pain

Herpes gingivostomatitis = fever, irritability, painful mouth ulcer, lip blister, poor appetite or reluctance to drink

Question 12

How do you treat a sore throat?

Answer 12

Primary = simple analgesics = paracetamol +/- Ibuprofen, aspirin

Secondary = Medicated lozenges or gargles
- Local anaesthetics = lidocaine, benzocaine
- Anti-inflammatory = benzydamine, flurbiprofen
- Antibacterial agents = chlorhexidine, cetylpyridinium chloride, benzalkonium chloride
- Povidine iodine = antibacterial, antiviral, antifungal (limited evidence)

Question 13

Regarding treatment options, what information should we provide?

Answer 13

How much to use, how often, max amount

Throat gargles have shorter contact time than lozenges, salt water gargle may ease throat pain

Drink plenty of water, drink warm liquids (tea/broth) or cool liquids or eating gelatine desserts/flavoured ice

Sucking throat lozenge promotes saliva production, soothing effect. DO NOT drink hot beverages after anaesthetic lozenge (burn risk)

Cool mist vaporizers relieve throat dryness

Question 14

How do you prevent sore throats/pharyngitis/tonsillitis?

Answer 14

Frequently wash hands (after blowing nose, caring for sick child)

Someone at home with pharyngitis = separate eating utensils/drinking glasses, wash thoroughly with hot soapy water

Toddler with pharyngitis chewing/sucking on toys = wash thoroughly in water and disinfectant soap, rinse well

Quick disposing of dirty tissues (used on runny nose, sneezes), wash hands