Sore throat

A sore throat refers to discomfort or pain in the pharynx and larynx, which often worsens when talking or swallowing. Various factors can contribute to throat pain, including viral and bacterial infections, allergic reactions, tumors, and vitamin deficiencies.

Diagnosis typically involves a physical examination of the airways, imaging tests such as X-rays and ultrasounds, and laboratory tests like bacterial cultures and serological analyses.

To relieve throat pain, treatments may include warm alkaline drinks, gargling, and physiotherapy procedures.

What are the causes?

Environmental factors

A dry, scratchy throat can result from prolonged exposure to low humidity indoors or living in hot, dry climates. This often leads to dryness of the mucous membranes and reduced saliva production, making discomfort more pronounced when speaking or eating solid foods.

The pain is typically worse in the morning, especially for people who sleep with their mouths open, as this further dries out the throat. In men, snoring can contribute to morning throat pain, making it painful to speak until they drink water.

Exposure to polluted air, such as in mines, sand quarries, or urban areas with heavy traffic emissions, can also trigger throat pain. Symptoms may appear suddenly when stepping outside or entering industrial environments and are often accompanied by a persistent, dry cough. Occasional throat irritation from air pollution is normal, but if the discomfort persists, interferes with eating or speaking, or becomes a chronic issue, it is important to consult a healthcare professional to determine the underlying cause.

Viral infections

Severe throat pain is a common symptom of many respiratory infections, which damage the mucous membranes of the throat and larynx. The pain may be caused by direct viral damage to the tissue, systemic infection effects, or nerve involvement. In most cases, a sore throat occurs alongside fever, fatigue, and general symptoms of illness. The most common viral infections that cause throat pain include:

• Viral pharyngitis – Initially presents with mild discomfort, scratchiness, and irritation in the throat, which gradually progresses to severe pain and a persistent dry cough. A hallmark symptom is the “empty swallow,” where swallowing saliva is more painful than swallowing food or liquids.
• Infectious mononucleosis – Causes extreme throat pain that makes eating difficult, with some patients even avoiding drinking water due to the severity. Swollen and inflamed lymph nodes accompany the throat pain.
• Adenovirus infection – Throat pain typically begins one to two days after nasal congestion and watery eyes. The discomfort is moderate but worsens when swallowing or speaking. Patients may notice white spots on the tonsils, and a barking cough often develops later.
• Herpetic throat Infection (Herpangina) – This condition is characterized by severe throat pain and high fever (39-40°C). Grayish vesicles appear on the throat’s mucous membranes, and when they rupture, the pain intensifies.

If throat pain persists, worsens, or is accompanied by difficulty breathing, high fever, or significant swelling, medical attention is essential to determine the cause and receive appropriate treatment.

Bacterial infections

A sore throat accompanied by pain while swallowing may indicate strep throat (tonsillitis). Symptoms often begin with mild irritation and discomfort in the throat, which quickly escalates into sharp pain that may radiate to the ears, neck, or back of the head. Some individuals may notice swollen, reddened tonsils with small pus-filled spots. These symptoms are usually accompanied by fever, fatigue, joint pain, and muscle aches. In severe cases where swallowing even water becomes unbearable, an intratonsillar abscess (peritonsillar abscess) may be developing.

In children, a sore throat combined with breathing difficulties could signal epiglottitis, an inflammation of the epiglottis. Due to intense pain, affected children often refuse food and water, and symptoms of swallowing difficulty (dysphagia) worsen within hours.

To ease discomfort and improve breathing, they may adopt a specific posture—sitting forward with their neck extended and mouth slightly open. A sore throat localized to one side, accompanied by a high fever, may indicate a retropharyngeal abscess, which requires urgent medical attention.

Laryngitis

Acute laryngitis often develops alongside a low-grade fever and fatigue. The throat pain can be intense, particularly if inflammation affects the back of the throat, making swallowing more painful. This condition is typically associated with a harsh, barking cough without mucus production. If the vocal cords become involved, the voice may temporarily disappear.

Chronic laryngitis presents with milder throat pain, but voice changes, persistent hoarseness, and vocal fatigue are the most noticeable symptoms. Individuals may struggle to speak for long periods, often experiencing discomfort and a strained voice by the end of the day.

