If you are experiencing a persistent sore throat, it is natural to feel concerned. This article aims to elucidate the potential causes of chronic sore throats and the diagnostic tests that may be employed. Insights are provided by Dr. Jean-Marc Juvanon, an ear, nose, and throat specialist and member of the French Society of Otorhinolaryngology (SFORL).
Definition of Persistent Sore Throat
Persistent sore throats can arise from a multitude of causes, some of which may not be directly related to the ear, nose, and throat (ENT) region. The discomfort may be localized in various areas, including:
- The pharynx
- The tonsils
- The larynx (the back of the throat)
The symptoms can vary depending on the specific area affected:
- Pharyngeal Pain: Symptoms may include a tickling sensation, burning or stinging, dryness, irritation, and a hoarse or broken voice.
- Tonsillar Pain: Individuals may experience difficulty swallowing saliva or food, with pain often being bilateral.
- Laryngeal Inflammation: Symptoms may manifest as hoarseness, sharp pain, and damage to the vocal cords.
Should the sore throat persist for more than one week and be accompanied by high fever, rash, neck swelling, or fatigue, it is advisable to consult a physician.
Duration of Sore Throat
In most instances, a sore throat is benign, typically lasting a few days and resolving spontaneously. Common causes include viral or bacterial infections, as well as toxic irritants. It is prudent to consult a pharmacist for advice regarding sore throat management. Additionally, a rapid angina test may be requested without a prescription to determine if the condition is due to bacterial infection.
Non-Local Causes of Sore Throat
Dr. Juvanon notes that a sore throat is classified as chronic when it persists for several months. Patients may experience continuous pain or intermittent episodes. In adults, smoking is a frequent irritant that can exacerbate throat discomfort.
Gastroesophageal Reflux Disease (GERD)
Dr. Juvanon identifies gastroesophageal reflux disease (GERD) as the second most prevalent cause of chronic sore throat. Acid reflux can irritate the back of the throat, particularly in individuals who consume very spicy foods or extremely hot beverages.
Psychosomatic Factors
Chronic sore throats may also have psychosomatic origins, characterized by involuntary contractions of the throat muscles. Patients may report sensations such as a lump in the throat or the feeling of an obstruction, referred to as pharyngeal paresthesia.
ENT-Related Causes
Local causes may include infections by viruses or bacteria, such as chronic caseous tonsillitis, which is common in adults with non-atrophied tonsils. In this condition, tonsillar secretions can obstruct the tonsils, leading to discomfort. Additionally, a goiter (enlargement of the thyroid gland) may contribute to chronic sore throat.
In cases where a persistent sore throat is accompanied by fever and nasal congestion, it may indicate a viral infection (e.g., COVID-19, influenza, herpes angina) or a bacterial infection (e.g., streptococcus). The presence of fever suggests that the immune system is responding to a pathogen. In instances of angina, swallowing may be painful, and lymphadenopathy may be observed.
It is crucial to remain vigilant, as a sore throat that persists and intensifies may signal the presence of throat cancer, particularly in individuals who smoke or consume alcohol. Dr. Juvanon notes that in cases of cancer, pain is often localized to one side and progressively worsens.
Symptoms and Associated Risks
Other accompanying symptoms may vary based on the underlying cause. It is essential to seek medical advice if a sore throat persists, as it may indicate a more serious condition, such as laryngeal cancer, especially in the presence of risk factors like alcohol consumption and smoking.
In the United Kingdom, over 1,500 patients are diagnosed with laryngeal tumors annually. Research has indicated that patients with this type of cancer frequently present with symptoms such as chest infections, insomnia, inflammation, and voice alterations. Additional concerning symptoms warrant immediate medical consultation, including:
- Earache
- Dyspnea (difficulty breathing)
- Dysphagia (difficulty swallowing)
Diagnosis and Testing
If you are experiencing a persistent sore throat, it is imperative to consult a healthcare professional. Dr. Juvanon explains that an ENT specialist will conduct a comprehensive clinical examination of the pharynx and larynx, utilizing a fibroscope or mirror, along with palpation of the neck. This examination can reveal signs of deep redness (potentially due to GERD), lumps, tumors, goiters, or caseous tonsils. If cancer is suspected, further diagnostic procedures, including biopsy and radiological assessments, may be necessary.
Treatment Options for Persistent Sore Throat
Upon establishing a diagnosis for a persistent sore throat, treatment will be tailored to the underlying cause:
- Smoking Cessation: Recommended for smokers and avoidance of secondhand smoke for others.
- Gastroesophageal Reflux: Implementation of dietary and hygiene measures, along with antacid medications.
- Goiter Management: Treatment of the underlying cause of the goiter.
- Allergic Reactions: Administration of antihistamines and avoidance of allergens.
- Bacterial Infections: Antibiotic therapy for recurrent bacterial angina.
- Chronic Laryngitis or Pharyngitis: Prescription of analgesics and mouthwashes.
- Chronic Caseous Tonsillitis: In severe cases, surgical removal of the tonsils may be indicated.
Dr. Juvanon emphasizes that the definitive treatment for chronic caseous tonsillitis is tonsillectomy, a significant procedure reserved for cases where symptoms are intolerable. Treatment for throat cancer will depend on the cancer’s stage and tumor location, potentially involving surgery, radiotherapy, or chemotherapy.