Sore throat ear infection

Ear infection (middle ear) – symptoms, treatment

Note, earache is a common symptom of middle ear infection but not all earaches are caused by a middle ear infection. A build-up of ear wax in the outer ear, or changes in altitude or air pressure, are examples of other causes of blockage or earache.

Treatment

Ear infections usually clear up on their own, so treatment may begin with managing pain and close monitoring of the condition. However, ear infection in infants and severe cases are likely to require treatment with antibiotic medication. Amoxicillin is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin.

The antibiotic should be taken exactly as directed and until the course has been finished. Babies or children should be taken back to the doctor or health nurse once the course of antibiotic has been finished to confirm that the infection has cleared up properly. An earlier return visit to the doctor may be necessary if there has been no improvement in your child’s symptoms. The doctor may want to try a different antibiotic.

After seeing your doctor, self-treatment may help to relieve symptoms, including:

  • Holding a moist warm face cloth or wheat bag against the infected ear
  • Taking paracetamol or ibuprofen for relief of pain or fever
  • Lying with the affected ear against your pillow, or sitting propped up in bed
  • Gently washing the outer ear with soap and a face cloth to remove any discharge
  • Keeping background noise in the home to a minimum.

You should never use cotton buds to clean your ears or your baby’s ears, or put anything into the ear that has not been prescribed by a doctor, as the eardrum is delicate and can be easily damaged.

Prevention

The risk of middle ear infections in babies can be reduced by keeping rooms warm and dry, ensuring a smoke-free environment and breast feeding for as long as possible (preferably longer than six months). Showing older children how to blow their nose properly can also help prevent ear infection. Children’s vaccinations should also be kept up to date.

Taking precautions to avoid catching a cold or flu will also reduce the risk of developing a middle ear infection. This can be achieved by washing hands frequently, not sharing eating and drinking utensils, covering the mouth when sneezing, and getting a seasonal flu vaccination.

The use of a nasal decongestant during a cold, influenza, or sinusitis, may also help to prevent an ear infection.

Further information

Ministry of Health
Healthline 0800 611 116
www.healthline.govt.nz
Royal New Zealand Plunket Society
PlunketLine 0800 933 922
www.plunket.org.nz

Why do I feel pain in my ear when swallowing?

Several other health problems can lead to ear pain when swallowing. They include:

Tonsillitis

This occurs when the tonsils become infected. Tonsillitis usually develops as a complication of a throat infection, and the result is a very sore throat.

A doctor can treat the infection with antibiotics.

Peritonsillar abscess

This infection is associated with tonsillitis. If tonsillitis goes untreated, pus can collect around one of the tonsils and cause severe pain. The pain is usually worse on one side. It may extend to the ear and worsen when swallowing or opening the mouth.

Some cases require surgery, during which a surgeon drains collected pus through an incision. Antibiotics may also be necessary.

Glossopharyngeal neuralgia

The glossopharyngeal nerve is located in the head and neck, and problems with it can cause this rare, painful condition.

Symptoms can include stabbing pain around one ear, as well as pain in the throat, face, under the jaw or on the tongue.

Some people can manage symptoms with prescription pain medication, though in extreme cases, surgery is necessary.

Swimmer’s ear

Swimmer’s ear develops when water gets into the ear canal, creating a warm, moist environment in which fungi and bacteria can multiply.

A doctor may prescribe medicated eardrops, and the infection should clear up within 7–10 days.

Temporomandibular joint dysfunction

Temporomandibular joint dysfunction occurs when the joint that connects the jaw bone to the skull becomes damaged. A person can experience pain when chewing, talking, or swallowing. Pain can also occur in the ears.

Treatments include painkillers, warm or cold compresses, lifestyle changes, nonsteroidal anti-inflammatory drugs, and rest. Doctors also advise people to stop clenching the jaw and grinding the teeth, if these are issues.

Glue ear

This occurs when fluid collects inside the ear. While the condition is usually painless, it can cause temporary hearing loss, and the pressure caused by the buildup can occasionally cause pain.

