Get to the Bottom of Your Sore Throat

A scratchy throat can be more than just an annoyance. Experts offer tips for assessing your sore throat “threat level.”

From the WebMD Archives

As a symptom of illness, sore throat rivals fatigue for being both commonplace and a potential sign of catastrophe. Usually, having a sore throat is nothing to worry about -- most are caused by cold and flu germs. In rare cases, however, a sore throat can signal something much more serious. One of the first symptoms of infection caused by the dreaded ebola virus, for example, is a sore throat.

And strep bacteria, a common cause of sore throat, especially in children, can spread like wildfire if it gets into the blood, damaging the liver, brain, kidneys, and other organs.

Jim Henson, creator of the Muppets, came down with a sore throat caused by a strep infection late Sunday, May 13, 1990. He was admitted to the hospital with pneumonia on Tuesday and died 20 hours later of septic shock, a life-threatening response to a severe infection.

"In the preantibiotic era, people died from sore throats all the time," says Robert T. Sataloff, MD, associate dean for clinical academic specialties at Drexel University College of Medicine in Philadelphia. "They'd end up with general toxicity and seed infections in the brain or lungs, and they'd die."

So how do you know the difference between a scratchy throat that will disappear on its own and the start of a potentially deadly infection?

Sore Throat Threat Level: Always "Guarded"

When it comes to sore throat, forget the "low" threat level. The symptom always merits "guarded" or even "elevated" alertness. Pay attention, but don't panic.

If you were talking loudly at a noisy, smoky bar, you may have strained your vocal cords, resulting in throat soreness. If you have hay fever, or if your allergies are acting up, that can make your throat feel scratchy. Even sleeping with your mouth open in the winter, when the air can get as dry as the Sahara, can cause a sore throat.

Even if your sore throat is caused by a viral infection, such as a cold or the flu, you probably can wait it out while drinking hot tea with honey and sucking on throat lozenges to ease the discomfort. Because most sore throats are caused by viruses that don't respond to antibiotics, there's not much you can do about them outside of resting so your immune system is strong and ready to fight the invaders.

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"Wait a day, drink plenty of fluids, take pain medication if you'd like," Sataloff tells WebMD. "You might as well try vitamin C. The data are controversial, but vitamin C doesn't do any harm, and there's some suggestion that vitamin C and antioxidants may have some efficacy. These are not unreasonable things to do when helping your body fight off an infection, and that's what it has to do since we don't treat viral infections with antibiotics."

Some people with gastroesophageal reflux disease (GERD) may experience hoarseness with a sore throat, but this will probably be accompanied by other symptoms, such as heartburn or the sour reflux of stomach contents.

(Do you have a favorite sore throat remedy? Tell us about it on the Health Cafe message board.)

When Sore Throat Hits "High" Threat

If your sore throat is accompanied by an achy feeling all over and you have a fever, you should elevate your threat level to "high." You might want to go to the doctor for a throat culture to see if you have a strep infection, especially if you have been around children, who frequently harbor strep bacteria.

"A strep infection can be dangerous for adults or kids," Sataloff says. "The greatest dangers are local inflammation and rapid spread to the throat and adjacent structures like the tonsils and lymph tissues. They can swell and obstruct the airway, and the bacteria can get into the bloodstream and cause infections elsewhere, such as the heart valves."

Inflammation is what makes a sore throat sore, and the greater the inflammation, the greater the danger, Sataloff explains.

"Extreme" Sore Throat Threat: Know the Symptoms

Raise your threat level to "extreme" if you are having difficulty swallowing or breathing, or if you develop a high fever with painful swelling of your lymph nodes. That could indicate tonsillitis, mononucleosis, or some other potentially dangerous infection. These symptoms can also signal strep throat.

"A simple sore throat can cause lots of problems," Sataloff says.

Lemierre's syndrome, for example, is a rare disorder that begins with a fever and sore throat. Soon blood clots form in the jugular vein, and when these infected clots break away, they carry the infection to other parts of the body.

The good news is that prompt treatment can forestall almost all the serious consequences of sore throat.

"We don't see them very often because people get treated," Sataloff says of the life-threatening complications of sore throat. "And if they don't get treated and the sore throat gets worse, then they get treated."

WebMD Feature Reviewed by Louise Chang, MD on January 20, 2009

Sources

SOURCES: Robert T. Sataloff, MD, professor and chairman, department of otolaryngology-head and neck surgery, Drexel University College of Medicine, Philadelphia. New York Times: "An Aggressive Infection, Abrupt and Overwhelming," May 17, 1990. Stratton, C. Trends in Microbiology, September 2006; vol 14: pp 474-479.

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