Sore Throats

What Causes a Sore Throat?

• Infections by contagious viruses or bacteria are the source of most sore throats. Other potential causes include:
• Viruses — Sore throats often accompany viral infections, including the flu, colds, measles, chicken pox, croup, or mononucleosis (mono). Mono has the longest duration of symptoms, such as sore throat and extreme fatigue, and can last several weeks. Other symptoms include swollen glands in the neck, armpits, and groin; fever, chills, headache, or sometimes, serious breathing difficulties.
• Bacterial infections — Strep throat is an infection caused by Streptococcus bacteria. This infection can also cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Symptoms of strep throat often include fever (greater than 101°F), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have a headache and stomach pain.
• Pertussis (Whooping Cough) — is a highly contagious respiratory disease caused by Bordetella pertussis bacteria. This infection can bring about violent, uncontrollable coughing, making it hard to breathe and causing you to make a “whooping” sound. Whooping cough can affect people of all ages, but can be especially serious, even deadly, for babies less than one-year-old.
• Epiglottitis — the most dangerous throat infection, because it causes swelling that closes the airway and requires prompt emergency medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. Epiglottitis is often not seen just by looking in the mouth.
• Allergies — You may also be allergic to pollens, molds, animal dander, and/or house dust, for examples, which can lead to a sore throat.
• Irritation — Dry heat, dehydration, chronic stuffy nose, pollutants, car exhaust, chemical exposure, or straining your voice are examples of irritations that can lead to a sore throat.
• Reflux — Occurs when you regurgitate stomach contents up into the throat. You may notice this often in the morning when you first wake up. Reflux that goes into the throat is called laryngopharyngeal reflux (LPR).
• Tumors — Tumors of the throat, tongue, and larynx (voice box) can cause a sore throat with pain going up to the ear. Other important symptoms can include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

What Are the Treatment Options?

• A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:
• Increase your liquid intake.
• Drink warm tea with honey (a favorite home remedy).
• Use a personal steamer or place a humidifier in your bedroom.
• Gargle with warm salt water several times daily: ¼ tsp salt to ½ cup water.
• Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat®, Tempra®) or ibuprofen (Motrin IB®, Advil®).
• For a more severe sore throat, your doctor may want to do a throat culture—swabbing the inside of your throat to see if there is a bacterial infection. If it is negative, your physician will base their treatment recommendation on the severity of your symptoms and the appearance of your throat on examination.
• If you have a bacterial infection your doctor will likely recommend an antibiotic (such as penicillin or erythromycin) that kills or impairs bacteria. Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When a combined infection like this happens, antibiotics may be recommended.
• It is important to take an antibiotic as your physician directs and to finish all doses, even if your symptoms improve, otherwise the infection may not be gone and could return. Some patients will experience returning infections despite antibiotic treatment. If you experience this, it is important to discuss this situation with your physician.
• You may also want to review these sore throat prevention tips:
  1. Avoid smoking or exposure to secondhand smoke. Tobacco smoke, whether primary or secondary, contains hundreds of toxic chemicals that can irritate the throat lining.
  2. If you have seasonal allergies or ongoing allergic reactions to dust, molds, or pet dander, you’re more likely to develop a sore throat than people who don’t have allergies. Treatment of seasonal or environmental allergies can decrease this risk.
  3. Avoid exposure to chemical irritants. Particles in the air from the burning of fossil fuels, as well as common household chemicals, can cause throat irritation. Wearing a mask may be helpful to decrease exposure, in certain situations.
  4. If you experience frequent sinus infections or have chronic post nasal drip, drainage from your nose or sinuses can cause throat irritation as well. Rinsing the nose with salt water may help decrease this drainage.
  5. If you live or work in close quarters such as a child care center, classroom, office, dormitory, prison, or military installation, you may be at greater risk of sore throat because viral and bacterial infections spread easily in environments where people are in close proximity. Minimizing contact with persons who are, or may be, sick and washing your hands frequently can help prevent the spread of infection.
  6. Maintain good hygiene. Do not share napkins, towels, and utensils with an infected person. Wash your hands regularly with soap or a sanitizing gel for at least 10 – 15 seconds.
  7. If you have reduced immunity (from HIV or diabetes, steroid treatment or chemotherapy, a poor diet, or extreme fatigue, for examples), you may be more susceptible to infections in general.

What Questions Should I Ask My Doctor?

• Is my sore throat the same as strep throat?
• How long before this sore throat goes away?
• How do I know if my sore throat is a serious problem?
• Should I take antibiotics to treat my sore throat?

Copyright 2022. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed August 2018.