Sore throat

A common complaint, sore throat may be local or it may be part of a serious illness. Tonsillitis (inflammation of the tonsils) and abscesses in the tissues of the tonsillar area are examples of localized throat conditions. Laryngitis is the inflammation of the voice box. Diphtheritic and streptococcal sore throat are conditions with marked systemic effects. Streptococcal sore throat resembles scarlet fever, but differs from it clinically in the absence of a skin rash.

Most sore throats are associated with the winter ailments of coughs and colds. Some are caused by the inhalation of irritants or the consumption of too much tobacco. Most are relatively mild, though in some the tonsils or larynx may be inflamed.

Tonsillitis

This is the inflammation of the tonsils, the fleshy lumps on either side of the back of the throat. The symptoms are soreness of the throat, difficulty and pain in swallowing, and a general feeling of being ill with headache, chilliness, and aches all over, all of which come on fairly suddenly. The patient may find it difficult to open his mouth. He also looks ill and has a flushed face. The tonsils will be swollen, red, and covered with many yellow spots or streaks con­taining pus. The tonsillar lymph glands become enlarged and can be felt as tender swellings behind the angles of the jaw on one or both sides. The temperature and pulse rate are normally raised. If treatment does not appear to be helping after 2-3 days, glandular fever should be considered as an alternative diagnosis. Feel in the armpits and groin for enlarged glands indicating glandular fever.

Laryngitis

This is inflammation of the voice box, or larynx, the area that includes the Adam's apple. In addition to the more general causes mentioned for sore throat, the inflammation might be caused by overuse of the voice. There is generally a sense of soreness of the throat, pain on swallowing, and a constant dry irritating cough, while the voice is usually hoarse and may be lost altogether. Usually the temperature is found to be normal, and the patient does not feel ill. Occasionally, however, there is a slight fever, and in other cases bronchitis may be present.

General treatment for sore throats

Take the patient's temperature, and feel for tender enlarged glands in the neck.

Patients with sore throats should not smoke.

For simple tonsillitis or sore throat, gargling with warm salt water (a teaspoonful of salt to half a litre of water) every 3 hours may be all that is needed.

Give patients with only a mild sore throat, and no general symptoms of illness and fever, acetylsalicylic acid or paracetamol to relieve the pain.

Mild sore throats should NOT be treated with antibiotics.

Patients with tonsillitis, or a sore throat at companied by fever, whose glands are swollen and who feel generally unwell should be put to bed and can be given paracetamol and a gargle as above.

Give patients not allergic to penicillin one injection of 600 000 units of procaine benzylpenicillin intramuscularly, and follow this after 12 heirs with the standard antibiotic treatment.

Subsequent management

Keep a check on the general condition of the patient and keep a record of his temperature, pulse, and respiration. Recovery will usually begin within 48 hours, and the patient can be allowed up when his temperature is down and he feels better.

Peritonsillar abscess can be a complication following tonsillitis.

Peritonsillar abscess (quinsy)

This is an abscess that can follow tonsillitis. It forms normally round one tonsil, and the swelling pushes the tonsil downwards into the mouth. The patient may find it so difficult and painful to swallow that he may refuse to eat. He may have earache on the affected side. The swelling on the tonsil will be extremely tender, and a finger pressing gently inwards just below and behind the angle of the jaw will cause pain. There is usually fever, sometimes quite high (up to 40 °C). The throat will be red and a swelling will be seen above the tonsil on the affected side.

General treatment

The patient should be put to bed and his temperature, pulse, and respiration taken and recorded every 4 hours. Give a liquid diet or minced food in a sauce, as solids are usually painful to swallow. Ice-cold drinks are much appreciated as they dull the pain and thus allow some fluid and nourishment to be taken.

Specific treatment

Give the patient one intramuscular injection of 600 000 units of procaine benzylpenicillin unless the patient is allergic to penicillin, and immediately start the standard antibiotic treatment.

If the patient cannot swallow whole tablets he may be able to take them ground up in water or in a teaspoonful of honey. If swallowing is impossible and the patient is not allergic to penicillin, give procaine benzylpenicillin, 600 000 units intramuscularly, every day for 5 days.

Give 2 acetylsalicylic acid or paracetamol tablets every 6 hours to relieve the pain.

Subsequent management

A peritonsillar abscess may settle down with treatment, or it may burst. The patient should be told that the abscess will be very painful before it bursts, and that when the abscess does break there will be severe pain, followed by a discharge of pus, which should be spat out. The patient should be given a mouthwash of water to gargle with after the abscess breaks. Soon after the abscess has broken, the patient will feel much better and he can be allowed up when his temperature has remained normal for 24 hours.

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