What is chronic sore throat?

Chronic inflammation of the throat (chronic pharyngitis) is a chronic inflammatory and/or irritating process of the mucous membrane of the pharynx without an infectious component, which results in the pain not disappearing or often recurring, or the sore throat lasting longer than several weeks.

Causes of chronic sore throat

If a sore throat does not go away even after antibiotic therapy, it is best to seek medical advice, as chronic pharyngitis has many possible underlying causes. Its development is associated with various unfavorable situations: excessive heat or cold, dry air, external irritants (dust, smoke, misuse of nasal decongestants, tobacco smoke, etc.), vocal strain, mouth breathing, hormonal disorders (menopause, hypothyroidism, etc.), previous operations (e.g. removal of tonsils), aging, chronic infection, allergy or allergic reaction (e.g. eosinophilic esophagitis), gastric acid reflux or throat cancer (rare).

At the same time, it seems that in chronic pharyngitis there is also a constitutional weakness of the mucous membrane of the pharynx.

Smoke and other environmental pollutants

Smoke contains fine airborne particles and may include harmful chemicals as well as pieces of burned material. Smoke can be produced by burning tobacco, wood, grass, coal, plastic, fireplaces or landfill fires, traffic exhaust, industrial exhaust, or almost any other combustible material or activity that involves burning carbon.

Particulate matter pollution is a common problem in urban areas, as well as in households and underdeveloped areas that rely on wood and coal for heating and/or cooking.

The degree to which smoke and other airborne environmental pollutants can cause sore throats and lung problems varies from person to person, but when problems do occur, they usually manifest as a dry and sore throat, runny nose, and cough. Long-term or frequent exposure to smoke can cause permanent sore throats.

If you live in an area like a big city, you may have a persistent sore throat due to smog, a build-up of pollutants in the air. Inhaling smog can be dangerous, especially on hot days. In addition to an irritated, sore throat, inhaling smog can cause worsening asthma symptoms, coughing, shortness of breath, and lung damage.

Smoking and exposure to secondhand smoke can cause a scratchy or sore throat, along with aggravation of any existing asthma, bronchitis, emphysema, etc. In mild cases, exposure to cigarette smoke toxins leads to a sore throat. But smoking is also a risk factor for throat cancer, which can also result in a sore throat.

Chronic inflammation of the tonsils

Another common cause of chronic sore throat is an infection of the structures in or around the throat. If the tonsils are not removed, then these are the structures that are most often affected. Since the inflammation is repeated (perhaps several times a year), changes can develop over time that supports chronic sore throat.

Post-nasal drip

In the case of post-nasal drip, excess mucus drains from the sinuses into the back of the throat. This can lead to a long-lasting burning, sore or scratchy throat. It can be triggered by weather changes, some medications, spicy food, deviated septum, allergies, dry air, and many other reasons.

In addition to a sore throat, some of the symptoms of post-nasal drip include bad breath, feeling the need to swallow or clear the throat all the time, a cough that gets worse at night, and nausea due to excess mucus in the stomach.

Allergy or allergic reaction

Allergic rhinitis. A sore throat can be persistent if there is an allergy related to the substances you inhale (pollen, dust, synthetic fragrances, mold, and so on). The most common symptoms associated with airborne allergens include a runny nose, cough, sneezing, itchy eyes, watery eyes, and itchy throat. Post-nasal drip and inflamed sinuses are the most likely cause of a sore throat due to allergies. In this case, the mucous glands of the nose and throat produce an excessive amount of thick mucus, which can cause swelling and irritation of the pharynx. The postnasal drip, itching, and sore throat associated with allergic rhinitis can cause recurrent or persistent sore throat.

Eosinophilic esophagitis. It is a disorder of the esophagus in which an allergic reaction (due to an allergy to food or to some environmental substance) causes irritation of the esophagus, and sometimes narrowing, as a result of which food is retained in the esophagus. Eosinophilic esophagitis cannot be diagnosed using standard allergy tests, and it is difficult to determine exactly which food is causing the problem since allergic reactions are often delayed in this case. Symptoms include sore throat, heartburn, difficulty swallowing (especially dry or thick foods), painful swallowing, recurring abdominal pain, nausea, and vomiting.

Laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is a disorder associated with gastroesophageal reflux disease (GERD) in which stomach acid backs up into the esophagus and reaches the back of the throat. Symptoms include a burning or sore throat, hoarseness, post-nasal discharge, difficulty swallowing, and a feeling of something stuck in the throat.

