Persistent Sore Throat: Why, When and How To Get Better

Everyone has had a sore throat at least once before in their lives. But what if your sore throat doesn't get better? For patients who come to see a top ENT specialist in Singapore, many have tonsillitis or tonsil infections. Other common reasons include acid reflux (gastritis) and a chronic postnasal drip irritating your throat.

A) If the top reason for a recurrent or persistent sore throat is tonsil infection, there may be other symptoms like fever and tiredness. You may also feel like something is irritating your throat. Some people may suffer earaches or itchy coughs. Others report recurrent tonsil stones, whitish smelly solid debris stuck at the back of your throat.

Suffering tonsillitis episodes repeatedly is ABNORMAL. In fact, it is BAD for your general health. Who wants to keep taking multiple courses of antibiotics which irritate your stomach to cause pain and diarrhoea? Who wants to keep missing school or work to stay home to recover? You might notice having a funny smell or bad breath. People around you might comment that your breath smells bad, a condition called halitosis. Acute tonsillitis causes severe throat pain, high fevers and difficulty swallowing. You may need admission to hospital for IV medications if you can't swallow.

What are the guidelines for removing your tonsils? Those thinking about a tonsillectomy should consider:

• Recurrent sore throats due to tonsillitis at least 3-4 times a year.
• Persistent tonsil stones
• Large tonsils causing airway obstruction or obstructive sleep apnea and snoring
• Recurrent bad breath coming from unhealthy tonsils
• Asymmetrical tonsils i.e. one tonsil is larger than the other, with suspicion of underlying cancer, especially if you smoke.

Many people decide to wait, hoping desperately that maybe their sore throats won't recur. BUT often enough, those troublesome tonsils start to flare up yet again. This is especially true if you come down with a bout of the flu or viral infection affecting your nose and airways.

Some are worried about the tonsillectomy surgery itself but you only need to know a few things before you decide whether to undergo tonsil surgery:

• A temporary sore throat after surgery: Common but manageable with simple painkiller tablets, throat sprays and gargles. Most patients feel much better after the first several days postop and can eat a relatively normal diet.
• Slight risk of postop bleeding: 2% on average may suffer bleeding from the tonsillectomy site due to secondary wound infection. If it occurs, it tends to happen within the first 14 days of surgery. This means we just need to get you past that magic 14-day window. Remember, the key to a smooth uneventful recovery after tonsil surgery is to take your painkillers regularly and keep eating and drinking. This helps to keep the back of your throat from forming too much "slough" scar tissue.
• Altered taste may rarely occur but is usually temporary. Don't worry, you'll still be able to taste your favourite foods like chicken rice and laksa eventually!
• Change in voice quality is rare. Most people who don't sing professionally are not bothered by this. Professional singers need to be aware that there may be slight changes in the resonance quality of their voice. This occurs because there is now no more tonsil tissue for the voice wave to be reflected off.

B) A postnasal drip is another common cause of an irritating sore throat. Many people notice an itchy throat. They may keep clearing their throat repeatedly. "I feel like I have a lot of phlegm stuck inside my throat! But I just can't seem to cough it up!"

The postnasal drip is like having a constant runny nose from the back of your nose. This mucus drip runs down into your throat to cause chronic inflammation. Postnasal drip can arise from nasal allergies, sinus infections or the flu. Use a hypertonic saline rinse to cleanse your nasal passages!

Simple medications such as a nasal steroid spray and antihistamines like Zyrtec can help to relieve the backdrip. If this keeps recurring, an allergy test (skin prick test or blood test) can help find out why.

Many patients visit a Respiratory physician first, thinking that their itchy throat, phlegm and cough are due to chest infection. But the nose is often to blame for producing excessive mucus flowing down the back of the nose. This mucus then keeps irritating the throat and airways to cause a recurrent cough. The cough reflex is actually protective as your body tries to close off the voicebox entrance leading to your lungs. But the cough reflex sometimes goes out of control! Then the cough disturbs your sleep and quality of life. Everyone around you keeps wondering if you have Covid-19!

C) Gastro-oesophageal reflux, acid reflux or gastritis may also be the cause of a chronic sore throat. Acid reflux may trigger a recurrent dry cough especially at night. In addition, patients may notice recurrent burping and bloating. The gullet or oesophagus is a muscular tube leading from your throat down to your stomach. It has a ring of muscle at the top end that should be closed when you're not eating. If this ring of muscle is loose, it may allow backflow of stomach acid up your gullet to disturb your throat and voicebox.

Lifestyle changes like reducing caffeine and alcohol, not eating too late at night, stopping smoking, eating regular meals with moderate meat intake balanced by lots of fruit and vegetables, can help to control the acid reflux symptoms. If this doesn't work, then medications such as proton pump inhibitors (PPI) e.g. Pariet, Nexium, Zimor, are prescribed to reduce stomach acid production. Vocinti is also a newer drug used to help this irritable stomach and bowel problem too.

ENT and Gastroenterology specialists often work together to help such patients get better: A fast painfree endoscopy of the upper throat and airway by ENT to clear this upper part first before the Gastro Dr scopes the gullet, stomach and part of the small intestine to check for ulcers and screen for Helicobacter Pylori bacteria, which is a risk factor for stomach ulcers and stomach cancer.

So now you know the top 3 causes of a persistent sore throat, I hope you'll be able to understand your ENT throat condition better. If my suggested simple measures don't help you feel better, then it may be time to visit your friendly ENT specialist in Singapore for a thorough checkup soon!