Oral thrush (Candidiasis)

Fungal infections affecting the mouth and throat can cause persistent sore throat pain, which worsens significantly while eating. Thick, white patches typically form on the mucous membranes, and painful cracks (angular cheilitis) may develop in the corners of the mouth.

Oral candidiasis is more common in people with weakened immune systems, such as those undergoing organ transplants, cancer treatments, or with immune deficiencies. In severe cases, the infection can spread to the entire respiratory tract, leading to additional complications.

Allergic reactions

Allergic pharyngitis and laryngotracheitis can cause moderate throat pain triggered by allergens. Symptoms often develop suddenly, starting with throat irritation and scratchiness. This is frequently accompanied by dry, non-productive coughing episodes that offer no relief.

Other common allergy symptoms include sneezing, watery eyes, and itching. People prone to allergies often report throat discomfort after inhaling pollen, exposure to household chemicals, or using certain cosmetics. In some cases, throat pain may occur after consuming specific foods.

Foreign objects in the throat

Swallowing fish or meat bones can cause sharp, stabbing pain if they become lodged in the throat. The pain is typically well-localized and may be accompanied by severe coughing, redness, and facial swelling due to persistent coughing fits. In some cases, breathing difficulties may arise.

Children may experience throat pain if they accidentally inhale small toy parts or other objects. Foreign body obstruction in the throat or airways is a medical emergency requiring immediate intervention.

Gastroesophageal reflux disease (GERD)

In adults, GERD (gastroesophageal reflux disease) is a common cause of recurrent throat pain. Stomach acid can back up into the throat, irritating the mucous membranes. The intensity of throat pain fluctuates throughout the day but is often most severe in the morning after sleep, as lying down promotes acid reflux. Other symptoms include a persistent dry cough, frequent throat clearing, and a burning sensation.

Many individuals also report acidic burping and heartburn, especially after eating. These symptoms are commonly seen in conditions like hyperacidic gastritis, peptic ulcers, and esophagitis.

Deficiency conditions

For proper regeneration of the throat’s mucous membrane, numerous biologically active substances and vitamins are essential. Nutritional imbalances or gastrointestinal disorders that impair nutrient absorption can lead to vitamin deficiencies, with throat pain being one of the possible symptoms. Common deficiency-related causes of throat pain include:

• Vitamin B2 Deficiency (Riboflavin Deficiency): Patients report a burning sensation and pain in the throat, especially while speaking or eating. Painful cracks may develop at the corners of the mouth (angular cheilitis), along with tongue inflammation.
• Vitamin B12 Deficiency: Affected individuals experience burning pain in the throat and tongue, with the tongue appearing bright red and glossy. Numbness and tingling sensations (paresthesia) in the lower limbs may also occur.
• Vitamin C Deficiency (Scurvy): Inadequate ascorbic acid levels can cause throat pain due to ulcerative lesions on the mucous membranes. Patients often describe a metallic taste in the mouth and bleeding gums.

Chronic diseases

Systemic diseases can lead to the accumulation of toxic metabolites and nitrogenous waste in the blood, contributing to chronic inflammation and atrophic changes in the throat. Throat discomfort may be linked to elevated blood glucose levels, often accompanied by dry mouth and catarrhal inflammation. Throat pain is commonly associated with the following conditions:

• Organ diseases: Chronic kidney disease (CKD), liver disorders.
• Endocrine disorders: Diabetes mellitus, Cushing’s syndrome, hypothyroidism.

Tumors

Persistent throat pain with difficulty swallowing that does not respond to standard treatment may indicate the growth of tumors in the pharyngolaryngeal region.

• Benign tumors may cause a constant sensation of pressure or fullness in the throat, as well as occasional choking while eating.
• Malignant tumors, such as throat or laryngeal cancer, may present with sharp neck and throat pain accompanied by coughing up blood (hemoptysis). Other warning signs include progressive voice loss, hoarseness, and intermittent dry coughing.

Medication-related complications

Long-term use of certain medications can contribute to throat pain.

• Nasal decongestant drops, when used frequently, can drain down the back of the throat, causing chronic irritation and inflammation of the mucous membrane. Patients often describe persistent throat tickling, burning sensations, and a dry cough.
• Prolonged use of corticosteroids or antibiotics can weaken local immunity, leading to increased throat sensitivity and dryness, especially when speaking.

