Description

Throat pain with swallowing (odynophagia) or without swallowing may be a lone complaint or accompanied by a variety of other complaints. The most likely etiologies are self-limited but must rule out potentially life-threatening causes.

Epidemiology

• Sore throat is a common complaint year-round, but etiology depends on season and age of patient.
• In winter months, viral agents are more active.
• In spring and fall, postnasal drip from allergic rhinitis is a common cause of throat irritation.

General Prevention

• Careful hand washing and avoidance of respiratory secretions are keys to minimizing spread of most infectious agents.
• Noninfectious etiology often triggered by specific exposure, so avoidance of that trigger would limit symptoms

Etiology

• Infectious
  • Urgent/emergent: epiglottitis, peritonsillar cellulitis/abscess, retropharyngeal abscess, Lemierre syndrome
  • Viral: adenovirus, influenza, coxsackie, parainfluenza, Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), human immunodeficiency virus
  • Bacterial: group A β-hemolytic Streptococcus (GAS), Streptococcus pyogenes, Mycoplasma pneumoniae, groups C and G streptococci, diphtheria, Neisseria gonorrhoeae, anaerobic bacteria, tularemia, Arcanobacterium haemolyticum
  • Fungal: Candida
• Allergic/inflammatory
  • Postnasal drip from allergic rhinitis
  • Gastroesophageal reflux disorder (GERD)
  • Eosinophilic esophagitis
• Environmental
  • Tobacco smoke or aerosolized irritant
• Trauma
  • Foreign body: either retained or causing laceration to posterior pharynx
  • Burns: hot liquids/foods
  • Caustic ingestion
  • Voice overuse
• Tumor
  • Acute lymphocytic leukemia (ALL) or T-cell lymphoma can rarely present as sore throat and fever.
• Miscellaneous
  • Kawasaki disease
  • PFAPA: periodic fever, aphthous stomatitis, pharyngitis, adenitis
  • Psychogenic pain
  • Referred pain