Sore throat

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

With inflammation of the throat (pharyngitis), the mucous membrane in the throat is inflamed. Acute pharyngitis usually accompanies colds. Chronic pharyngitis, on the other hand, is the result of excessive smoking or radiation therapy, for example. Read more on the topic: What are the causes and symptoms of a sore throat? What can be done about the complaints? How quickly does pharyngitis heal?

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J31J02

Pharyngitis: description

The term pharyngitis actually stands for an inflammation of the pharynx: the mucous membrane that lines the throat is inflamed. Doctors differentiate between two forms of disease - acute and chronic pharyngitis:

• Acute pharyngitis: An acutely inflamed throat is very common and usually accompanies a cold or flu-like infection.
• Chronic pharyngitis: This is an inflammation of the lining of the throat that has lasted for more than three months. It is not the result of an infection, but of persistent mucosal irritation factors such as tobacco smoke or chemical pollutants.

Pharyngitis: symptoms

The symptoms of acute and chronic pharyngitis are partly similar, but there are also differences:

Acute sore throat: symptoms

Acute pharyngitis usually announces itself with a scratchy and burning sensation in the throat. This progresses to a sore throat, often radiating into the ears. People also have pain when swallowing. The dry and rough feeling in the throat causes the patient to clear his throat or cough frequently. The mucous membrane of the throat is reddened and - with an additional runny nose - mucous.

If the sore throat is caused by the typical pathogens of acute respiratory diseases, there are often other symptoms. A runny nose and other cold symptoms such as hoarseness or cough as well as possibly increased body temperature are then typical.

Bacterial superinfection

Sometimes bacteria also settle on the virally inflamed mucous membrane of the throat (bacterial superinfection). This can usually be recognized by the fact that a high fever and headache are added to the other symptoms of pharyngitis.

In addition, the mucous membrane in the throat is then bright red, the tonsils are swollen and have whitish-yellow coatings (tonsillitis, tonsillar angina). If the patient has run out of tonsils, the lateral cords are often colored bright red and swollen instead (lateral cord angina, lateral angina). These side cords are lymphatic ducts that run down from the upper posterior wall of the pharynx on both sides.

Chronic sore throat: symptoms

If the inflammation lasts longer than three months, it is called chronic pharyngitis. Symptoms develop slowly over weeks. The throat feels dry, which is why people swallow or clear their throat more often. You may also feel a lump in your throat. Difficulty swallowing (when swallowing empty), feeling thirsty and dry cough are also symptoms of chronic pharyngitis.

The other symptoms depend on the type of chronic sore throat:

• Atrophic form (pharyngitis sicca): The most common form of chronic pharyngitis. The mucous membrane of the throat is dry, pale, particularly delicate and thin (atrophic), shiny like a varnish and covered with somewhat tough mucus.
• Hypertrophic form: the mucous membrane of the throat is thickened, reddened and covered with thick mucus. There are either lenticular-sized lymph nodes on the posterior wall of the pharynx (pharyngitis granulosa) or thickened, bulging side cords (pharyngitis lateralis).

Pharyngitis: causes and risk factors

Acute and chronic pharyngitis have very different causes:

Acute sore throat: causes

Acute pharyngitis is due to infection. It usually develops in the context of a cold or a flu-like infection. That means: The triggers of the throat inflammation are usually viruses, which are responsible for the typical respiratory diseases. These include adenoviruses, rhinoviruses, influenza viruses, and parainfluenza viruses.

Occasionally, the viral triggers of systemic diseases (diseases of the whole body) also lead to acute pharyngitis. These include cytomegaloviruses, Epstein-Barr viruses (causative agents of Pfeiffer's glandular fever), measles and rubella viruses. Only rarely are other viruses to blame for acute pharyngitis, such as the herpes simplex virus.

The viral infection in acute pharyngitis can weaken the immune system so that bacteria (especially beta-hemolytic streptococci) also settle on the inflamed mucous membrane. Doctors speak of a bacterial superinfection here. A purely bacterial sore throat, on the other hand, is very rare.

Because it is caused by pathogens, the acute inflammation of the throat is contagious.

