A season of sore throats

It’s that time of the year again – cold weather full of sniffles, sore throats, congested noses and general misery.

It’s also one of the busiest times of the year for the family doctors as we see huge numbers of patients with these symptoms to seek some sort of medical advice and to enquire whether antibiotics are indicated.

First I want to talk about the cold and sore throat that seem to linger for days and days or tends to come back very quickly.

Quite a lot of my patients get surprised to learn that not every cold like symptom is an infection, let alone a serious bacterial one needing antibiotics.

Quite significant proportions of these colds are related to weather or environment related sensitivity. In the spring season, this association is more typical and more widely recognised and appreciated. It’s in relation to the response of the upper airways (nose and throat area) to pollen and is commonly known as hay fever. It’s easy to recognise with the hallmark nose running like a tap, puffy and itchy watery eyes and series of sneezing fits.

But this type of allergy is not necessarily limited to a particular season or allergen. It can last through different seasons and even through the whole year and it can be to all sorts of different elements in our environment such as grass, dust mite, pet dander to name a few. And it may present in completely different manner of congested or blocked nose, throat irritation and cough.

When such a sensitivity is present in us, it can make our airways inflamed as they try to fight off the irritation caused by the allergen. We experience this inflammation as runny or stuffed nose, tickly throat, dry cough, fullness in the areas of cheeks and temple, blocked and itchy ears. The tickly throat and the cough are related as they are caused by dripping of the fluid, produced as a result of this inflammation, through the back of the nose down to the throat. It’s not uncommon to wake up with quite sore throat as a result of this process and to bring up chunks of gunky phlegm first thing in the morning which quite commonly worries people regarding the possibility of an infection causing all this trouble. The blocked ears are caused by the same fluid condensing in the little alleyway connecting our ear, nose and throat. The fullness in the face and head is due to the same fluid from the inflammation getting accumulated in normally air filled spaces in our face and head called sinuses. One very typical sign of sinus congestion is that leaning forward whilst sitting up in a chair will worsen the congestion or the headache.

Another quite common reason of sore throats in winter tends to be the dry air. Loss of humidity, accompanied with a blocked nose makes it necessary for us to breathe through our mouths, drying up our throat and making it scratchy and painful as breathing through nose naturally moisturises the air we are breathing. Using a humidifier may help here.

Quite a few cultural groups firmly believe that eating or drinking cold stuff can give you a cold. They might be onto something with this as consuming cold stuff does indeed increase your chances of getting sore throat, although not a cold. This is due to the fact that cold foods cause congestion of the upper airway lining, making it bit inflamed in a similar fashion to response to an allergen and the swelling weakens its natural defence mechanisms, thus making it easier for the omnipotent viruses to attack and get hold.

So in response to one of the most commonly asked question about whether cold foods can give you cold, the answer is no but it can definitely predispose you to catch one.

So the above mentioned cause of sore throats is allergy/ sensitivity related and its incidence is about 30% amongst causes of sore throats. It’s incidence is unfortunately even higher in Melbourne due to the environmental conditions we have here.

It obviously doesn’t need treatment with antibiotics or even with cold and flu measures but with anti allergy medications such as antihistamine – in form of tablets or nasal spray. Antihistamine or decongestant nasal sprays are effective and quick acting relief remedies but due to their side effects their use should be limited to about 5 days at a time. If the symptoms come back quite quickly after stopping these medications then steroid nasal sprays can be used safely and effectively to control the symptoms. A key with using nasal sprays effectively is knowing the correct technique so make sure you ask your health care provider or pharmacist for a demonstration when you are a first time user.

If an episode of sore throat is associated with fever, body aches and muscle pains, and swollen neck glands then it’s highly likely to be an infectious bout. Overwhelmingly vast majority of these cases tend to be either viral or mild bacterial infections which our bodies are capable of flighting quite well with some simple support such as plenty of warm fluids, throat lozenges, over the counter cough syrup, panadol, salt water gargles, lemon and honey drinks, plenty of rest and if possible home made mum’s recipe chicken soup – the last one is definitely one of the best remedy for most of the ailments known to mankind!

The warning signs which indicate that a trip to the doctors is indicated for a review or a reassessment are high fevers not responding to simple temperature control measures such as panadol and or nurofen, significantly troublesome sore throat causing difficulty swallowing, sufficiently tender glands in the neck and the most reliable of all signs – a feeling of being sick as the best expert on you is you and no one knows better than yourself when you are ill.

Glandular fever quite often mimics bacterial tonsillitis and make you feel quite sick for about a week but your health care provider should be able to make the clinical judgement about differentiating the two as the former, although quite distressing, doesn’t require any antibiotics and tends to get better with some tender loving and care whilst the latter may require antibiotics. When the antibiotics seem indicated then your health care provider may take a throat swab, give you a script for antibiotics with instructions to start if either you feel any worse or it you get a phone call in 24-48 hours about the swab result.

Another common cause of feeling quite ill with high fevers, generalised body aches, fatigue, loss of appetite, sore throat and congestion is influenza. It is different from cold due to the severity of symptoms it causes. Antibiotics do not work for this either and the best remedy is getting a flu shot well in advance of the season and to pay attention to simple hygiene measures such as covering mouth and nose with a tissue or hanky (I can’t believe I just wrote that! Does anyone still call them that or uses one?!) and hand washing with soap and water after coming back from outside, before eating etc.

So on the whole, you may notice that not all sore throats are infections and not all infections are bacterial. I am not drawing on any firm statistics here (although there are plenty available nowadays) but for every 20-25 cases of sore throats I see, maybe about 1 needs antibiotics but all 25 need clear advice and explanation about what they have, what are the things they can do to help themselves, including use of over the counter medications or home remedies, and clear instructions about what warning signs they should look out for indicating a need for review.


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