Rare causes

• Xerostomia (Chronic Dry Mouth)
• Dental conditions: Periodontitis, galvanism (caused by mixed-metal dental fillings), tooth eruption issues
• Heart diseases: Unstable angina, atypical heart attack presentation
• Disorders of adjacent organs: Zenker’s diverticulum (pharyngeal-esophageal pouch), thyroid disorders
• Nerve disorders: Pharyngeal neurosis, glossopharyngeal neuralgia
• Spinal disorders: Cervical osteochondrosis, tuberculous spondylitis, radiculitis
• Eagle Syndrome (Stylohyoid Syndrome)

If throat pain persists despite treatment or is accompanied by additional symptoms, a thorough medical evaluation is recommended to identify the underlying cause.

Sore throat and no fever: what can it be?

A sore throat without a fever can be caused by a variety of conditions, ranging from mild to more concerning. One common cause is viral infections, such as the common cold or mild flu, which may irritate the throat without always causing a fever.

Other possibilities include allergies, which can trigger postnasal drip and throat irritation, or environmental factors like dry air, smoking, or exposure to pollutants. Acid reflux (GERD) can also lead to a sore throat due to stomach acid irritating the throat lining.

Less commonly, a sore throat without fever could be due to strep throat in its early stages, though this is typically accompanied by other symptoms like swollen lymph nodes or white patches on the tonsils.

If the sore throat persists for more than a few days, is severe, or is accompanied by difficulty swallowing, breathing, or a rash, it’s important to consult a healthcare provider to rule out more serious conditions like bacterial infections or mononucleosis.

Diagnosis

An otolaryngologist (ENT specialist) is responsible for determining the cause of throat pain. A comprehensive diagnostic approach includes a detailed examination of the oral cavity and respiratory tract using instrumental and laboratory methods. If additional symptoms are present, imaging studies of the chest and abdominal organs may be required. The most effective diagnostic methods for acute throat pain include:

Instrumental examination

• Pharyngoscopy and Indirect Laryngoscopy provide a detailed assessment of the respiratory tract.
• Otoscopy is performed to rule out ear-related causes of throat pain.
• The examination focuses on mucosal appearance, the presence of plaque, and ulcerations.

Bacteriological testing

• A throat swab, sputum sample, or plaque specimen is collected for bacterial culture.
• This method is crucial for diagnosing conditions like strep throat, viral or bacterial pharyngitis.
• Rapid diagnostic tests (Immunofluorescence Assay, RIF) detect pathogens in throat washings.

Ultrasound imaging (Sonography)

• Recommended for persistent neck and throat pain to assess neighboring structures.
• Detects abscesses, cysts, and abnormal growths in the parapharyngeal space.
• Thyroid ultrasound is routinely performed to rule out thyroid-related causes.

Radiological examination

• Laryngeal X-ray is indicated for severe neck and throat pain to exclude tumors.
• CT scan of the larynx offers detailed imaging for complex cases.
• In some cases, radioisotope thyroid scanning may be required.

Laboratory testing

• Complete blood count (CBC) and biochemical analysis help detect infection or inflammation.
• Fasting blood glucose levels are assessed to rule out diabetes-related complications.
• If needed, liver function tests, acute-phase markers, and enzyme levels are measured.

To diagnose endocrine disorders as a potential cause, thyroid and adrenal hormone levels are evaluated. Serological tests (RIF, ELISA, PCR) help identify infectious agents.

Additional studies may include:

• X-ray and CT scan of the cervical spine for musculoskeletal causes.
• Esophagogastroduodenoscopy (EGD) and esophageal pH monitoring if acid reflux is suspected.
• Dental evaluation to check for tooth and periodontal inflammation.

If you experience persistent or severe throat pain, a comprehensive medical assessment is necessary to identify the underlying cause and determine the most effective treatment.

Treatment

Sore throat remedies

To reduce throat pain before receiving a diagnosis, the following measures are recommended:

• Drink plenty of warm fluids such as tea and herbal infusions, but avoid milk-based beverages as they may worsen symptoms.
• Gargle with calendula tincture and use lozenges to soothe the throat.
• Avoid strong odors and household chemicals that may irritate the throat lining.
• Eat warm, soft foods that are easy on the throat, such as soups and porridges.
• If the pain is severe or accompanied by fever and weakness, seek medical attention immediately.

