We all get sore throats from time to time. Some people
are troubled excessively by sore throats, sometimes
a specific diagnosis can be made and there is a clear
treatment, other times it is less clear-cut. Common
causes of a sore throat would be: 1) viral pharyngitis
2) recurrent acute tonsillitis 3) gastro oesophageal
reflux (GOR) 4) muscle tension.
1) The commonest cause of a sore throat is a self-limiting
viral infection (acute pharyngitis/viral pharyngitis)
usually symptomatic treatment is all that is necessary.
If this becomes very frequent or prolonged, one must
consider the possibility that it many be a manifestation
2) Silent gastro oesophageal reflux. Most people commonly
consider acid indigestion as being heartburn felt in
the chest or stomach. It is being increasingly recognised
however that acid may escape from the stomach and escape
into the oesophagus (gullet) and cause a variety of
symptoms including a poorly localised discomfort in
the throat. The throat diagnosis will depend on history,
a thorough examination including endoscopy of the throat
to exclude more serious causes and often a trial of
medicine designed to suppress acid formation.
3) Acute tonsillitis, this is a common condition of
childhood and may follow on from an acute viral infection.
It may be difficult to distinguish viral and bacterial
infections of the throat and tonsils. Initially patients
should be treated symptomatically with pain relief and
kept well hydrated. The use of antibiotics is controversial
in some cases of acute bacterial tonsillitis the effective
antibiotics may be to shorten the period of ill health
however there are many studies that have looked at this
issue and have shown that the effect is at best marginal
and increasingly there is pressure not to prescribe
antibiotics unless absolutely necessary.
Throat links click here:
Your GP may have strong views
on the subject; most of these conditions are dealt with
by a General Practitioner rather than an ENT specialist.
If despite management by your General Practitioner the
patient seems to suffer repeated attacks and is loosing
a lot of time off school/work then the benefits of removing
the tonsils (tonsillectomy) may out weigh the disadvantages.
4) Muscle tension – chronic sore throats may be
the result of muscle tension, either due to poor position
or associated with voice abuse.
Commonly a hoarse voice is associated with a simple
acute laryngitis, again a viral infection like pharyngitis,
which is often uncomfortable but short lived, and self-limiting.
A hoarse voice in an adult smoker raises the possibility
that this may be due to a cancer of the voice box and
any adult smoker over the age of 40 who has a hoarse
voice, which persists for more than six weeks, must
seek urgent medical attention. A hoarse voice which
is not due to a cancer may well be due to straining
the voice box, this occurs often in singers, teachers,
actors or anybody who has to project or use their voice
a lot. Anybody who smokes is also liable to irritate
the larynx and gastro oesophageal reflux may also present
as a hoarse.
The complaint of a “sensation” of a lump
in the throat is very common. Lumps in the neck, which
are visible to an outside observer, are less common.
The perception of a lump in the neck or throat, often
described, as a “frog in the throat” is
often worrying but fortunately rarely due to a serious
disease. Patients often feel at the base of the neck
that there is something there and they have to continually
clear their throat. Sometimes the voice is slightly
affected. If the complaint is long standing and there
is no change in diet or weight, it is extremely unlikely
that there is a sinister cause. Weight loss and the
need to eat finely chopped food is however a sinister
symptom and anybody with such complaints should seek
urgent medical attention. A complaint of a lump in the
neck, which is visible externally, should always be
taken seriously. There are many causes for this as they’re
many organs within the head and neck, which can produce
disease. An ENT surgeon is trained to consider what
the likely origin of the lump is over what type of disease,
i.e. infection or tumour is the likely cause.
The site of the lump is the single most useful guide
to the possible cause.
1) Thyroid gland – should it become enlarged (goitre).
Usually the cause of this is a benign goitre, which
consists of multiple cysts. There may be a benign lump
or rarely a malignant lump. Diagnosis usually rests
on blood tests, a needle biopsy and sometimes an ultra
2) Lymph glands, there are many lymph glands within
the neck and indeed the whole human body. Strictly speaking
we refer to these as lymph nodes, not lymph glands,
but often the public will talk about “their glands
are up”. This may be a non-specific reaction to
a generalised infection or an inflammatory or malignant
process nearby e.g. tonsillitis or cancer of the throat.
For this reason any lump in the neck, which is not associated
with an acute cold and does not resolve within three
weeks should be examined by a Doctor urgently.
3) Salivary glands including parotid and submandibular
– the saliva in our mouth is produced by various
glands within the neck, the two largest of which are
the parotid gland just below and in front of the ear
and the submandibular gland which is tucked up underneath
the jaw bone. These may become enlarged because of infection
(e.g. mumps) obstructed by a stone or a tumour. Removal
of the submandibular gland or the parotid gland (parotidectomy)
are delicate operations with risk and complications
of which the patient must be aware.
Neck Lumps links click here:
Cancer of the head and neck
Fortunately cancer of the head and neck is rare. Unfortunately
it often presents late and the treatment may involve
major surgery and/or radiotherapy. Cancer of the mouth,
voice box or gullet is almost unheard of in non-smokers.
If caught early treatment is often highly successful
and for this reason an adult smoker with any of the
following symptoms should seek medical attention urgently.
1) A hoarse voice, which persists for more than six
2) A sore throat which persists for more than six weeks
3) difficulty swallowing food,
4) change in diet or weight loss,
5) any neck lumps which persists for more than three
5) A mouth ulcer that does not heal.
For Cancer of the Head and Neck links click here: