By Dr Annabelle Leong
Most sore throats usually recover within a few days but sometimes, they don’t! So if you keep getting sore throats, did you know that it’s time to see an ENT specialist? Sore throat problems occur commonly in children and adults. We see many patients with sore throats at our busy ENTcare Clinic in Singapore.
Here is a short case study of a real-life patient who came to see me.
Figure 1: This is a 30 year old man who had been suffering from recurrent severe sore throats due to severe tonsillitis. Note how swollen and inflamed his tonsils are!
So what are the top 3 causes of a Persistent Sore Throat?
- Tonsillitis
- Acid reflux (gastritis)
- Nasal Allergies and postnasal drip
How Do I know if this is a “Normal” sore throat?
A sore throat may just be something like a viral pharyngitis, what we call a “standard” sore throat. But if you suffer severe or frequent sore throats, then it could be tonsillitis. Tonsil infections usually start off as viral but some nasty episodes may be bacterial. Strep throat is a common term used for bacterial tonsil infections which need antibiotic treatment.
A throat swab may be useful to try to identify which bacteria is the cause. On the other hand, the throat swab may not always be able to “grow” the bacteria, especially if you have had a few courses of antibiotics before.
I usually prescribe a course of painkiller and anti-inflammatory medications for symptom relief. If the sore throat still doesn’t get better, then antibiotics may be the next step.
If you have difficulty swallowing due to the throat infection, then you may need hospital admission for IV medications to be given.
When Should I Consider Removing my Tonsils?
There are international guidelines for when to consider a tonsillectomy.
For example:
3 – 4 episodes of sore throats a year for 2 years.
6 -7 episodes per year for a year
The indications for tonsil surgery are mainly divided into reasons for severe infection and breathing or sleep apnea problems.
Of course, if one tonsil looks suspicious compared to the other one, then sometimes tonsil surgery is needed to rule out a tonsil cancer. Smokers and people who carry the HPV (Human Papilloma Virus) infection are at higher risk of developing throat cancer.
Women sometimes test positive for HPV infection on their cervical smears (PAP smear).
How Can I Treat Acid Reflux to Treat my Sore Throat?
Acid reflux or gastritis may sometimes result in acid flowing up from your stomach into your throat. This leads to inflammation and can give rise to a “lump in throat” sensation. Perhaps you are already seeing a Gastro Dr for your stomach issues!
A course of anti-reflux medications such as Pariet or Nexium can be help relieve your sore throat. Taking some Gaviscon at night may also help protect your throat from acid irritation.
Lifestyle modifications such as avoiding spicy food or irregular mealtimes, are often helpful too. Never eat late at night then go straight to bed! Allow time for digestion for about 60 minutes before you go to bed at night to prevent sore throat from acid reflux.
Are my Nasal Allergies and Sinus issues Causing my Sore Throat?
The short answer is yes, your nasal allergies and sinusitis may be irritating your throat by causing a persistent backdrip of mucus. Bacteria from your nose and sinuses are carried in these secretions to flow down into your throat, hence causing secondary throat inflammation. Itchy throat symptoms are very likely due to your persistent postnasal drip!
Very often, “morning sinus” issues turn out to be allergic rhinitis actually. So you probably won’t need antibiotics here but it would be helpful to rinse your nose gently and have some antihistamine medications instead. Nasal steroid sprays can also help reduce nasal congestion and backdrip.
Is My Blocked Nose Normal?
Remember, having a blocked nose isn’t normal. If your nose feels congested, then you end up breathing through your mouth so you wake up with a dry mouth and throat in the morning! Mouth-breathing is definitely abnormal and you should find out why.
Allergy testing may help to find out why you suffer nasal allergies and sinus infections. Allergic rhinitis means that your body is hypersensitive to something and hence reacting to it, including sneezing and having a runny blocked nose. We usually just arrange a simple blood test as allergy testing. Skin prick allergy testing is another option but it means you have to stop all steroid and antihistamine medications for at least a week.
So what is the final word on Sore Throat Problems?
Dr Annabelle’s 5 Helpful Tips to Help Your Sore Throat Get Better.
- Drink plenty of water, especially warm water: 6-8 glasses daily
- Try taking some anti-inflammatory medications such as Neurofen or Advil.
- Avoid eating spicy or sour foods until your sore throat recovers
- Try using a sea-salt rinse to clean your nose of trapped mucus
- Try a course of anti-acid reflux medications. Antacids and Gaviscon can usually be bought off the counter without Dr prescription.
Ultimately, you should see your ENT specialist in Singapore if you or your child constantly have sore throat or blocked nose problems!