In the winter months, many of us are likely to pick up a cold or two, with one of the most common symptoms being a sore throat, but in some cases a sore throat can be a sign of something more worrying.
If you find you are suffering from a persistent sore throat, our Consultant ENT, Thyroid and Head & Neck Surgeon, Mr Robert Hone will help you to understand what the common causes and symptoms are of your throat problems and how our private ENT service can help soothe your discomfort.
What are persistent throat symptoms?
There are numerous causes for irritable throat symptoms and these are often termed ‘globus symptoms’ or ‘benign throat symptoms’. They include:
- Throat discomfort and irritability
- Sore throats
- The sensation of a lump in the throat (usually on swallowing)
- Throat clearing
- Excessive phlegm
- Postnasal drip
- A croaky voice
The symptoms come and go but are frustrating and often difficult to treat, with a high chance of them returning in the future. The causes are usually not concerning however, if you have a persistent sore throat for more than six weeks, pain in your ears, perhaps accompanied with a persistently hoarse voice and/or increased difficulty in swallowing you should seek an urgent appointment with your GP.
What are the causes of these symptoms?
These symptoms can be caused by a wide range of conditions and often continue after an upper respiratory tract infection such as the common cold or even COVID-19, which are caused by different viruses. These infections cause irritation and inflammation in the throat which persists beyond the end of the virus. The main causes for the symptoms above are:
- Chronic laryngitis (inflammation on the voice box)
- Persistent rhinitis/sinusitis (inflammation of the nose and sinuses)
- Poor vocal hygiene
- Reflux or indigestion (which is often silent)
How are throat problems diagnosed?
Establishing the cause of your symptoms is very important, as it will help tailor the right treatment for you. Your ENT Consultant will want to take a history of your symptoms, including what they are and when they started, to try and identify the most likely cause. Once your history has been reviewed, your Consultant will examine you by looking in your throat and nose, feeling your neck, and passing a small camera into your nose to examine your sinus openings and throat. This is called a fibreoptic nasal endoscopy and it can be done very easily during your appointment.
It is very important to thoroughly examine your nose and throat to exclude any worrying conditions. Depending on the findings, your Consultant may occasionally wish to request a scan to investigate you further with an ultrasound, CT, MRI or swallow assessment depending on what they believe is the cause.
What are the treatments for throat symptoms?
Firstly, it is important to look after yourself when you have an upper respiratory tract infection by maintaining good hydration and using simple over-the-counter painkillers such as paracetamol and ibuprofen. You can also consider lozenges and anti-inflammatory mouthwash/spray to help your sore throat, and nasal decongestants to relieve your blocked nose. Your symptoms should resolve within five to 10 days. It is not uncommon to suffer with a number of upper respiratory tract infections over the course of the year.
Vocal hygiene and hydration
The treatment of persistent throat symptoms depends on the cause. However, most treatment is simple lifestyle modification, including vocal hygiene and treating the underlying condition depending on what is identified in the patient’s history and examination. Your symptoms are often caused by a number of problems that are contributing to your persistent throat problems.
Vocal hygiene is very important and involves maintaining good hydration with two litres of water a day (more if you regularly exercise) and avoiding excessive fizzy drinks, caffeine and alcohol while not overstraining your throat and voice.
Laryngopharyngeal reflux is where your stomach contents come into your throat and cause irritation along with all the aforementioned symptoms. It is best managed with lifestyle changes such as avoiding certain foods, not eating near bedtime and weight loss (if you are overweight). Medical treatments can be started and are usually trialled to see if they have a beneficial effect. Gaviscon Advance is a widely used medication for laryngopharyngeal reflux, but tablet medications with a proton pump inhibitor may be used. However, this is not always as effective, and must be given every morning and evening.
Steroids and antibiotics
Rhinitis and rhinosinusitis are inflammation of the nasal lining and sinuses causing blockage and/or increased secretions. It may be intermittent or persistent and allergic or non-allergic. If allergy-related then avoid the allergens and use antihistamines, topical intranasal steroids and saltwater nasal washes. Non-allergic cases are treated with topical intranasal steroids and saltwater nasal washes with or without specific courses of antibiotics.
These treatments should improve your symptoms, but if they do not improve and depending on the cause, your Consultant may consider referring you for speech and language therapy for further tailored treatment, or to other specialties for further investigations.
Access our ENT service
Are you struggling with any ear, nose or throat conditions such as ear or sinus infection? You can catch up on our recent webinar here to hear our Consultant ENT, Thyroid and Head & Neck Surgeon Mr Robert Hone discuss common winter ear, nose and throat conditions.
Published on 19 December 2022