Approach to Patients with Sore Throat
Objectives
- Enumerate causes of a case presented with the complaint of sore throat.
- Identify reasons that led patients to seek help for a sore throat.
- Differentiate between viral and bacterial causes of sore throat.
- Discuss the common symptoms and signs of sore throat.
- Identify different modalities and benefits of investigations in a case of throat.
- Discuss appropriate management options for a case of sore throat.
- Identify indications for tonsillectomy.
- Use the watchful waiting strategies for use of antibiotics and referrals to tonsillectomy.
- Adopt both modification of help-seeking behavior and opportunistic health promotion in such cases.
CASE SCENARIO
Khalid is a 20-year old college student. He presents with history of lethargy for 3 days and a sore throat that started today.
- He is also having runny nose and mild red itchy eyes.
- Throat is so sore that he can hardly swallow solid food.
- He does not have any known drug allergies and takes no regular medications.
On examination:
- Temperature is 37.8°C, and tonsillar congestion present.
- He is well hydrated. There are no other signs or symptoms.
- He is anxious about his illness as he is sitting a final 2nd year exam next week.
What’s Sore Throat?
It’s a painful inflammation of the mucous membranes lining the pharynx.
Sore Throat Causes
- Acute pharyngitis, tonsillitis, or acute exudative tonsillitis may all cause sore throat. These are considered together under the term ‘sore throat’.
Differential Diagnosis
- Pharyngitis
- Tonsillitis
- Epiglottitis
- Peritonsillar abscess
- Laryngitis
- GERD
Etiology
- Viral cause (50 to 80%), including influenza and primary herpes simplex, Epstein-Barr virus (EBV).
- Bacterial causes, most common is (GABHS). Others are:
- Chlamydia pneumonia
- Mycoplasma pneumonia
- Haemophilus influenza
- Neisseria meningitides
- Neisseria gonorrhoeae (5-36%).
- Fungal cause, including Candida.
Noninfectious Causes
- Irritants
- Allergies
- Stomach acid ‘GERD’
- Injuries
- Muscle strain
- Dryness
- Tumors
Why are Patients Seeking Help for a Sore Throat?
- A UK study found that only one in 18 episodes of sore throat led to a GP consultation.
- Practitioners should be aware of underlying psychosocial influences in patients presenting with sore throat.
Reasons for Seeking Help
- Affecting Function
- Relieve the symptoms
- Sick leave
- Medication “Antibiotics”
- Psychosocial factors.
