Sore Throat A Problem?

Sore throats are very common. The general compliant that ‘my throat hurts’ is one every parent will likely encounter at some stage as their child grows up. There are a range of causes for a sore throat and sometimes the way a child describes a problem is not specific. In their perspective, they may mean that they have a toothache, or a dry mouth and complain that it is ‘sore’. However, there are three causes of sore throat that require specific discussion; they are pharyngitis, tonsillitis and reflux.

The word ‘pharynx’ means throat. So, pharyngitis is inflammation of the throat. The tonsils sit within the pharynx, so in a way, tonsillitis is a form of pharyngitis. Some doctors will use the term pharyngitis to differentiate a sore throat from tonsillitis. It can be a bit confusing when technical interpretations of words are applied, so the simple explanation is that usually doctors will say tonsillitis when the tonsils themselves are infected or inflamed and pharyngitis when it is other parts of the throat.

SO WHEN SHOULD A CHILD’S SORE THROAT NEED INTERVENTION?

Pharyngitis:

Pharyngitis is usually a viral infection that causes irritation within the throat. The child will be unwell, but usually not too badly and will complain of some pain with swallowing. They may have a bit of a runny nose as well. Such episodes are usually short lived and simple pain relief medication should settle such cases down. If the sore throat problem seems more significant, then it may be tonsillitis instead.

Tonsillitis:

Tonsillitis is usually a bacterial infection and the symptoms are usually quite marked and the child is usually quite unwell. Occasionally the problem can be glandular fever and in such cases the patient can be very unwell indeed. The issue with tonsillitis is that the bacterium that commonly causes the infection (known as Streptococcus or more simply Group B Strep) can cause damage to the heart in a condition known as Rheumatic Heart Disease.

The infection of the tonsils may also lead to serious infections around the throat known as a quinsy, with deep infections into the neck. It is a complication of tonsillitis. It is a collection of pus that develops between the back of one of your tonsils and the wall of your throat. This is known as an abscess

Tonsillitis will often result in significant fevers, a marked sore throat and checking inside, will reveal white pus sitting over the surface of the side of the throat, where the tonsils are present. Antibiotics are needed for tonsillitis, so if there is any suggestion that your child has a significant illness going on, do not delay seeing your GP.

Reflux:

Reflux is another reason for a sore throat problem. This is usually felt in the lower part of the throat rather than up higher. Reflux describes the process whereby the contents of the stomach travel back up the oesophagus. If this reaches all the way up to the throat, the stomach acid can cause significant irritation. Apart from a feeling of discomfort, the child may have other symptoms such as a cough, croaky voice, asthma-like symptoms and a feeling of a lump in the throat. Reflux in children usually will sort itself out, but sometimes it needs medication and investigating certain foods that the child eats. Often these dietary measures that can be undertaken will settle things down. The GP may be able to work out if reflux is the cause of the sore throat but sometimes your child will need to see a specialist.

A sore throat problem requires action to investigate the seriousness of the situation. Sometimes the soreness might be prolonged and serious and should not be ignored. Always seek advice from your GP. Your child may need to be referred to an ear, nose and throat specialist, who will solve the mysterious sore throat problem.

Dr David MacIntosh is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development and its relationship to ENT airway problems and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr MacIntosh can be contacted via this website