PERSISTENT SORE THROAT: IS IT ALWAYS TONSILLITIS?

By Dr Annabelle Leong

Most sore throats heal and get better on their own but if your sore throat keeps recurring, then you should ask, “Why do I keep getting sore throats?”

As a busy ENT specialist in Singapore, we see many patients who suffer from sore throat symptoms. Although the standard sore throat or “pharyngitis” will usually recover, sometimes it may be due to recurrent tonsillitis, inflammation of the tonsils which sit at the back of your throat. This may be viral or bacterial, needing a course of antibiotics to be prescribed by your family doctor.

However, there are many other causes of a persistent sore throat though:

Quinsy or peritonsillar abscess
Throat ulcers
Acid Reflux and gastritis
Postnasal drip from Allergic rhinitis and Nasal allergies
Sinus infection
Fungal yeast infection of the throat
Throat cancer

A. Quinsy or peritonsillar abscess

Sometimes, 10% of patients who have acute tonsillitis, go on to develop a quinsy. A quinsy is a collection of infected pus sitting behind the tonsil. It is usually extremely painful, affecting your ability to swallow and making it difficult for you to open your mouth. It needs to be drained urgently, followed by some strong antibiotics, to clear this severe infection completely. So if you are suffering a very severe sore throat especially only on one side of your throat and you can’t really open your mouth fully, you need to be seen in A&E by your ENT specialist in Singapore urgently.

B. Throat ulcers

You might be suffering an outbreak of multiple ulcers all over your throat, mouth and tongue. These are very painful and can feel like knives cutting into your throat. Although throat ulcers may be caused by viral infection, other causes also include vitamin deficiencies and auto-immune diseases.

C. Acid reflux and gastritis

Acid reflux is the backflow of stomach acid up into the throat. It doesn’t always have to be associated with heartburn. It can feel more like a lump in throat or persistent throat irritation or itchy throat. Some patients notice a persistent dry cough and keep feeling they need to clear their throat again and again.

The treatment of acid reflux is to make some lifestyle changes such as reduce caffeine and alcohol, eat less spicy and oily food. A course of medications to modulate stomach acid production such as Nexium and Pariet (proton pump inhibitors or PPIs) is useful in helping your acid reflux get better. Sometimes, you may need to see a gastroenterologist (stomach specialist) for an endoscopuy of the stomach.

D. Postnasal drip from Allergic rhinitis and nasal allergies

Don’t forget that if you keep suffering a blocked runny nose with backdrip, this may mean a chronic allergic reaction in your nose to allergens such as house dust mite, the most common trigger of allergic rhinitis, allergic asthma and eczema in Singapore.

The postnasal drip keeps flowing down the back of the nose into your throat, to give you a persistent sore throat. Allergy testing, either a blood test or skin prick test, is useful to identify the triggers underlying allergic rhinitis. A course of nasal medications such as saline nasal douche, nasal steroid spray and antihistamine medications like Telfast, is often helpful in calming your nasal allergies.

Nowadays, patients with severe allergic rhinitis are undertaking sublingual immunotherapy (SLIT) for House Dust Mite in Singapore to desensitize their bodies. SLIT is a very successful and safe treatment plan for those with House Dust Mite-related allergic rhinitis but it takes at least three years, according to all the numerous studies published.

E. Sinus infection

Catching the flu may lead to bacterial growth in your nasal sinuses to cause infection. The infected secretions in your nose flow down into the back of your throat to give you a persistent sore throat. The first-line medication for acute sinusitis is antibiotics, together with using a nasal rinse, nasal steroid spray and antihistamines to decongest your nose.

If your symptoms of blocked nose, yellow nasal discharge, headaches, facial pain, toothache, drag on past 3-4 weeks, then it’s time to see your friendly ENT specialist in Singapore. A CT sinus scan may be indicated, in addition to a sinus swab and suction clearance to send off a specimen for cultures.

F. Fungal yeast infection of the throat (oral thrush)

Some patients grow fungus or yeast inside their throats, especially if they are:

Diabetic
Have been using steroid inhalers for asthma
Immunocompromised (weak immune systems) e.g. patients with cancer, HIV infection or have been on prolonged steroid medications.

You have to be careful because fungal infections can spread rapidly in your throat and can sometimes be challenging to treat. So if you see multiple white patches in your mouth or throat, then please see your ENT specialist in Singapore for early diagnosis and treatment.

G. Throat Cancer

Finally, the one condition which we all worry about if you have a persistent sore throat!

The risk factors for tonsil or throat cancer are smoking, alcohol and Human Papilloma Virus (HPV) infection. HPV has many different strains of virus and is linked to a higher risk of cervical cancer, throat, tonsil and tongue base cancer.

In women, HPV infection is usually detected in their cervical smears. All women under the age of 45 should be vaccinated against HPV, with the Gardasil vaccine (Gardasil-9). In fact, everyone, male and female, should have the Gardasil vaccine to prevent HPV spread through our population. Routine throat swabs are not helpful in detecting HPV infection in the throat unfortunately.

But if you keep getting a sore throat or if you notice a warty nodule or lump growing inside your mouth or throat, then you should definitely get it checked out promptly. Warts are HPV-related and are sexually transmitted through saliva and bodily fluids. Most are usually benign or non-cancerous but they may carry a slight risk of transforming into pre-cancerous lesions. HPV strains 16 and 18 are the viruses which are most associated with throat cancer.

If you see some strange warty lump in your throat, then you should have it removed surgically and sent off for analysis. Please see your friendly ENT specialist in Singapore to have it checked out.