LPR can also be caused by nutritional problems, abnormalities of the circular muscle of the esophagus (at the junction of the esophagus into the stomach), and being overweight. In many cases, certain foods (alcohol, caffeine, fatty foods, spicy foods), stress, and smoking are associated with reflux. It is possible to have LPR without GERD or to have GERD without LPR.

Mouth breathing

If you are a chronic mouth breather, especially while you sleep, it can lead to repeated sore throats. Discomfort or pain is most often felt in the morning after waking up, with the fact that it probably stops after fluid intake.

Symptoms of night breathing include dry mouth, scratchy or dry throat, hoarseness, tiredness and irritability upon waking, bad breath, dark circles under the eyes, and brain fog (feelings of mental sluggishness, poor concentration, forgetfulness, etc.).

If most of the time one breathes through the mouth, there is probably some kind of obstruction that prevents proper breathing through the nose (nasal congestion, sleep apnea, enlarged tonsils, or vegetation in the pharynx).
Throat cancer

Throat cancer is a fairly rare cause of chronic sore throat, but it is still quite serious if it occurs. The most important risk factors for throat cancer are smoking and alcohol consumption. Throat cancer generally starts in the larynx or pharynx, and a sore throat is just one of the symptoms. Other symptoms include difficulty swallowing, shortness of breath, chronic cough, changes in voice/hoarseness, feeling of something stuck in the throat, unexplained weight loss, etc.

Risk factors for chronic sore throat

Anyone can get a sore throat, but several factors can increase the likelihood of chronic sore throat.

That includes:

  • allergies
  • older age
  • smoking
  • weakened immune system
  • poor air quality (passive smoking, chemicals, pollution, etc.).

Chronic sore throat – symptoms

The symptoms of chronic sore throat are very different from those that occur in the case of inflammation of an infectious nature, and may include:

  • feeling of dryness
  • burning sensation when swallowing
  • a feeling of dryness in the throat
  • stabbing pain in the throat
  • tickling sensation in the throat
  • feeling that something is stuck in the throat
  • scratch
  • hoarseness
  • difficulty swallowing
  • frequent need to cough
  • enlarged tonsils
  • enlarged lymph nodes.

Diagnosis of chronic sore throat

If you are not sure what the underlying cause of a chronic sore throat is, be sure to seek the help of an ear, nose, and throat specialist.

The diagnosis of chronic pharyngitis is based on medical history and physical examination. Based on the information obtained, the doctor can request additional tests in order to better assess the severity of the condition and prevent possible complications.

Chronic sore throat – treatment

Chronic pharyngitis is often more difficult to treat, and treatment options depend on the cause of pharyngitis.

The most common cause of chronic sore throat is a long-term infection of the tonsils in people who have not had them removed. In this case, an extended course of antibiotics is usually prescribed. If such an approach does not give the expected result and the inflammation of the tonsils becomes chronic, occurs repeatedly, or has led to the development of a serious complication (eg. peritonsillar abscess), surgical removal of the tonsils can be considered.

Learn more about when and why to have tonsil surgery.

In chronic pharyngitis, which does not have an infectious component, the usual treatments can lead to the relief of symptoms. In these cases, it is usually advisable to avoid unfavorable environments (very dry, smoky, etc.) and those factors that aggravate the symptoms (cold or hot food, excessive air conditioning or heating, etc.). Symptoms can be alleviated at home: use lozenges, gargle with saline solution, inhale, drink enough fluids, take hot drinks with lemon and honey, using an air humidifier, rinsing your nose with saline solution, stopping smoking if you are a smoker, relieve pain with medications that over-the-counter (eg ibuprofen).

If chronic sore throat is the result of vocal strain, be sure to take time to rest your voice, drink plenty of fluids, and avoid raising your voice whenever possible.

If there is some disease or condition behind the chronic inflammation of the throat, it is necessary to treat the underlying disease (allergy, gastroesophageal reflux disease, GERD, etc.).

When to see a doctor?

If more serious symptoms start to appear, it is best to seek the advice of an ear, nose, and throat specialist. See your doctor right away if you develop any of the following problems associated with chronic sore throat:

  • a sore throat that is very painful (making it difficult to eat, talk or sleep) or lasts longer than a week
  • high temperature (more than 38 ˚C)
  • intense, severe pain on one side of the throat, along with swollen lymph nodes
  • difficulty swallowing or breathing, opening the mouth, or turning the head
  • pain in the ear
  • joint pain
  • hoarse voice lasting more than two weeks
  • rash
  • swelling of the neck or face.

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