The sore throat

Many people suffer from recurring sore throats. The causes are manifold and range from dry mouth and throat mucosa due to restricted nasal breathing (snoring), viral or bacterial tonsillitis to malignant changes in the mouth and throat (tonsillar cancer, tongue cancer, etc.).

In addition to alleviating the acute symptoms, the focus must be on finding the cause. Treating the symptoms alone does not make sense and leads to a lot of suffering and frustration for patients, especially in the long term, because the therapy differs greatly here.

 

Possible causes for a soar throat:

 

• Viral pharyngitis (by far the most common cause).

• Bacterial tonsillitis (angina tonsillaris, bacterial tonsillitis)

• Recurrent acute tonsillitis

• Dry mouth syndrome (often due to poor nasal breathing and snoring)

• Tonsil stones (these usually cause a foreign body sensation and/or bad breath rather than a real sore throat)

• Malignant changes (carcinomas)

• Infections of the base of the tongue and the lateral cords (especially after removal of the palatine tonsils)

• Abscesses in the mouth, throat and neck area

• Aphtae (small superficial mucosal wounds, often on the mucous membrane of the lips and tongue)

 

Therapies for a soar throat:

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Not every sore throat or tonsillitis requires an antibiotic!

 

Symptomatic therapy and accompanying measures:

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Regardless of the cause, therapy to relieve the symptoms (sore throat, burning tongue, difficulty swallowing, etc.) is similar in most cases.

A therapy consisting of different modalities, "intensive and short" rather than "low-dose and prolonged" usually shows better results.

In addition to general physical rest, a combination of anti-inflammatory and pain-relieving medicines should be used, and attention should be paid to moistening and caring for the mucous membranes of the mouth and throat. Here, home remedies such as inhaling saline solutions, gargling with saline solutions, hanging damp cloths in front of the radiators and next to the bed to better humidify the surrounding air and regularly airing the rooms can be used as supportive measures. The use of various gargle solutions and teas cannot be generally recommended, as these can dry out the mucous membranes even more and upset the normal bacterial flora in the mouth and throat.

Especially in the context of infections of the upper respiratory tract (including the common cold), nasal breathing should be improved with decongestant sprays. However, it is essential to avoid using these sprays for too long (danger of "privinism" - persistent damage to the nasal mucosa and thus developing "dependence" of the nasal mucosa on nasal sprays).

 

 

Therapy of viral pharyngitis:

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Sore throats and pharyngitis are largely triggered by viral infections. Unfortunately, there is no causal therapy. Viral infections are simply part of life - especially in the colder months of the year. This stimulates and "trains" our immune system to be able to react correctly to future, possibly even severe infections. In the case of viral infections, antibiotics should not be prescribed under any circumstances. A partial improvement that occurs in connection with taking antibiotics is usually due to the regular duration of the viral infections (usually 10 to 14 days). In this case, therapy should focus on alleviating the symptoms and optimising the accompanying measures (see above). In some viral throat and tonsil infections (infectious mononucleosis, EBV infection, Pfeiffer's glandular fever), taking certain antibiotics can even trigger a severely itchy skin rash. Most viruses cannot really be determined in the context of the infection. Only in the case of the above-mentioned mononucleosis is it important to identify the pathogen (this is done clinically by the experienced (ENT) doctor, i.e. he recognises the cause by the appearance of the infection), as further measures are absolutely necessary here. Blood samples can confirm a diagnosis if the findings are uncertain.

 

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Therapy of bacterial tonsillitis and pharyngitis and for recurrent acute tonsillitis:

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If the cause is almost certainly bacterial, an antibiotic - usually a classic penicillin - should be taken. However, this decision should be made by a doctor who has a lot of experience with these types of illnesses. Too often an antibiotic is prescribed unnecessarily. Or the wrong antibiotic or an antibiotic with too low a dose is chosen, sometimes prescribed for too short or too long. This leads to a lack of the hoped-for success and the patients suffer from unnecessary side effects (diarrhea, intolerances, allergies, stomach complaints). In rare cases it is necessary to change the antibiotic due to lack of success. I will be happy to advise you on this.

 

I am often asked whether tonsils should be removed surgically. First of all, it has to be said that a tonsillectomy is not a trivial matter and only leads to an improvement of the symptoms in correctly selected cases. I would be happy to discuss with you whether a tonsillectomy is indicated and promising in your case. If necessary, I will be at your disposal.

