Causes of Throat Pain and Treatment Options

Lower throat pain (pharyngitis) can be caused by a number of ailments. It happens when your pharynx, a tube between your tonsils and voice box, is inflamed and swollen. Some causes, like strep throat and acute laryngitis, are temporary and often resolve on their own.

Other sore throat causes, like acid reflux, can be chronic and require treatment from a healthcare professional. Throat pain can make it difficult to eat and drink. If severe enough, swallowing problems from pharyngitis can lead to weight loss or other health concerns.

This article will cover the different causes of throat pain and explain when you should see a healthcare provider. It will also offer suggestions for easing a sore throat.

Causes of Throat Pain

There are many possible causes of throat pain. These causes include viral infections, bacterial infections, sinus infections, allergies, acid reflux, exposure to irritants, laryngitis, medical procedures, and throat cancer.

Viral Infections

A virus is the most common reason for sore throat. Examples of viral infections that can cause lower throat pain include:

Other causes can include infections typically associated with childhood, such as herpangina, measles, chickenpox, and croup.

Bacterial Infections

Strep throat is a bacterial infection of the throat. It can cause severe throat pain and painful swallowing. The tonsils may become very swollen.

A bacteria called Arcanobacterium haemolyticum can cause throat pain as well as a rash. Some types of sexually transmitted infection, such as the Neisseria gonococcus (gonorrhea) bacteria, also cause sore throat, as does a throat infection from chlamydia.

Bacterial causes of throat pain need to be treated with antibiotics. If left untreated, strep throat complications can include heart or kidney damage.

Sinus Infections

Your sinuses are a set of hollow cavities in your skull. Bacteria, viruses, and even fungus can infect the sinuses and cause post-nasal drip. This is when mucus runs down the back of the throat.

The infected mucus can cause throat pain. If the cause is a fungal infection (like Candida) then antifungal medications will be used to treat the infection.

Allergies

Dust, mold, or dander allergies can cause post-nasal drip that contributes to a sore throat. Some people feel an itchy sensation from the inflammation caused by allergies.

Certain foods (apples, cherries, tree nuts, bananas, and cucumbers among them) can lead to pollen food allergy syndrome (PFAS) and symptoms of itchy or swollen throat. While there is a wide range of treatment options for allergies, this type means avoiding the food that causes it.

Acid Reflux

Stomach acid can enter the esophagus, back of the throat, and mouth while you are sleeping. That’s why a sore throat caused by acid reflux is often worse in the morning. Nighttime acid reflux can also wear away the protective enamel on teeth.

Environmental Irritants

Irritation from dry air, chemicals, or cigarette smoke can cause a sore throat. Causes can be as diverse as cold temperatures, the chemicals used in indoor swimming pools, and the sulfur dioxide from volcano eruptions.

Treatment will usually mean limiting or removing the cause of the exposure.

Laryngitis

Laryngitis is an inflammation of your voice box. This can happen when you overuse your voice.

Laryngitis can be a problem for singers and other people who use their voices as part of their work. The condition also causes hoarseness and throat pain when talking.

Intubation

Intubation is a procedure where a breathing tube is inserted into the airway. This can cause irritation that leads to throat pain.

Breathing tubes are used during surgery or due to illness or injury. The pain is temporary and will usually go away a day or two after the tube is removed.

Surgery

Throat surgeries like tonsil removal or a thyroidectomy (removal of the thyroid) can cause throat pain. It’s also common to experience temporary throat pain after other surgeries when anesthesia was used, or if you become dehydrated.

Other Medical Procedures

Medical procedures like esophagogastroduodenoscopy (EGD) may cause throat pain. During an EGD, an endoscope is inserted through the mouth and into the throat. This procedure is also called an upper endoscopy.

Throat Cancer

Tumors or other growths associated with throat cancer can cause throat pain. This is not a common cause of sore throat. Other causes are much more likely.