Glue ear may not require treatment, though it can take months to go away completely. If the condition is severe, a doctor may place small tubes called grommets in the ear to drain the fluid.

Earwax or an object in the ear

An earache can result from an object becoming lodged in the ear. A doctor should remove any ear obstructions.

People can use ear drops to soften a buildup of earwax. If the wax is particularly stubborn, a doctor may have to flush the ear with water.

Dental abscess

A bacterial infection can cause pus to collect in the teeth and gums. This buildup is called a dental abscess. Pain in the affected tooth is the primary symptom, but an abscess can also cause pain in the ear.

A person should receive treatment as soon as possible. The dentist can drain the pus and remove the abscess, which will reduce pain and other symptoms.

Eagle syndrome

Problems with the ligaments and bones in the neck or skull can cause Eagle syndrome. A person may experience pain in the back of the throat, face, and ears, which can worsen when they move their head.

Surgery may be required to correct the underlying problems.

Ear damage

Ear pain can also result from damage. Pushing earbuds too far into the ear canal or scraping it with a finger or cotton bud can cause the eardrum to puncture.

Most damage to the ear will heal on its own. A punctured eardrum may take several months to fully heal.

Getting to the Root of Ear Infections

An ear infection, or otitis media, occurs when viruses or bacteria enter the middle ear and cause it to become infected. If you’ve had an ear infection, you know it can cause extreme discomfort. What you may not know is how important it is to get an ear infection diagnosed as early as possible — if left untreated, it could lead to serious complications.

How does an ear infection develop? Your ear has three parts: the outer ear, the middle ear, and the inner ear. Ear infections affect your middle ear, which is where your eustachian tubes connect the back of your nose to the ears. Eustachian tubes normally allow fluid to drain from your ears, but when these small tubes becomes blocked from something such as a cold or allergies, fluid can build up in the middle ear. A fluid-filled middle ear is susceptible to infection, because bacteria or viruses can grow in the fluid.

An ear infection often occurs after you have developed another illness, such as a cold or a sore throat — the bacteria or viruses that caused your illness can also lead to an ear infection.

Ear infections occur most commonly in babies and young children. In fact, most children will have had at least one ear infection by the time they turn 3. This is partially due to the fact that children’s immune systems have not yet fully matured, making it harder for children to fight off infections. Also, children’s eustachian tubes are smaller and straighter than adult eustachian tubes, making them more likely to become plugged with fluid. Because children get ear infections much more often than adults, there is a common misconception that they only occur in young children. However, older children and adults can get them, too.

The Painful Symptoms of an Ear Infection

The most obvious sign of an ear infection is ear pain, which occurs because of increased pressure on your eardrum. An ear infection can also decrease your ability to hear, because excess fluid in the middle ear hinders the ability of the eardrum and bones in the ear to function as they should to help you hear. People who have ear infections may also notice the following symptoms:

  • Dizziness
  • Sensation of ear blockage
  • Fever

Ear infections can be particularly difficult to diagnose in babies and very young children, because their language skills may not allow them to communicate how they feel. Common symptoms of an ear infection in kids include:

  • Increased irritability
  • Trouble sleeping
  • Pulling at one or both ears
  • Fever
  • Leakage of fluid from the ear
  • Balance problems
  • Signs of hearing disturbance (for example, lack of response to quiet sounds)
  • Loss of appetite

Finding Relief: How to Treat an Ear Infection

If you suspect that you or your child may have an ear infection, see a doctor as soon as you can. When left untreated, an ear infection can lead to a more serious infection (for example, an infection of the brain), permanent hearing loss, and problems with speech and language development (in children).

A doctor can diagnose an ear infection by examining your ear to look for inflammation and fluid.

Treatment for an ear infection often involves taking an antibiotic to kill the bacteria that is suspected of affecting the middle ear. Your doctor may also recommend the following treatments to make you more comfortable as your infection clears:

  • Pain medications (such as acetaminophen or ibuprofen)
  • Heating pad placed over the ear(s)
  • Prescription ear drops to reduce ear pain

Your doctor will most likely schedule a follow-up appointment to see if treatment is working. In some cases, more than one antibiotic will have to be used to manage an ear infection. And in severe cases where fluid does not clear from your ears for more than three months and is affecting your hearing, your doctor might recommend surgically placing temporary tubes in the ears to help circulate air in the middle ear.

