Persistent sore throat: Top 3 Reasons and What To Do

Everyone has had a sore throat at least once before in their lives but sometimes, your sore throat doesn’t seem to be getting better! So what might be causing your sore throat? In children and adults who come to see a top ENT specialist in Singapore, many have sore throats due to tonsillitis or recurrent tonsil infections. Other common reasons for a persistent sore throat would include acid reflux (gastritis or gastro-oesophageal reflux GERD) and a chronic postnasal drip irritating your throat.

A) So if the top reason for a recurrent or persistent sore throat is tonsil infection, there may be other common throat symptoms as well, such as fever, tiredness, feeling like something is irritating your throat inside, earache or ear pain, itchy cough or backdrip sensation. Some people also report suffering recurrent tonsil stones, these whitish smelly solid debris which get stuck at the back of your throat until you either manage to dig them out from your tonsils or cough/gag it up. Suffering tonsillitis episodes again and again is not normal and certainly not good 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 have to stay home to recover from tonsillitis? You might notice having a funny smell or bad breath, or the people around you might start to comment quietly that your breath smells bad, a condition called halitosis. Acute tonsillitis results in severe throat pain, high fevers, difficulty swallowing and may even need admission to hospital for stronger intravenous or IV medications as you can’t swallow standard oral tablets.

So what are the guidelines for when to consider removing your tonsils in the form of a tonsillectomy? My reasons for when to advise my patients to consider undergoing a tonsillectomy are:

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

Many people decide to wait….and wait…. and wait….in the desperate hope that maybe, just maybe, their sore throats won’t recur and that the next episode of acute tonsillitis will just hopefully never happen again. BUT often enough, those troublesome tonsils start to flare up yet again, especially if you come down with a bout of the flu or some other viral infection affecting your nose and airways. Some are rather worried about the actual tonsillectomy surgery itself but there’s really only a few issues to be aware of before you make up your mind whether to undergo tonsil surgery:

1. A temporary sore throat after surgery: Common but manageable with simple painkiller tablets, throat sprays and gargles. Most patients are feeling much better after the first several days postop and can eat a relatively normal diet.
2. Slight risk of postop bleeding: 2% on average may suffer bleeding from the tonsillectomy site due to secondary wound infection and if it does occur, tends to happen within the first 14 days of surgery. This means we just need to get you past that magic 14-day window and you should be fine afterward. Remember, the key to a smooth uneventful recovery after tonsil surgery is to take your painkillers regularly and keep eating and drinking to keep the back of your throat from forming too much “slough” scar tissue.
3. Altered taste may rarely occur but is usually temporary, so don’t worry, you’ll still be able to taste your favourite foods like chicken rice and laksa eventually!
4. Change in voice quality is a possible rare event but most people who don’t sing professionally, are not bothered by this, if they even notice anything at all. Of course, professional singers who depend on their voice for their careers need to be aware that sometimes, there may be a very slight change in the resonance quality of their voice because there is now no more redundant tonsil tissue for the voice wave to be reflected off. You’ve got to consider the huge advantage of not suffering nasty tonsillitis anymore after surgery, against the risk of throat/tonsil infections spreading to your voicebox to cause laryngitis infection if you choose not to go for surgery!

B) A postnasal drip is another common cause of an irritating sore throat, with many people also noticing an itching deep inside their throat and a recurrent urge to keep clearing their throat repeatedly. “Dr, I feel like I have a lot of phlegm stuck inisde my throat but I just can’t seem to cough it up!” is a very common symptom which many patients with a persistent backdrip from their nose and sinuses, keep complaining about. The postnasal drip is like having a constant runny nose from the back of your nose, running down into your throat to cause chronic inflammation. This may occur due to uncontrolled nasal allergies (allergic rhinitis or “morning sinus”), sinus infections or coming down with the flu or the common cold.

A helpful method to alleviate these annoying symptoms is to use a hypertonic saline sinus rinse to irrigate or cleanse the nasal passages of the mucus buildup. Simple medications such as a nasal steroid spray and/or taking antihistamines like Zyrtec and Telfast, are also good ways to relieve the backdrip. If this keeps recurring, then of course, taking an allergy test, in the form of a skin prick test or blood test, can be a good idea to find out what could be irritating your poor nose and throat.

Many patients mistakenly visit a Respiratory or Chest physician first, thinking that their itchy throat, phlegmy sensation and a recurrent dry cough are all due to an underlying chest infection. But very often, the nose is to blame for producing excessive mucus flowing down the back of the nose to keep 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 the lower airways of your lungs but it’s just that the cough reflex sometimes goes out of control and then starts to disturb your sleep and daytime quality of life. And everybody around you keeps wondering if you now have Covid-19!

C) Gastro-oesophageal reflux, acid reflux or gastritis may also be the root cause of a chronic sore throat, recurrent dry cough especially at night, recurrent burping, bloating and gassiness. 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 opening into your throat but sometimes, if this ring of muscle is loose, then it may inadvertently 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 ad 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!

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