Chronic inflammation of the throat

In contrast to acute pharyngitis, chronic pharyngitis is not caused by viruses or bacteria and is therefore not infectious. The chronic inflammation in the throat is caused by persistent irritation of the mucous membrane. This can have very different reasons:

• excessive consumption of tobacco or alcohol
• Heartburn (regurgitation of acidic stomach acid up into the throat)
• dry room air in overheated rooms
• frequent inhalation of chemical fumes or dust in the workplace
• Impaired nasal breathing (for example because of a curved nasal septum or greatly enlarged tonsils)
• repeated inflammation of the sinuses (sinusitis)
• Radiation therapy in the head or neck region
• Hormonal changes during menopause
• excessive or incorrect use of the voice (such as constant clearing of the throat and coughing)

A chronically inflamed throat can also develop in connection with chronic inflammation of neighboring organs and tissues. These include, for example, chronic runny nose (inflammation of the nasal mucous membrane), chronic angina (tonsillitis) and chronic bronchitis.

Pharyngitis: examinations and diagnosis

It starts with a detailed doctor-patient conversation: The doctor asks you about your precise symptoms, for example how long you have had a sore throat and whether there are any other symptoms. In the case of chronic inflammation of the throat, he will ask about possible triggers such as tobacco or alcohol abuse or chemical exposure.

The mirror examination of the neck provides the doctor with important information: he examines the mucous membrane of the throat with the help of a small flashlight, a headlamp or a forehead mirror. In addition, he presses the patient's tongue down with a tongue depressor so that he can see better.

If the doctor discovers whitish deposits on the throat wall (suspected bacterial superinfection), he can take a smear to carry out a rapid streptococcal test.

If you have an earache, your doctor will also do an ear exam. Maybe it's just radiating pain from the sore throat, but maybe it's also an otitis media.

If pharyngitis lasts for a long time, the doctor can use the mirror examination to determine the type of disease - chronic inflammation of the throat with tissue atrophy (atrophic form) or with tissue swelling (hypertrophic form). If the cause of the chronic pharyngitis is suspected to be obstructed nasal breathing, he will also examine the nose.

Pharyngitis: treatment

How you treat a sore throat depends on whether it is an acute or chronic inflammation and whether bacteria have also colonized it.

Acute sore throat: therapy

Acute inflammation of the throat (acute pharyngitis) is usually caused by viruses. So it can only be treated symptomatically. For this purpose, the doctor will prescribe, for example, pain reliever and antipyretic preparations (with active ingredients such as ibuprofen or paracetamol). Lozenges, sprays or gargle solutions with locally anesthetic ingredients are also beneficial for sore throats.

In addition, the doctor will prescribe antibiotics for a sore throat if bacteria have also lodged in the throat or caused the infection. The germs are mostly streptococci, which is why the doctor generally prescribes penicillin - an antibiotic that works well against these bacteria.

Chronic throat inflammation: therapy

If you want to get rid of a chronic inflammation of the throat, you must first remove the triggering stimulus (tobacco, alcohol, chemicals, etc.) or at least avoid it as far as possible.

Once the cause of the irritation has been eliminated, the inflammation often heals on its own within a few weeks. This healing process can be supported, for example, with:

• anti-inflammatory drugs (ibuprofen, diclofenac etc.)
• Inhalations and gargle solutions (with salt water or anoint solution)
• Lozenges (with sage, salt, hyaluronic acid or Icelandic moss)

If radiation treatment on the head or neck has damaged the salivary glands and thus reduced saliva production, the throat can be sprayed with artificial saliva. This helps against chronic drought-related inflammation of the throat.

Surgery is sometimes necessary when obstructed nasal breathing is the cause of chronic pharyngitis. For example, the surgeon can straighten a curved septum or enlarge the openings in the sinuses.

Surgical intervention also helps with so-called pharyngitis lateralis: the overgrown, excess (hypertrophic) tissue of the lateral cords is either burned or removed with a laser.

If the chronic pharyngitis occurs in conjunction with chronic tonsillitis, the tonsils are often surgically removed.

Pharyngitis: home remedies

To get rid of the symptoms quickly, many patients with acute sore throat use home remedies.