When to See a Healthcare Provider for Throat Pain

If your sore throat lasts more than a week and you do not know its cause, see a healthcare provider. Your provider will need to rule out serious conditions that might lead to dangerous health problems.

Viral and Bacterial Infections

If your throat pain is caused by an infection, you will probably have other symptoms. These may include:

• Fever
• Cough
• Fatigue
• Sore muscles

See a healthcare provider if you have extreme pain or severe swelling of the tonsils. Throat pain accompanied by a rash is often bacterial. A healthcare provider can decide if you need antibiotics.

Post-Nasal Drip

A sore throat with post-nasal drip is rarely cause for concern. Still, if it lasts longer than a few weeks, you should see a healthcare provider. Your primary care provider is a good place to start, but you may also need to see an allergist. An allergist can determine if allergies are the cause of your throat pain.

Acid Reflux

If you have throat pain that is worse in the morning or is accompanied by stomach pain and heartburn, it could be acid reflux. This requires a provider’s diagnosis. It is not an emergency, but it does need to be treated.

Primary care and general practitioners often diagnose acid reflux. They can perform diagnostic tests or refer you to a specialist if needed.

Over-the-counter and prescription medications can treat throat pain related to acid reflux. It is still important to see a healthcare provider for an initial diagnosis, though. This will help rule out any serious conditions.

Throat Pain After Surgery

Throat pain that happens just after you have had general anesthesia or a breathing tube inserted is probably not cause for concern. If the throat pain does not go away within a few days, though, you may want to contact your healthcare provider.

Some surgeries, such as a thyroidectomy, can cause throat pain on their own, so keep this in mind.

How Throat Pain Is Diagnosed

There are many different ways to diagnose throat pain. A healthcare provider may examine you, look at your medical history, or order tests and/or imaging.

Throat Culture

A throat culture is a test where the back of the throat is brushed with a long cotton swab. The swab is usually sent to a laboratory to be analyzed for bacteria. If it is a rapid strep test, you will get immediate results.

A sore throat that is caused by sinusitis or infections of the nasal passageways may be diagnosed with a throat culture. The clinician may also take samples of your sputum, which is the material you cough up.

Allergy Testing

Blood tests or allergy skin tests can tell a healthcare provider if your sore throat is caused by allergies.

During a skin test, a clinician exposes you to an allergen (something you may be allergic to) through a tiny scratch in your skin. If you are allergic, you will have a reaction. Blood tests can also look for antibodies (immune system proteins) to specific allergens.

The results of skin testing are available immediately. Blood test results may take a few days.

Medication Trials

A trial of acid reflux medication can help your healthcare provider find the cause of your sore throat. If you respond to the medication, your provider may diagnose you with acid reflux.

Similarly, a trial of antihistamine medication can help your provider to diagnose allergies. This may be done before allergy testing.

Imaging

Medical imaging including computed tomography (CT) scans, ultrasounds, or magnetic resonance imaging (MRI) scans can be used to diagnose throat pain. This may be done if the suspected cause is a lump, growth, or sinusitis.

Acid reflux and similar problems are often diagnosed with an upper endoscopy. Another test that can be used is a barium swallow. During this test, you will be asked to drink a thick solution containing barium. The barium coats your esophagus and stomach to make them visible on x-rays.

Physical Exam

Your healthcare provider will also do a physical exam to look at your throat and feel your neck. You’ll also be asked about your symptoms and health history.

Your provider will examine you for lumps or bumps in the throat. A lump or bump that accompanies a sore throat could be a lymph node. It could also be something more concerning, like cancer. If your provider cannot identify it as a lymph node, you may need a biopsy.

How Throat Pain Is Treated

There are a few options for treating your sore throat. Many of these can be started right away.

Lifestyle Treatment Options

Some simple steps can help ease your sore throat:

• Drink plenty of fluids.
• Avoid smoke.
• Use a humidifier, a device that adds moisture to the air.

You also can try lozenges, hard candies, tea with honey, or frozen treats to help soothe the throat. Gargling with salt water can help: Mix 1/2 teaspoon of salt in 1 cup of warm water and rinse your throat with it.