Find more information in the Everyday Health Ear, Nose, and Throat Center.

Symptoms of Ear Infection

Topic Overview

Ear pain may be the first symptom of an ear infection , especially if you have moderate to severe ear pain during or shortly after you have a cold. Other symptoms of an ear infection may include:

  • Swelling, heat, or tenderness around or behind the ear.
  • Redness of the ear, ear canal, or skin around or behind the ear.
  • Drainage from the ear that does not look like earwax .
  • Itching of the ear or ear canal.
  • Fever.

Several different parts of the ear can become infected.

  • Ear pain and fever may be caused by a middle ear infection ( acute otitis media ), especially if cold symptoms, such as a runny or stuffy nose or a cough, have been present for a few days.
  • Ear pain may also be caused by a fluid-filled blister on the eardrum (bullous myringitis).
  • Itching, a feeling of fullness in the ear, and pain that is worse when you chew, press on the “tag” in front of your ear, or wiggle your earlobe may be caused by an infection of the ear canal ( otitis externa ).
  • You may have an infection of the outer ear ( cellulitis ).

Complications of a middle ear infection can be caused by other serious problems.

  • Redness, swelling, pain behind the ear, and fever may be caused by an infection of the bone located behind the ear (mastoiditis). Pain will get worse when you press on the bone behind the ear. This infection is rare and usually occurs 10 to 14 days after a middle ear infection.
  • Headache with severe stiff neck , irritability, confusion, and excessive sleepiness may be caused by an infection of the lining of the brain ( meningitis ).
  • Severe dizziness ( vertigo ) and hearing loss may be caused by swelling and irritation in the inner ear ( labyrinthitis ).

If you have symptoms of an ear infection or think that complications of an ear infection are developing, call your doctor for an evaluation.

Ear Infections in Children

What is an ear infection?

An ear infection is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Five out of six children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to a doctor. The scientific name for an ear infection is otitis media (OM).

What are the symptoms of an ear infection?

There are three main types of ear infections. Each has a different combination of symptoms.

  • Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear—commonly called an earache. Your child might also have a fever.
  • Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument.
  • Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.

How can I tell if my child has an ear infection?

Most ear infections happen to children before they’ve learned how to talk. If your child isn’t old enough to say “My ear hurts,” here are a few things to look for:

  • Tugging or pulling at the ear(s)
  • Fussiness and crying
  • Trouble sleeping
  • Fever (especially in infants and younger children)
  • Fluid draining from the ear
  • Clumsiness or problems with balance
  • Trouble hearing or responding to quiet sounds

What causes an ear infection?

An ear infection usually is caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. Because of the infection, fluid builds up behind the eardrum.

Parts of the ear

The ear has three major parts: the outer ear, the middle ear, and the inner ear. The outer ear, also called the pinna, includes everything we see on the outside—the curved flap of the ear leading down to the earlobe—but it also includes the ear canal, which begins at the opening to the ear and extends to the eardrum. The eardrum is a membrane that separates the outer ear from the middle ear.

The middle ear—which is where ear infections occur—is located between the eardrum and the inner ear. Within the middle ear are three tiny bones called the malleus, incus, and stapes that transmit sound vibrations from the eardrum to the inner ear. The bones of the middle ear are surrounded by air.

The inner ear contains the labyrinth, which help us keep our balance. The cochlea, a part of the labyrinth, is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. The auditory nerve carries these signals from the cochlea to the brain.

Other nearby parts of the ear also can be involved in ear infections. The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. Its job is to supply fresh air to the middle ear, drain fluid, and keep air pressure at a steady level between the nose and the ear.

Adenoids are small pads of tissue located behind the back of the nose, above the throat, and near the eustachian tubes. Adenoids are mostly made up of immune system cells. They fight off infection by trapping bacteria that enter through the mouth.

Why are children more likely than adults to get ear infections?

There are several reasons why children are more likely than adults to get ear infections.

Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain.

A child’s immune system isn’t as effective as an adult’s because it’s still developing. This makes it harder for children to fight infections.

As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear.

How does a doctor diagnose a middle ear infection?

The first thing a doctor will do is ask you about your child’s health. Has your child had a head cold or sore throat recently? Is he having trouble sleeping? Is she pulling at her ears? If an ear infection seems likely, the simplest way for a doctor to tell is to use a lighted instrument, called an otoscope, to look at the eardrum. A red, bulging eardrum indicates an infection.

A doctor also may use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum. A normal eardrum will move back and forth more easily than an eardrum with fluid behind it.

Tympanometry, which uses sound tones and air pressure, is a diagnostic test a doctor might use if the diagnosis still isn’t clear. A tympanometer is a small, soft plug that contains a tiny microphone and speaker as well as a device that varies air pressure in the ear. It measures how flexible the eardrum is at different pressures.

How is an acute middle ear infection treated?

Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye’s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.)

If your doctor isn’t able to make a definite diagnosis of OM and your child doesn’t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can’t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there’s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn’t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics.

If your doctor prescribes an antibiotic, it’s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn’t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It’s also important to return for your child’s follow-up visit, so that the doctor can check if the infection is gone.

How long will it take my child to get better?

Your child should start feeling better within a few days after visiting the doctor. If it’s been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks.

What happens if my child keeps getting ear infections?

To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren’t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out.

If placement of the tubes still doesn’t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.

Can ear infections be prevented?

Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child’s risk for ear infections.

  • Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year.
  • It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated. The vaccine is strongly recommended for children in daycare.
  • Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu.
  • Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections.
  • Never put your baby down for a nap, or for the night, with a bottle.
  • Don’t allow sick children to spend time together. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.

What research is being done on middle ear infections?

Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics.

Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks?

Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery.

Understanding the impact that ear infections have on a child’s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines.

NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.

Where can I find additional information about ear infections?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language.

Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on ear infections:

  • Otitis media (ear infection)
  • Speech-language development
  • Early identification of hearing loss in children

Sore throat and ear pain

Based on the patient’s clinical presentation, he was given a diagnosis of herpes zoster oticus—also known as Ramsay Hunt syndrome. Patients with Ramsay Hunt syndrome typically develop unilateral facial paralysis and erythematous vesicles that appear ipsilaterally on the ear and/or in the mouth. This syndrome is a rare complication of herpes zoster that occurs when latent varicella zoster virus (VZV) infection reactivates and spreads to affect the geniculate ganglion.

An estimated 5 out of every 100,000 people develop Ramsay Hunt syndrome each year in the United States; men and women are equally affected. Any patient who’s had VZV infection runs the risk of developing Ramsay Hunt syndrome, but it most often develops in individuals older than age 60.

Vesicles in the mouth usually develop on the tongue or hard palate. Other symptoms may include tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. Because the symptoms of Ramsay Hunt syndrome suggest a possible infection, the differential diagnosis should include herpes simplex virus type 1, Epstein-Barr virus, group A Streptococcus, and measles.

A diagnosis of Ramsay Hunt syndrome is typically made clinically, but can be confirmed with direct fluorescent antibody (DFA) analysis, polymerase chain reaction (PCR) testing, or viral culture of vesicular exudates. DFA for VZV has an 87% sensitivity. PCR has a higher sensitivity (92%), is widely available, and is the diagnostic test of choice, according to the Centers for Disease Control and Prevention.

Treatment with an oral steroid, such as prednisone, in addition to an antiviral such as acyclovir or valacyclovir, may reduce the likelihood of postherpetic neuralgia and improve facial motor function. However, these benefits have not been demonstrated in randomized controlled trials.

In this case, the FP prescribed oral valacyclovir 1 g 3 times a day for 7 days and oral prednisone 50 mg/d for 5 days for the patient. After one week of treatment, the patient’s symptoms resolved and the vesicles in his mouth crusted over. He did not experience postherpetic neuralgia or have a recurrence.

Adapted from: Moss DA, Crawford P. Sore throat and left ear pain. J Fam Pract. 2015;64:117-119.

