What exactly is inflamed and how pharyngitis differs from sore throat
In everyday life, any sore throat is called a sore throat, and this creates confusion from the first day of illness. Meanwhile, we are talking about different anatomical zones. With pharyngitis, the mucous membrane of the back wall of the pharynx is inflamed - it looks reddened, sometimes granular, with pronounced vessels and mucus flowing down it. With tonsillitis, which is called tonsillitis, the main blow falls on the palatine tonsils: they are enlarged, bright red, often with plaque or plugs in the lacunae. Often the inflammation affects both zones at once, and then the doctor writes “pharyngotonsillitis.”
The difference is not in terminology, but in what follows the diagnosis. Isolated pharyngitis is almost always viral and requires only relief of symptoms. Acute tonsillitis with typical symptoms may turn out to be streptococcal, and then an antibiotic is really needed - not so much to speed up recovery, but to prevent complications from the heart, joints and kidneys, as well as to stop infectiousness. Therefore, the first question at the appointment is not “how red is the throat,” but “what is the picture as a whole”: is there a cough and runny nose, are there plaques, are the cervical lymph nodes enlarged, what is the temperature.
- Pharyngitis is inflammation of the back wall of the pharynx; Typical: soreness, dryness, sensation of a lump and pain, worse when swallowing empty
- Tonsillitis (tonsillitis) - inflammation of the tonsils; typical: severe pain when swallowing food, plaque, large painful lymph nodes under the jaw
- Laryngitis is inflammation of the larynx and vocal folds; the main symptom is not pain, but hoarseness and barking cough
- Nasopharyngitis - inflammation also affects the nasopharynx, adding a runny nose and mucus running down the back wall
- Viral pharyngitis is almost always accompanied by a runny nose, cough and hoarseness - this triad practically excludes streptococcus
Why antibiotics often don't work
Antibiotics act on bacteria and are completely useless against viruses. Since the vast majority of acute pharyngitis is caused by rhinoviruses, adenoviruses, parainfluenza viruses, influenza and coronaviruses, taking an antibiotic in such a situation does not shorten the disease by a single day. The improvement that a person associates with the pills would have occurred without them: viral pharyngitis goes away on its own in 5-7 days, regardless of treatment.
- The antibiotic does not reduce the temperature of a viral infection and does not reduce a sore throat
- It does not prevent bacterial complications - a long-debunked idea
- But it often causes diarrhea, nausea, candidiasis and allergic reactions, including severe ones
- Each extra course increases the resistance of bacteria, and the next time an antibiotic is really needed, it may not work
- A separate problem is self-medication with leftover packaging: an incomplete course in the wrong dose is especially effective in growing resistant flora
Here it is important to understand the logic of a doctor prescribing an antibiotic for a confirmed streptococcal infection. The sore throat itself will go away without it, at most a day and a half later. The real goal is to prevent acute rheumatic fever, which attacks the heart valves and joints, as well as pyogenic complications such as peritonsillar abscess. That is why, in case of proven streptococcus, the course must be completed to the end, even when the throat stops hurting on the third day. An interrupted course relieves symptoms, but does not solve the problem for which the treatment began.
How do you know if you need an antibiotic?
The decision is not made by eye. There is a set of clinical signs that assess the likelihood of streptococcal infection, and the final answer is provided by laboratory confirmation. An adult receives points for the absence of a cough, plaque on the tonsils, enlarged painful cervical lymph nodes and a temperature above 38 degrees; Age is taken into account separately, since streptococcus is much more common in children and adolescents than in adults.
- Осмотр глотки, оценка миндалин, налётов, задней стенки и лимфоузлов шеи.
- Подсчёт клинических признаков: при их минимальном числе тест обычно не нужен, и лечение сразу симптоматическое.
- Экспресс-тест на бета-гемолитический стрептококк группы А — мазок с миндалин, результат готов ориентировочно за 5-10 минут.
- Посев мазка of глотки — более медленный, но и более чувствительный метод; применяют при отрицательном экспресс-тесте и сохраняющихся подозрениях, особенно у детей.
- Общий анализ крови по показаниям: он не различает вирус и бактерию надёжно, но помогает в сложных случаях.
- При затяжном течении — осмотр носа и носоглотки эндоскопом, поскольку причиной часто оказывается не глотка, а стекание слизи сверху.
