Sore Throat and Voice Problems
1) What are the common causes of sore throat?Sore throat or acute pharyngitis is the most common disorder seen in general medical practice. Although a sore throat is often viewed as a mild to moderate infectious process with minimal end results, it can also be the presenting symptom of a serious illness. The majority of sore throats are due to viral and bacterial infections of the lining of the throat.
The lining of the throat or pharynx, extends from the naso-pharynx (behind the nose), through the oropharynx (behind the oral cavity), to the laryngo-pharynx (behind the voice-box or larynx). This lining has high concentrations of lymphoid tissues, especially on the tonsils and adenoids that are prone to reactive changes (swelling and pain), especially in response to pathogenic viral and bacterial organisms. These lymphoid tissues form a sort of “ring of defense” (Waldeyer’s Ring) that filters out pathogenic organisms that we may breathe or take in orally.
Other not uncommon causes of a sore throat are post nasal drip of secretions from the nose, and sinuses and acid reflux from stomach juices going up to the throat and causing acid burns (instead of staying down in the stomach). Fungal infections are uncommon in a normal healthy person. Tonsillar or deep neck abscesses, infections from dental origins, foreign bodies being stuck in the throat, tumors of the pharynx are other causes of a sore throat.
2) Does having a frequent sore throat indicate any serious medical problem? What are the symptoms to look out for?
Occasionally, the “ring of defense” (Waldeyer’s Ring) of lymphoid tissue, especially the tonsils and adenoids, is chronically infected and can be the source of recurrent flare-ups of sore throats and generalized infections.
The patient (usually a child) will have a history of recurrent attacks of sore throat with fever and malaise. He or she may be underweight and short of stature from the failure to grow normally.
Another symptom to look out for is noisy breathing, with snoring at night from an obstructed upper airway. Recurrent ear aches from obstructed auditory tubes due to chronically enlarged adenoids, bad breath from food particles getting stuck in the tonsillar crypts, and tender enlarged glands in the neck (which are involved after an overwhelming infection of the Waldeyer’s ring) are other symptoms to look out for.
A person with persistent sore throat or voice problem who has not improved with treatment from his family doctor should be referred to an ENT specialist.
3) How do lozenges help in treating sore throat? What do they contain and how much can one take? What are other home remedies in treating sore throat?
Lozenges in general have some local anesthetic agents that do numb and relive a sore throat. Most lozenges also contain some mild antiseptic that are bacteriostatic, that is, prevents the growth of bacteria. They act mainly to encourage secretion of our own saliva when we suck on it. Our saliva flowing down a sore throat eases the discomfort, prevents the drying of the lining, and washes away the bacteria and the debris, which an infection produces. Saliva is more effective than any of the ingredients in a lozenge. Saliva also contains substances that help prevent pathogen growth and even kills bacteria.
The amount of lozenges one takes is usually restricted, as too much of their ingredients in our system can cause abdominal symptoms like “wind” or even a stomachache. One should follow the instructions (which come with lozenges) on the frequency and quantity to take. Some lozenges contain a lot of sugar and should be avoided. They are bad for your dental hygiene due to a high level of sugar content.
One of the best things to do for a sore throat is to sip water regularly. This should be at body temperature and not too cold or too hot, as the temperature extremes would further irritate the throat. It is a poor substitute for saliva but it does prevent the throat from drying and helps to wash the throat irritants away. Dehydration in the presence of a fever that often accompanies a sore throat will contribute to soreness and prolong the illness.
Taking warm tea with some honey and lemon, which is soothing, is a home remedy that is good and soothing. Inhaling steam with a dash of oil of pine or menthol is also very soothing for the throat and helps to humidify the lining of the throat. Gargling with salt water is also useful to keep the soreness down.
4) Is sore throat a common problem with Singaporeans?
Sore throat or acute pharyngitis is the most common disorder seen in general medical practice in Singapore. Among Singapore patients presenting with voice problems, more than 85% of them have hoarseness of voice and soreness of throat. In professional voice users, such as lecturers, teachers, sales persons, commodity traders, singers, lawyers and politicians, sore throat and voice problems may be incapacitating.
5) What precautions can one take to prevent soreness on the throat if one’s occupation involves using loud voices, such as teachers, lecturers, sales people, army officers, etc?
I usually tell my patients the 14 Rules for Vocal Health:
· No smoking.
· No drugs, except by prescription. Some over-the-counter medication can dehydrate the throat and voice box.
· No Alcohol. This also dehydrates the throat and voice box.
· Don’t sleep with one’s mouth open. This is the commonest cause of a blocked nose – by not breathing through the nose, which serves to warm, humidify and clean the air we breathe. Mouth breathing dries the throat and voice box.
· Don’t yell or scream. This serves to cause the vocal cords to come together at great force and is damaging to the surface of the cords.
· Don’t talk over noise. Wait for the noise levels to come down before speaking.
· Don’t clear your throat. This is a bad and abusive habit to the vocal cords – literally causing them to grind with each other, and damaging the surface.
· Don’t talk too much or too loudly.
· Keep your throat lubricated. Like a well-oiled machine, it will function best when moist.
· Limit consumption of full cream milk products (especially chocolates). This tends to bring up a lot of phlegm in certain people.
· Drink plenty of water. Your urine should be the color of water. This is an indicator that you are drinking enough water.
· Use steam twice a day.
· Open the back of your throat. You may want to see a speech therapist on how to.
· Use your tummy muscles (not your neck muscles) to project your voice like a singer.
|Dr Allumootil Benjamin John
MBBS (Singapore), FRCS (ENT)(Glasg), FAMS (ENT)
Clinic: A B John Ear, Nose And Throat (ENT) Clinic & Surgery
Address: 3 Mt Elizabeth, #15-10, Mt Elizabeth Medical Centre, Singapore 228510Tel: +65 6735 9654
Fax: +65 6735 6514