Overview
A sore throat, also known as pharyngitis, is a common occurrence and is caused by an inflammation of the throat. It can be very painful, and you may feel a scratchiness and irritation, especially when you swallow or talk. There are many causes of sore throats.
Signs and symptoms
The most common signs and symptoms associated with a sore throat include:

  • Pain or scratchy feeling in your throat
  • Dry throat
  • Pain that worsens when talking or swallowing
  • Swollen glands in your neck or jaw area
  • Hoarseness
  • Swollen or red tonsils
  • White patches on the tonsils

Depending on the cause of the sore throat, you may experience other symptoms, including fever, coughing, chills, and headache.
Causes and Common Triggers
Most sore throats are caused by viruses that are responsible for causing the common cold and the flu. Sometimes sore throats may be due to a bacterial infection such as strep throat. Other common causes may include:

  • Allergies (ie, pet dander and pollen)
  • Irritants such as smoking and pollution
  • Mononucleosis
  • Tonsillitis
  • Gastric reflux

A sore throat can also be the result of excessive coughing, yelling, or screaming.
Testing and Diagnosis
During an examination, your doctor will examine your throat and touch the area around your neck to check for swollen glands. Your doctor will also listen to your lungs. If strep throat is suspected, your doctor may do a simple test that requires obtaining a sample of throat secretions via swabbing the back of your throat. Your doctor may order a blood test if needed.
Prevention
Because sore throats are typically caused by viruses or bacteria, practicing good hand-washing techniques with soap and warm water is one of the best ways for you to reduce or prevent getting a sore throat. Other preventive measures include:

  • Using alcohol-based hand sanitizers when soap and water are not available
  • Routinely cleaning environmental surfaces with disinfectants to minimize the spread of germs
  • Reducing exposure to allergens/irritants when possible
  • Using a humidifier to eliminate dryness in your home

Management
Most sore throats resolve with minimal treatment and without complications. When recovering from a sore throat, it is important to stay hydrated to keep your throat moist. Drinking warm beverages such as broths or teas can help to ease the pain associated with sore throats. Furthermore, cold beverages, ice chips, or popsicles can also provide pain relief. Gargling periodically with saltwater rinse may also help ease sore throat pain.
Treatment and Care
A sore throat caused by a virus typically lasts a few days and only requires symptomatic relief if necessary. If the sore throat is due to a bacterial infection such as strep throat, your doctor will prescribe the appropriate antibiotic. It is important that you complete the entire course of therapy to prevent re-infection and discuss any concerns or adverse effects with your doctor. If the sore throat is due to something other than a viral or bacterial infection, your doctor will determine the best treatment for you. After reviewing your medical and medication history, your doctor may recommend the use of a nonprescription analgesic such as acetaminophen, ibuprofen, or naproxen for pain relief.

Homeopathic and Alternative Remedies
Many individuals may elect to use homeopathic or alternative remedies for the relief of sore throats. Many of these therapies are available as teas, sprays, and lozenges, and they may include the following ingredients:

  • Licorice root
  • Sage
  • Honeysuckle flower
  • Chinese herbs

Prior to using these therapies, you should always check with your doctor or pharmacist to ascertain the appropriateness of use, especially if you are pregnant, breast-feeding, or taking any other medications, or if you have any other medical conditions.
Self-Care
Several nonprescription products are formulated to provide symptomatic relief of the pain and discomfort associated with sore throats. Various anesthetic and antiseptic lozenges, sprays, and orally disintegrating strips can be used to relieve sore throat pain. In addition, when appropriate, you may also use OTC analgesics for pain relief.
Before using any medication, it is important to check with your primary health care provider, especially if you are taking any other medications or have any pre-existing medical conditions. If your sore throat shows signs of worsening or infection, you should seek medical care immediately.
Resources for Patients
Medline Plus
Nemours Foundation
Centers for Disease Control and Prevention
Mayo Clinic
Resources for Pharmacists
National Institutes of Health
American Academy of Otolaryngology—Head and Neck Surgery
Mount Sinai Hospital

A sore throat can be a real pain in the neck, literally, but is very common and usually nothing to worry about. Sore throats are typically caused by viruses such as a cold or flu and should clear up in a few days.

