From Croaky to Clear: Managing Hoarseness and Sore Throat

Written By: Dr Emma Warner

A sore throat (or pharyngitis) is a very common condition usually caused by an infection in the throat. Usually this will be a viral infection, and will settle in a few days with medications targeted at helping ease your symptoms.  

Sometimes a bacterial infection, or an infection such as bacterial tonsillitis or glandular fever can cause it. Some people also suffer from a chronic sore throat caused by irritants such as smoking, pollution or allergies, or from other conditions such as acid reflux.  

This blog will primarily deal with an acute (short term) sore throat caused by an infection.  

What are the symptoms?  

Aside from the throat being sore, you may also experience:  

• A hoarse voice or difficulty speaking  
• A mild cough. 
• A high temperature (fever)

• Fatigue 
• Swollen glands in your neck 
• Pain when you swallow  
• Headaches or muscle aches  

Common infectious causes of sore throat 

• Viral infections, colds and flu                                                                                                                

Many people have a sore throat as a part of a cold or the flu. This tends to be relatively milder in severity (although of course, still very frustrating). 

Viral infections can affect any part of your mouth and throat, from the tonsils, the pharynx (throat, causing pharyngitis) or the larynx (or voice box, causing laryngitis). 

• Tonsillitis 

Tonsillitis is an infection of the tonsils at the back of the throat. This can be caused by a virus or bacteria, and in tonsillitis you may find your symptoms are much worse with a higher fever and feeling more unwell than with a usual sore throat associated with a cold. You may be able to see your tonsils are enlarged or that there is pus on them.  

Some patients with severe tonsilitis or those who develop complications (such as a tonsil abscess or ‘quinsy’) may need to go to hospital for intravenous antibiotics, fluids and other supportive treatment, although this is not common. Other infections, such as glandular fever (infectious mononucleosis or “mono”). 

Do I need any tests? 

Not usually. Your doctor can usually help to predict what is causing your sore throat based on an assessment of your symptoms and an examination of your throat.  

Sometimes a swab will be done from the throat to analyse the germs depending on your situation.  

You may need a blood test if you are suspected to have a condition called glandular fever or if you are on certain medications or have certain medical conditions that put you at risk of a low white blood cell count.  

Will I need an antibiotic prescription? 

Usually you will not need an antibiotic. It is important not to give antibiotics when they are not required as firstly, they can cause unwanted side effects, and secondly, there is a risk of the antibiotics becoming less effective over time as the more the bugs are exposed to the antibiotic, the better they get at adapting and “beating” them.  

As mentioned above, most sore throats are caused by viruses, and antibiotics are only helpful if your infection is bacterial. Sometimes your body will actually be able to deal with bacterial throat infections really well on its own too. However there are certain indicators that can suggest antibiotics might be needed (see below)   

If you fit 3 or 4 of the below symptoms, it is worth coming in for an assessment with your doctor as it is possible that you will require antibiotics (although not always).  

1. You have a high fever  
2. You can see white or yellow pus on your tonsils. 
3. You have tender lymph glands in your neck. 
4. You do not have a cough. 

How to treat a sore throat  

Most cases of sore throat will settle within a few days with rest, hydration and medication to relieve your symptoms:   

• Stay hydrated - this can help ease the soreness in the longer term even if it is difficult to swallow initially. Dehydration can make you feel very poorly, so it is important to drink enough. If it is painful to swallow try sipping cool water.  
• Painkillers - simple painkillers like paracetamol/acetaminophen and ibuprofen can be really helpful with easing the discomfort and help if you have a fever. Some people are unable to take ibuprofen, so always read the label. If you are able to take ibuprofen, you can absolutely take paracetamol and ibuprofen together, just make sure you do not exceed the recommended doses. Ibuprofen also shouldn’t be taken on an empty stomach, so if you are struggling to eat, paracetamol might be a better choice. 
• Lozenges, gargles and sprays - there are many formulations and brands available, many of these have antiseptic agents in and some can actually help to numb the throat a little to help with pain.  
• Food - try to eat as much as you can tolerate to help with your energy and recovery. You may find that soft foods like yogurt, mashed banana, congee or icecream are best.  
  

When will I feel better again? 

A sore throat will typically get worse over two to three days and then start to improve. Most people will be feeling better in a week’s time with supportive treatment. 

When should I see a doctor?  

You should see a doctor if any of the following apply to you  

• If you are not improving after 3-4 days and starting to feel worse  
• If your symptoms are very severe 
• If you are unable to drink or unable to swallow your own saliva  

• If you are unable to open your mouth  
• If you have a high fever for more than 48 hours 
• If you are having breathing difficulties you should seek emergency medical care  
• If you have cancer or are undergoing treatment, have had heart valve replacement, have a reduced immune system for any reason  
• If you are on any medications that put you at risk for a low white blood cell count  

The 'take home' message is to see a doctor if symptoms of a sore throat are very severe, unusual, or you are still feeling worse or no better in 3-4 days.