Medications

There are a variety of medications available for treating the causes of throat pain. Other medications can treat sore throat symptoms.

Antibiotics

Antibiotics are used to treat bacterial infections like strep throat. They do not work against viruses. This treatment may be a one-time injection or oral antibiotics taken over a period of time.

Make sure to let your healthcare provider know if you have any drug allergies. There are many alternative antibiotics you can take if you are allergic to penicillin or another antibiotic.

Antihistamines

Antihistamines can help your allergy symptoms. When you encounter an allergen like pollen, mold, or dander, your body releases histamine. Histamine plays a role in the sensation of pain, so taking an antihistamine can help with an allergy-related sore throat. Over-the-counter antihistamines include:

• Zyrtec (cetirizine)
• Claritin (loratadine)
• Allegra (fexofenadine)

Acid Reflux Medication

Successful treatment of acid reflux can take time. The sooner you are diagnosed and treated, the sooner symptoms like sore throat will go away.

Your healthcare provider may start you on a trial of an H2 (histamine) blocker or a proton pump inhibitor (PPI). Both of these medication types are available over the counter. They include:

• Pepcid (famotidine), an H2 blocker
• Prilosec (omeprazole), a PPI
• Prevacid (lansoprazole), a PPI
• Nexium (esomeprazole), a PPI

Pain Medication

Pain medication can help control the pain from any type of sore throat. Over-the-counter options include:

• Aspirin
• Advil (ibuprofen)
• Aleve (naproxen)
• Tylenol (acetaminophen)

These medicines are very effective at controlling sore throat pain.

If your sore throat pain is severe and/or the pain makes it hard to swallow, your provider may prescribe glucocorticoids. These include:

• Sterapred (prednisone)
• Baycadron (dexamethasone)

Over-the-counter throat sprays like Cepacol (benzocaine/glycerin) and Vicks Formula 44 (glycerin/phenol) can also help relieve your pain. Cough drops may also be helpful.

Complementary and Alternative Medicine

Warm, caffeine-free tea can help you stay hydrated. Some people report relief after taking a commercial product called Throat Coat. Among other things, Throat Coat contains:

Findings on a variety of Chinese herbs and acupuncture are inconclusive and more study is needed. Traditional providers don’t usually recommend these remedies. Still, some people have found them helpful.

Talk to your healthcare provider before taking herbal medications, especially if you are also taking prescribed medication.

Preventing Throat Pain

Many of the causes of sore throat can be prevented. If you know why your throat is sore, you may be able to prevent future sore throats by treating the underlying cause. Lifestyle changes and better hygiene can also help you avoid sore throats.

Preventing Viral and Bacterial Infection

Hand washing is the best way to prevent sore throats caused by viruses and bacteria. Wash for at least 20 seconds. Make sure you wash from your fingernails to your wrists. Thorough hand washing greatly reduces your chances of getting an infection. Hand sanitizer is a good alternative when you are not near a bathroom.

Preventing Acid Reflux

Acid reflux can be related to your weight. Ask your healthcare provider if this may be true for you. If so, weight loss is a great lifestyle adjustment. It can reduce your symptoms and help prevent long-term throat pain.

Long-term Allergy Treatment

Ask your healthcare provider about long-term use of oral or nasal allergy medications. Immunotherapy such as allergy shots may also be an option.

Summary

Sore throats can have many causes, including viruses and bacteria, acid reflux, and allergies. See a healthcare provider if your sore throat lasts more than a week or if you have painful swallowing. A sore throat can be diagnosed with lab tests or a simple exam. Sometimes imaging may be required. 

Over-the-counter medications can treat the cause and the symptoms of many sore throats. Alternative remedies may also help. If you have a bacterial infection, you may need antibiotics. 

Hand washing can help prevent sore throats caused by viral and bacterial infections. Lifestyle changes and long-term medication use may help sore throats that have other causes.