Having a Sore Throat Does Not Mean Just a Throat Infection – You might be suffering from These!

What is a “Sore throat ”?

A sore throat is a scratchy or itchy sensation in the throat which causes discomfort to the patient while swallowing. Many patients may call this scratchy or itchy sensation –

• Irritation in throat
• Discomfort in throat
• Pain in throat
• Burning in throat

Most common causes of a sore throat –

Virus: RHINOVIRUS, INFLUENZA VIRUS, CORONAVIRUS, ADENOVIRUS etc.

Bacteria: Streptococcus pyogenes, Staphylococcus aureus, etc.

Less discussed but now common causes of Sore throat which are not detected and the patient remains in distress are —

1. Laryngopharyngeal reflux
   
2. Subacute thyroiditis (aka De Quervain Thyroiditis)
   
3. Tonsil Stones (or Tonsilloliths)
   
4. Excessive Kadha intake (one of the COVID-19 aftermath in India)

LARYNGOPHARYNGEAL REFLUX (or LPR) and GERD

Laryngopharyngeal Reflux refers to the black flow of stomach contents into the throat. There is another disease that is also related to backflow of stomach contents known as GERD (or Gastroesophageal reflux disease), which is very similar to but still different from LPR. In GERD patient DOES NOT have any throat symptoms.

Symptoms of GERD will be –

1. Epigastric burning

2. Heartburn

3. Bloating

4. Belching

5. Heaviness in the chest

6. Difficulty in swallowing

However, in LPR, the patient will have throat symptoms.

Symptoms of LPR will be –

1. SORE THROAT

2. COUGH

3. SENSATION OF LUMP IN THROAT

4. SENSATION OF CONSTANT CLEARING THROAT

5. Excessive saliva/mucus production

6. THROAT PAIN

7. BAD BREATH

8. HOARSENESS OF VOICE

TREATMENT OF LPR/GERD :

1. ANTACIDS

2. PROTON PUMP INHIBITORS

3. LIFESTYLE CHANGES such as AVOID SPICY FOOD AND CHILLIES.

Elevation of the head USING GERD PILLOW /GERD MATTRESS / BED RISERS to 6 inches or more THAT AVOIDS REFLUX OF ACID also helps a lot.
Because of their shape and angle, when a patient lies on the pillow or the mattress, the inclination is such that the acid does not reflux to the throat and remains in the stomach where it is meant to be present.

4. WEIGHT LOSS

5. REGULAR EXERCISE

6. SMOKING CESSATION

7. REDUCING THE INTAKE OF Alcohol, beverages, chocolate, peppermint, and caffeine.

8. EATING MORE FREQUENTLY, BUT WITH SMALLER MEALS

9. AVOID TIGHT-FITTING CLOTHES

10. The patient should AVOID FOODS AND DRINKS within 3 hours before sleep.

11. The patient may be encouraged to lie on his/her left side, as in the left position the diaphragmatic crura causes a natural kink at the gastro-oesophageal junction, which prevents acid reflux.

12. AVOID activities that require lifting, bending, stooping.

13. Increased water intake might help in some patients.

If after following all the above medications and behavioral modifications, the patient is still suffering from LPR/GERD, the following should be done-

1. 24-hour Ambulatory pH monitoring: It is the GOLD STANDARD to diagnose LPR/GERD.

2. Esophagoscopy: Endoscopic examination of oesophagus

3. Esophagogram: To diagnose abnormalities of the esophagus like hiatal hernia, strictures, esophageal rings, extrinsic compression on food pipe, motility disorders, diverticula, pharyngeal pouch, malignancy, etc.

4. Esophageal manometry: To look for achalasia cardia or diffuse esophageal spasm

5. Pepsin immunoassay: Detection of PEPSIN in throat sputum by immunoassay appears to be a sensitive test to diagnose LPR

6. Mucosal biopsies: Oesophageal biopsy, stomach biopsy, posterior laryngeal mucosa biopsy can be done

SUBACUTE THYROIDITIS (DE QUERVAIN’S THYROIDITIS)

The diagnosis of subacute thyroiditis is often overlooked because the symptoms can mimic Throat infection.

The peak incidence occurs at 30-50 years. Occurs more frequently in Women than Men.

The patient with Subacute thyroiditis will also have symptoms like a throat infection such as –

• Sore throat
• Fever
• Weakness
• Difficulty in swallowing
• Pain during swallowing.
• Enlarged surrounding lymph nodes.

Apart from this, the distinguishing feature will be the presence of a painful and mildly enlarged thyroid gland.

Diagnosis can be made by a simple Ultrasound of the neck, and if required FNAC (fine needle aspiration cytology).

TONSIL STONES

This condition is very commonly presented to an ENT doctor when the patient complains that he/she sees creamish-white or white particles in the throat and they keep coming in the mouth spontaneously or while coughing or sneezing. These particles are very foul-smelling and some even think of them as an indication of cancer.

However, it is NOT AT ALL related to cancer and patients do not need to worry about this. These are just food debris that is stuck in the tonsils.

Due to poor mouth rinsing and gargling, these food particles get stuck in the throat and cause –

• SORE THROAT.
• Bad Breath.
• Discomfort in throat.
• Sensation of something scratching the throat from inside.

These can be treated at home by simple gargling of the mouth every time the patient eats something with simple lukewarm water or the patient may use Betadine 2% (w/v) mint gargles also.
[Take 150-200 ml of lukewarm water and mix 5-10 ml of betadine gargles in it. Now do gargling at least three times in a day for 2-3 weeks, and if required may be for a longer duration].

EXCESSIVE KADHA INTAKE

Kadha is a homemade immunity booster drink (what many people think of….!!!) or a multi-spice potion that is very commonly used in Indian households.

During COVID times, it is very commonly seen that almost all homes developed their own recipe of making kadha from youtube or internet articles or Whatsapp or google, and started drinking it 2 to 4 times a day like an immunity booster to save themselves from catching coronavirus infection.

However, I would like to break this to everyone reading this that………..
Kadha CAN NOT act as a miracle potion in saving you from catching a coronavirus infection. eg. If you come in contact with a coronavirus-positive patient without a mask and shake hands with him…..you CAN NOT think that because you have been drinking kadha 2-4 times in a day all these times so you can not catch the infection.

Drinking kadha may have some beneficial effects on some individuals and intake in moderation is still justified.

However, it was seen that people started presenting to ENT OPD with complaints of severe throat pain, excessive sore throat, the sensation of something stuck in the throat, the sensation of a lump in the throat after drinking kadha.  

Kadha is a drink that can contain various ingredients which can vary from—-

• Ginger
• Black Pepper
• Cinnamon
• Turmeric
• Giloy
• Liquorice
• Indian ginseng
• Dry ginger
• Fennel
• Long pepper
• Cardamom
• Basil
• Mint
• Cloves

These ingredients when not put in a properly measured amount do not make an “immunity booster kadha” rather patient makes a “TROUBLE DRINK” for himself.

Because of excessive kadha intake, many patients have reported to ENT OPD with—

• SORE THROAT
• Severe congestion of the throat leads to severe pain in throat.
• Burning stomach
• Chest discomfort
• Hyperacidity
• Flaring up of GERD and LPR
• Mouth and tongue ulcers
• Indigestion leading to further flaring up of GERD and LPR.

Hence, I suggest that kadha might be having its good effects when made properly with the right ingredients mixed in the right proportion and if taken in moderation…………..

But if not made properly and if taken in excess will DEFINITELY cause distress and discomfort to the patient.

THANK YOU

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