Throat Soreness

WHEN TO SEE YOUR DOCTOR

* You also have a fever of 101°F or higher, difficulty swallowing, swollen glands in your neck or white patches on your tonsils or in the area where your tonsils used to be.

* You have been exposed either to strep throat or mononucleosis, or there is a community outbreak.

* You have a history of rheumatic fever.

* You also have a reddish, sandpaper-like rash on your trunk.

* You get sore throats frequently and haven't been to a doctor.

What Your Symptom Is Telling You

When your throat is sore, it usually means that there is an inflammation somewhere between the back of your tongue and your voice box. One cause might be breathing through your mouth because of a congested nose, or some stomach acid creeping up into your esophagus. Either your own smoking or inhaling someone else's sidestream smoke can cause a sore throat, as can fumes and chemicals in the environment or exposure to a substance you're allergic to. Overly dry indoor air during the winter months can also irritate your throat and make it sore.

Your sore throat might also result from an infection, such as mononucleosis or the infamous strep throat.

Symptom Relief

Fortunately, there's a lot you can do to soothe the soreness.

Breathe through your nose. If your nose is stuffed up, you're undoubtedly breathing through your mouth, a practice that dries out and irritates your throat. Decreasing swelling in your nasal passages so you can breathe through your nose again may clear up your sore throat, too, says Frederick Godley, M.D., an otolaryngologist with the Harvard Community Health Plan in Providence, Rhode Island. (To unstuff your nose, see Nose, Stuffy, on page 392.)

Mist away your misery. Sleep with the soothing mist of a bedroom humidifier, particularly during months when you have the heat on, to ease your sore throat pain, says Dr. Godley.

Humidify yourself, too. When you're in pain from a sore throat, drink an extra glass of water with every meal and another at bedtime, Dr. Godley advises. A well-hydrated throat is less likely to hurt.

Gargle. A salt water gargle will ease your sore throat pain. Use 11Ž2 teaspoons salt to one quart warm water, advises Edward Mortimer, M.D., a pediatrician and epidemiologist at Case Western Reserve University in Cleveland.

Skip those smokes. Whether it's your own tobacco smoke or the passive smoke you inhale from a nearby cigarette, stay away from it, advises Robert M. Centor, M.D., professor and chairman of the Division of General Internal Medicine at the Virginia Commonwealth University/Medical College of Virginia in Richmond. The irritants in tobacco smoke not only inflame your throat but can also lead to throat cancer, he warns.

Buy some houseplants. There is growing evidence that fumes from glues, carpets and furnishings in new buildings can cause health problems, including sore throat, says Dr. Godley. "Architects and contractors are now 'baking' new buildings at 90°F for two weeks before occupancy to drive off toxins and glue fumes," he says.

Can't put your own home or office in the oven? Keep plants in your rooms, and be sure you have access to windows that open for fresh air, Dr. Godley advises. The plants will absorb toxins, and fresh-air breaks will improve the climate for your throat, he says.

Heal your heartburn. Even if you don't feel the symptoms of heartburn, your sore throat may be caused by acid reflux—stomach acid that seeps up past the esophagus and into the throat at night. (To control the reflux see Heartburn on page 249 and Regurgitation on page 439.)

Super Throat Soothers

No matter what the cause of your sore throat, you'll still want relief from the pain. Try these preparations to soothe and comfort.

Suck on lozenges. There are a lot of throat lozenges, but all that matters is choosing the one that works for you, says Dr. Centor. Some doctors recommend lozenges that contain phenol, which kills surface germs in the throat while it numbs the pain.

Get a coat for your throat. Demulcents are ingredients containing mucilage, which coats and soothes irritated throat membranes, says Varro E. Tyler, Ph.D., professor of pharmacognosy at Purdue University in West Lafayette, Indiana.

"Slippery elm bark, for example, is a good demulcent for sore throat and has been approved by the Food and Drug Administration as a drug," Dr. Tyler says. Look for lozenges containing slippery elm at pharmacies or health food stores.

While you're at the health food store, you can also pick up some marshmallow root or mullein root to brew a throat-coating Take an analgesic. Over-the-counter painkillers like acetaminophen or ibuprofen can help kill sore throat pain, says Dr. Mortimer. But if you're treating a child or young adult, avoid aspirin. In children and young adults who have the flu or chickenpox or any fever, aspirin can cause Reye's syndrome, a life-threatening neurological disease.

The Strep Steps

Even though it's common, strep throat can be tricky to diagnose, doctors say. But it's crucial to treat it, because untreated strep infections can pose a danger to your heart. That's why a persistent sore throat should be brought to the attention of your doctor.

Your doctor is likely to suspect strep throat if you have any combination of these symptoms along with your sore throat: fever, white patches on the tonsil area, swollen glands in your neck and difficulty swallowing, says Dr. Centor.

Expect a test or two. A blood test and throat swab or culture will help your doctor distinguish between the strep bacteria and a virus, says Dr. Godley, but cultures aren't foolproof. Mononucleosis, for example, may take weeks to appear in cultures. Your doctor may need to ask you to come back several times for tests.

Stay the course. The most important part of your treatment for strep, says Dr. Mortimer, is that you take your antibiotics for the full number of days prescribed, even though you may feel better after a day or two. The usual medication is a ten-day course of penicillin (or erythromycin).

The contagious part of the illness will pass 24 to 36 hours after treatment begins, but you need to continue the treatment so the infection doesn't recur.

Use caution with antibiotics. Dr. Centor adds an important caution: "Even if a bacterial infection is suspected, don't take the antibiotics amoxicillin or ampicillin for a sore throat." If you have undetected mononucleosis, these drugs may produce a rash which resembles penicillin allergy, and might result in you being falsely labeled as allergic to penicillin.