Read our expert advice on sore throat symptoms, causes and treatment tips:

What is a sore throat?

A sore throat is characterised by pain or irritation of the throat that often feels worse when you swallow. Sore throats are common, especially during the winter months when infections spread faster because we spend more time indoors in centrally heated rooms with the windows closed. Sore throat symptoms typically include the following:

  • Pain in the throat and difficulty swallowing.
  • Earache.
  • Dry, scratchy throat.
  • A red throat.
  • Swollen tonsils.
  • A high temperature.
  • Swollen glands in your neck.
  • Bad breath.

What causes a sore throat?

90 per cent of sore throats are caused by viral infections such as the common cold and 10 per cent are caused by a bacterial infection.

Viral throat infection

  • The sore throat virus can come from a variety of sources, including the common cold virus, influenza and the Epstein-Barr virus – the cause of glandular fever.
  • Viral infections originate from airborne droplets from coughing and sneezing and from not washing hands.
  • GPs do not usually prescribe antibiotics for viral throat infections because they won’t relieve your symptoms or speed up your recovery.
  • Vital throat infections usually clear up within a week.

Bacterial throat infection

  • Among the bacteria that cause sore throats, the group A streptococcus is the most common.
  • Symptoms related to a bacterial throat infection include a high fever, pus visible on the tonsils and enlarged and tender lymph nodes in the neck.
  • The incubation period between picking up the infection until the disease breaks out, is up to four days.
  • Antibiotics may be prescribed if your GP thinks you could have a bacterial throat infection.
  • In a small minority of patients, a sore throat caused by bacteria is treated with penicillin, or erythromycin (eg Erythroped) in cases of penicillin allergy.
  • The doctor usually makes the diagnosis from your symptoms, but occasionally a swab or a blood sample are required to identify the cause.

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How to treat a sore throat

Antibiotics are not usually prescribed for sore throats as they are unlikely to work unless there is a bacterial infection present. However, symptoms of a sore throat such as pain, dryness and difficulty swallowing can be treated with over-the-counter medication that you can get from your local pharmacist.

• Painkillers

In the majority of cases, a sore throat is caused by a viral infection, and can be treated at home with paracetamol or ibuprofen to relieve the pain and bring your temperature down. Gargling with soluble aspirin (300mg) may also be effective for inflamed sore throats.

• Lozenges and pastilles

Lozenges and pastilles containing lemon and honey may help to lubricate and soothe the throat. Try Jakemans Honey & Lemon Menthol sweets to soothe a dry sore throat.

• Throat sprays

A throat spray containing a local anaesthetic such as benzocaine may help if you are having difficulty swallowing, as it is targeted to the back of the throat and can numb the pain quickly.

The following self-help tips can also help soothe the pain of a sore throat:

✔️ Drink plenty of fluids.

✔️ Eat soft food.

✔️ Gargle warm salty water.

✔️ Get plenty of rest.

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When should you visit a doctor?

You should visit your GP if you have the following symptoms:

  • You sore throat persists for more than a week.
  • Your sore throat is severe and you have a marked difficulty in swallowing.
  • You also have a high fever.
  • You also have a rash.
  • You have a weakened immune system, because of an illness such as HIV or chemotherapy.

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When should you worry about a sore throat?

Usually a sore throat causes no trouble and only lasts about a week, but the following complications may arise:

  • A secondary infection may occur in the middle ear, sinuses or chest.
  • If it is a streptococcus infection, there may be a rash (scarlet fever).
  • An uncommon complication is a throat abscess usually only on one side.
  • In very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) may occur.

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Last updated: 08-10-19

Dr Juliet McGrattan (MBChB) Dr Juliet McGrattan Dr Juliet McGrattan spent 16 years as a GP, two years as a Clinical Champion for Physical Activity for Public Health England and is the Women’s Health Lead for the 261 Fearless global running network. Her award winning book, Sorted: The Active Woman’s Guide to Health was published by Bloomsbury in 2017.

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