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ULY CLINIC

18 Septemba 2025, 13:11:13

Throat pain (sore throat)

Throat pain, commonly known as a sore throat, refers to discomfort in any part of the pharynx: the nasopharynx, oropharynx, or hypopharynx. Pain may range from mild scratchiness to severe discomfort and is frequently accompanied by ear pain due to shared innervation by cranial nerves IX and X.

Throat pain can result from infection, trauma, allergy, cancer, systemic disorders, surgery, or endotracheal intubation. Nonpathologic causes include dry mucous membranes from mouth breathing, laryngeal irritation from alcohol, smoke, or chemicals, and vocal strain.

Anatomy of the Throat

The pharynx is divided into three regions:

Nasopharynx: Soft palate and posterior nasal cavity
Oropharynx: Area between the soft palate and upper edge of the epiglottis
Hypopharynx: Area between the epiglottis and cricoid cartilage

Disorders in any of these areas may produce throat pain. Proper assessment is essential to localize the cause.

History and Physical Examination

History

Onset: sudden vs gradual; location and severity
Associated symptoms: fever, dysphagia, ear pain
Past medical history: prior throat problems, allergies, systemic disorders
Surgical history: recent tonsillectomy, adenoidectomy, or intubation

Physical Examination

Examine the pharynx for redness, exudate, swelling
Use a tongue blade or laryngeal mirror; fiberoptic nasopharyngoscopy may be needed
Observe tonsils for erythema, exudate, or asymmetry
Obtain exudate for culture if bacterial infection suspected
Examine nose and ears if symptoms suggest sinusitis or referred pain
Palpate neck and lymph nodes for tenderness or enlargement

Medical causes of throat pain

Cause	Key Features	Associated Symptoms / Signs	Notes / Pathophysiology
Agranulocytosis	Sore throat with ulcers on gums/palate	Fever, chills, fatigue, anorexia, bleeding	Low neutrophil count → susceptibility to infection
Avian flu (H5N1)	Sore throat with systemic flu-like illness	Fever, cough, headache, myalgia, conjunctivitis	Viral respiratory infection
Acute bronchitis	Lower throat discomfort	Fever, chills, cough, rhonchi, wheezing, back/muscle pain	Inflammation of bronchi → referred throat pain
Chronic fatigue syndrome	Nonspecific sore throat	Myalgia, cognitive dysfunction, incapacitating fatigue	Symptom complex; no clear infection
Common cold	Mild sore throat	Cough, sneezing, rhinorrhea, fatigue, myalgia	Viral upper respiratory infection
Contact ulcers	Pain on posterior vocal cords	Ear pain, hemoptysis, chronic throat clearing, reflux	Vocal cord irritation in men with stress
Foreign body	Localized throat pain	Persistent pain after removal	Mechanical irritation of tonsil or pyriform sinus
GERD	Chronic throat pain	Hoarseness, lump sensation, red/swollen arytenoids	Acid reflux irritates hypopharynx
Influenza	Sore throat with systemic illness	Fever, chills, headache, malaise, cough, muscle aches	Viral infection
Laryngeal cancer	Pain when swallowing hot/citrus liquids	Hoarseness (>3 weeks), dysphagia, ear pain, cervical lymphadenopathy	Intrinsic vs extrinsic laryngeal tumors
Mononucleosis	Sore throat with enlarged tonsils	Fever, cervical lymphadenopathy, splenomegaly, hepatomegaly	EBV infection
Necrotizing ulcerative gingivitis	Abrupt sore throat, tender gums	Ulceration with gray exudate, halitosis, fever, malaise	Acute bacterial infection of oral cavity
Peritonsillar abscess	Severe unilateral throat pain	Ear pain, dysphagia, drooling, trismus, deviated uvula, tender cervical nodes	Complication of bacterial tonsillitis
Pharyngitis (bacterial, viral, fungal)	Red, swollen pharynx	Fever, malaise, exudates, lymphadenopathy	Type-dependent: bacterial → abrupt; viral → mild; fungal → white plaques
Sinusitis	Throat pain from postnasal drip	Purulent nasal discharge, facial pain/swelling, cough, halitosis	Secondary irritation of oropharynx
Tongue, tonsillar cancers	Localized throat pain	Ulcers, white lesions, ear pain, dysphagia	Malignant lesions affecting oral cavity/pharynx
Tonsillitis (acute or chronic)	Painful, red tonsils with exudate	Dysphagia, fever, malaise, halitosis	Bacterial or viral infection; chronic → mild persistent symptoms
Uvulitis	Pain or foreign body sensation	Swollen red or pale uvula	Often allergic; can cause airway obstruction

Other causes:

Endotracheal intubation, tonsillectomy, adenoidectomy, or local throat surgery

Special considerations

Provide analgesic sprays or lozenges to relieve pain.
Prepare for throat culture, CBC, and monospot tests if infectious etiology suspected.

Patient counseling

Emphasize completing the full course of antibiotics if prescribed.
Advise on hydration, throat-soothing measures, and avoidance of irritants like smoke or alcohol.
Monitor for red flag signs: persistent pain >3 weeks, dysphagia, or unexplained lumps.

Pediatric pointers

Sore throat is common in children; causes include:
- Acute epiglottitis
- Herpangina
- Scarlet fever
- Acute follicular tonsillitis
- Retropharyngeal abscess
Same evaluation principles as adults, with attention to airway compromise.

References

Berkowitz, C. D. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.
Buttaro, T. M., Tybulski, J., Bailey, P. P., Sandberg-Cook, J. Primary Care: A Collaborative Practice. Mosby Elsevier; 2008.
Sommers, M. S., Brunner, L. S. Pocket Diseases. F.A. Davis; 2012.
Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.
Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.