Teas against sore throat

Many patients find warm tea very pleasant when they have a sore throat. The following medicinal plants are particularly suitable as home remedies for sore throat because of their anti-inflammatory properties:

• chamomile
• thyme
• sage
• ginger
• Blackberry (blackberry leaves)
• blueberries
• Marigold

The following medicinal herbal teas are recommended for dry, irritating coughs:

• Marshmallow
• mallow
• Ribwort plantain
• Icelandic moss
• Mullein

When a fever starts, it is best to use medicinal herbal teas that stimulate sweat production:

• Linden blossom
• Elderflower

You can read more about the effects and the correct preparation of the teas in the respective medicinal plant articles.

You can additionally support the healing process by inhaling the steam of the freshly boiled tea (for example chamomile). This moisturizes the mucous membranes and, depending on the tea, counteracts the inflammation.

Gargle

You can also use cooled herbal teas for gargling. Take a sip and use it to flush your mouth and throat.

Alternatively, you can also prepare a special gargle solution: To do this, dissolve one of the following ingredients in a glass of lukewarm water:

• two tablespoons of apple cider vinegar or
• a tablespoon of lemon juice or
• a teaspoon of sea salt

Stir well and gargle with the solution several times a day.

Neck wraps and pads

Other home remedies for sore throat are cold compresses on the neck. This relieves the pain and has a decongestant effect on the stressed mucous membranes.

Prießnitz neck wrap: Put a cloth in cold water (10-18 degrees), wring it out and wrap it around your neck. Avoid the spine. Cover with a dry cloth and let act for 30 minutes to several hours. After removing the wrap, protect your neck from the cold.

Cold quark pad: once or twice a day, spread 250 to 500 grams of quark (room temperature) onto one or two gauze compresses and place on the neck. Cover with the excess gauze and a cotton cloth and fix. Let the overlay work for 20 minutes to several hours. Then rest.

Healing earth pad: Mix the desired amount of healing earth with a little cold water to a spreadable paste and apply approx. 0.5 to 2 cm thick directly onto the neck. Cover with a cloth and fix with another cloth. Let the overlay work for one to two hours until the healing clay is dry. Then clean, dry and oil the skin. Use once or twice a day.

Tips for everyday life

The following tips will help protect the mucous membranes if you have a sore throat:

Avoid irritating substances: Mucous membrane-irritating factors such as nicotine, alcohol and hot spices should be avoided in the case of a sore throat - especially in the case of chronic pharyngitis.

Keeping the mucous membrane moist: If you suffer from dry sore throat (pharyngitis sicca), you should keep your throat mucous membrane as moist as possible. That means, for example: drink a lot. Warm honey milk and lukewarm black currant juice are well suited. Also, avoid overheated rooms in winter and ventilate regularly. A water evaporator can also help.

Eat garlic: The tuber has a mild anti-inflammatory effect. If you have chronic inflammation of the throat, feel free to cook or season with garlic more often.

Pharyngitis: disease course and prognosis

Acute sore throat is generally harmless and heals on its own within a few days. Bed rest, home remedies and, if necessary, painkillers from the pharmacy have a supportive effect.

Complications of an acute sore throat

If bacteria are involved, a purulent sore throat usually develops, which should definitely be treated by a doctor. Otherwise there is a risk of serious complications such as chronic tonsillitis (chronic tonsillitis). This in turn can be the starting point for serious secondary diseases such as rheumatic fever, kidney, heart or joint inflammation. In unfavorable cases, the affected organs suffer permanent damage, such as heart valve defects.

As a further complication of a bacterial infection in the throat region, the local inflammation can spread to the surrounding connective tissue and lead to an encapsulated accumulation of pus (abscess) there - for example near the tonsils (peritonsillar abscess). Such an abscess must be treated with antibiotics and possibly also punctured and emptied. This is to prevent the inflammation from spreading to other parts of the body, such as the chest and the heart (danger to life!).

Sometimes an acute inflammation of the throat spreads to the larynx or the vocal cords (laryngitis = laryngitis). The patient then becomes hoarse or has no voice at all. The most important tips for laryngitis are: Don't talk or whisper, drink plenty of water (warm drinks!).

Chronic inflammation of the throat

The duration of the chronic inflammation of the throat depends on whether and how quickly the triggering stimuli (tobacco, alcohol, chemical exposure, etc.) can be eliminated.

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