What really helps
The goal of treatment for viral pharyngitis is to reduce pain and allow the mucous membrane to recover. Simple things work, and their effect should not be underestimated: adequate pain relief allows you to drink and sleep normally, and this directly affects the speed of recovery.
- Painkillers and antipyretics in age-appropriate dosages are the most effective way to relieve pain; they are prescribed by a doctor, taking into account concomitant diseases
- Drink plenty of warm drinks: it moisturizes the mucous membrane and makes swallowing easier; hot drinks, on the contrary, increase irritation
- Air humidification up to 40-60 percent and ventilation - dry air is the main enemy of a sore throat, especially in winter when heating
- Rinsing with warm physiological or weak saline solution - gently cleanses and moisturizes, unlike aggressive mixtures
- Lozenges and sprays with local anesthetics and antiseptics - provide temporary relief; sprays are not used in young children due to the risk of laryngospasm
- Smoking cessation during illness, including electronic devices and hookah
- Soft, not spicy or hot food; complete vocal rest is not needed if there is no laryngitis
It’s worth mentioning separately about honey: a teaspoon of honey really reduces irritation and night cough in children over one year old, and this is one of the few home measures with a proven effect. Children under one year of age are not given honey due to the risk of botulism. But milk with soda, rubbing, jars, mustard plasters and warming the neck for a sore throat do not make sense: they do not affect the virus or inflammation, but heating during a purulent process is downright dangerous.
Why are soda with iodine and other folk rinses harmful?
Gargling with soda with the addition of a few drops of iodine is one of the most rooted home practices and at the same time one of the most harmful for pharyngitis. Soda is alkaline and destroys the natural layer of mucus that protects the epithelium of the pharynx and retains moisture. Iodine in an alcohol solution is a chemical irritant and, with regular contact, causes a burn to the mucous membrane. Salt in high concentrations draws water out of cells. As a result, a person who gargles every hour “to make it go away faster” does not get a recovery, but a dried out, thinned mucous membrane that itches and hurts without any infection.
It is this mechanism that most often lies behind the complaint “the throat does not go away for months, I treat and treat, but it gets worse.” The patient believes that he is fighting a persistent infection and intensifies rinsing; The mucous membrane suffers more from this, the soreness increases, and the circle closes. It is often enough to completely abolish all aggressive solutions and simply moisten the throat for two to three weeks for the complaints to go away without a single medication.
- Baking soda - washes away protective mucus, increases dryness and itching
- Alcohol iodine - chemically burns the epithelium; in addition, it is absorbed and affects the thyroid gland, which is especially important for thyroid diseases and pregnancy
- Strong saline solution - dehydrates the mucous membrane; Only a weak concentration close to physiological is safe
- Alcohol tinctures and diluted vinegar - direct burn, no benefit
- Kerosene, gasoline and similar remedies from folk councils - severe chemical burns and poisoning, still occur today
- Lubricating the throat with Lugol's solution with a cotton swab injures the epithelium mechanically and chemically, and has no proven benefit
Chronic pharyngitis: when the throat is sore for months
Chronic pharyngitis is not a lingering cold and almost never an “undertreated infection.” This is a condition of constantly irritated mucous membrane, and it is pointless to treat it with antibiotics: as long as the irritating factor is active, the inflammation will return. The task of the doctor and the patient is to find this factor, and in most cases it lies outside the pharynx itself.
- The reflux of acidic stomach contents into the throat is a very common and almost always overlooked cause; Typical morning soreness, lump sensation, coughing after eating and when lying down
- Constant drainage of mucus from the nose due to chronic rhinitis, sinusitis or allergies
- Breathing through the mouth due to a stuffy nose or deviated septum: the air is not moistened and warmed through the nose, but directly dries out the throat
- Smoking, including electronic devices and hookah, and secondhand smoke inhalation
- Dry dusty air, air conditioning, industrial work with chemical fumes
- Professional voice workload for teachers, salespeople, call center operators
- Abuse of vasoconstrictor drops and aggressive rinses
- Diabetes mellitus, thyroid disease, taking certain medications that cause dryness
Hence the logic of treatment: first the cause is eliminated, not the inflammation. They restore nasal breathing, treat reflux, humidify the air, quit smoking, and improve voice mode. Local funds play a supporting role. This approach requires patience - a noticeable result appears in a few weeks, and not in three days - but it gives a lasting effect, while the next course of antibiotic eliminates complaints for a week and brings them back.