 

 

Therapy of dry mucous membranes:

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Many patients suffer from dry oral mucosa. This is mainly a disease of older age, but young patients can also be affected. Dry oral mucous membranes can cause pain, recurrent infections or difficulty swallowing. The causes are manifold and range from age-related dry mouth due to reduced activity of the salivary glands, increased breathing through the mouth (often due to restricted nasal breathing), medication side effects, eating and drinking habits, consequences of radiation therapy in the head/neck area to systemic diseases (e.g. Sjögren's syndrome). Especially the latter should be excluded. In addition to a detailed examination of the mucous membranes, laboratory values (blood tests) and taking samples can also be helpful. The therapeutic options then depend on the cause and the current symptoms. The focus here is also often on symptomatic therapy and optimisation of the accompanying measures (see above).

 

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Therapy of tonsilar stones:

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Tonsilar stones do not require therapy per se. In some cases, however, patients can be significantly limited in their quality of life due to bad breath or the feeling of a foreign body. In rare cases, recurrent infections can also lead to sore throats. Therapies range from changing eating habits, to mouth rinses, to the removal of tonsil stones (by a doctor or by the patient themselves). In cases of great suffering, the complete removal of the tonsils (tonsillectomy) can also be considered. Together we will find a solution to relieve your discomfort.

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Therapy of malignant changes:

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Malignant lesions of the mouth and throat often occur triggered by excessive alcohol and nicotine consumption. Especially the combination of these substances significantly increases the risk. Sometimes, however, viral infections (HPV infection) are also causative for the development of malignant changes. In particular, long-term sore throats, perhaps in connection with other complaints (bad breath, weight loss, difficulty swallowing, etc.) should definitely be clarified by a specialist in ENT medicine. A malignant change can be diagnosed by taking samples under local anaesthesia (sometimes a sample is also taken under general anaesthesia). As an ENT specialist with specialisation in ENT tumours, I can help you here.

If you have been suffering from symptoms and changes for a longer period of time and the risk factors (alcohol +/- nicotine) apply to you, I will be happy to look after you here and initiate all the necessary steps and in some cases also carry them out in my practice. If changes are discovered in the early stages, it may be possible to remove them completely during the initial sampling. Regular ENT check-ups also help to clarify changes as gently as possible through early detection.

 

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Therapy of infections of the base of the tongue and the lateral cords:

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The base of the tongue and the lateral cords belong - like the tonsils - to the front line of defence of the human immune system. Painful infections of the base of the tongue and the lateral cords can occur in many patients, especially after the tonsils have been removed (tonsillectomy). The patients' quality of life is often significantly impaired by the severe pain and difficulty in swallowing. Sometimes, due to the impairment, an intravenous therapy with an antibiotic is also necessary in the context of an inpatient admission. Together we will find an optimal solution for you.

 

 

Therapy of abscesses in the mouth and throat area:

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Abscesses in the mouth and throat area must be treated with antibiotics and, as a rule, also treated surgically. Abscesses (e.g. in the context of tonsillitis) can be caused by an prolonged infection. Sometimes, however, they develop very quickly without this prolonged course of the disease. Warning symptoms are an increasing impairment of the general condition, a clearly restricted opening of the mouth, increasingly slurred speech and pronounced difficulties in swallowing (all of this possibly despite taking an antibiotic). If this is suspected, I am available for acute appointments. Otherwise, I recommend an assessment in a hospital outpatient clinic for ENT medicine.   

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Therapy of aphtae of the oral mucosa:

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Many people suffer from sometimes recurrent superficial mucosal lesions of the oral mucosa. The mucous membranes of the lips, tongue and soft palate are particularly often affected. Sometimes there are clearly assignable causes (e.g. viral infections). In many cases, however, the cause is not entirely clear. Especially in cases of recurrent occurrence, a general immune deficiency and systemic (autoimmune) diseases should be clarified. Attention should be paid to careful dental hygiene, abstinence from nicotine, choice of toothpaste and avoidance of certain foods. These measures often lead to a significant improvement in the symptoms. Numerous gels and creams are available to alleviate the symptoms. In severe cases, systemic therapy (medication to be swallowed or administered via the vein) is also indicated.

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