Medicine

The treatment approach depends on the underlying cause of throat pain. Etiotropic therapy, which targets the root cause, is the most effective. Combining medications with physiotherapy can help relieve pain and manage symptoms. Common physiotherapy treatments include inhalations with essential oils and medicinal solutions, ultrahigh-frequency (UHF) therapy, magnetotherapy, and laser therapy.

• Antibiotics – If throat pain is caused by a bacterial infection, antibiotics are prescribed to target respiratory pathogens. For fungal infections (candidiasis), antifungal medications are used.
• Anti-inflammatory Drugs – Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, fever, and pain by inhibiting inflammatory mediators and cytokines.
• Antiseptics – Antibacterial agents like chlorhexidine help eliminate bacterial growth in the throat and airways. Gargling with peppermint, eucalyptus, and other natural solutions several times a day may also relieve discomfort.
• Antihistamines – If throat pain occurs due to allergies, oral antihistamines are recommended. In severe cases, aerosol corticosteroids may be necessary.
• Vitamins – Vitamin deficiencies can contribute to throat pain. B-complex vitamins, such as cyanocobalamin (B12) and riboflavin (B2), may be prescribed after laboratory testing to correct deficiencies.
• IV Therapy – In cases of severe infections with systemic toxicity, intravenous crystalloid and colloid solutions are used to detoxify the body.
• Acid-Reducing Medications – If gastroesophageal reflux disease (GERD) is causing throat irritation, proton pump inhibitors (PPIs) are prescribed to lower stomach acid levels.

Surgery options

Surgery is necessary when throat pain is caused by purulent infections or tumors. Surgical procedures may include:

• Abscess Drainage – If a retropharyngeal or peritonsillar abscess is present, an incision and drainage procedure is performed, followed by washing the area with antibacterial and antiseptic solutions.
• Benign Tumor Removal – If a benign growth is causing throat pain, a minimally invasive resection of the pharynx may be performed.
• Cancer Surgery – If a malignant tumor is diagnosed, a hemilaryngectomy (partial removal of the larynx) with tracheostomy may be necessary. In the long term, laryngoplasty (voice box reconstruction) may be considered if feasible.

If you experience persistent or worsening throat pain, consult a healthcare provider to determine the most appropriate treatment for your condition.

References:

Business Insider (2019) 9 of the most common vitamin deficiencies and how to prevent them. Available at: https://www.businessinsider.com/most-common-vitamin-deficiencies-2019-1

Centers for Disease Control and Prevention (2024) Sore Throat Basics. Available at: https://www.cdc.gov/sore-throat/about/index.html

Cleveland Clinic (2023) Scurvy: Symptoms, Causes & Treatment. Available at: https://my.clevelandclinic.org/health/diseases/24318-scurvy

Cleveland Clinic (2024) Persistent Sore Throat (Chronic Pharyngitis): Causes & Treatment. Available at: https://my.clevelandclinic.org/health/diseases/22280-chronic-pharyngitis

Cleveland Clinic (2024) Vitamin B12 Deficiency: Symptoms, Causes & Treatment. Available at: https://my.clevelandclinic.org/health/diseases/22831-vitamin-b12-deficiency

Healthline (2022) Sore Throat: Treatment, Causes, Diagnosis, Symptoms & More. Available at: https://www.healthline.com/health/sore-throat

Mayo Clinic (2025) Sore throat – Diagnosis & treatment. Available at: https://www.mayoclinic.org/diseases-conditions/sore-throat/diagnosis-treatment/drc-20351640

Mayo Clinic (2025) Sore throat – Symptoms & causes. Available at: https://www.mayoclinic.org/diseases-conditions/sore-throat/symptoms-causes/syc-20351635

Medical News Today (2025) Sore throat: Causes, symptoms, and when to see a doctor. Available at: https://www.medicalnewstoday.com/articles/311449

Merck Manual (2022) Riboflavin Deficiency. Available at: https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/riboflavin-deficiency

National Health Service (2020) Sore throat. Available at: https://www.nhs.uk/conditions/sore-throat/

Singh, P. and Singh, S. (2012) Vitamin D Deficiency in E.N.T. Patients. Indian Journal of Otolaryngology and Head & Neck Surgery, 64(4), pp. 364–367. doi: 10.1007/s12070-011-0399-5.

UpToDate (2023) Sore throat in adults: Beyond the basics. Available at: https://www.uptodate.com/contents/sore-throat-in-adults-beyond-the-basics

WebMD (2024) Is Your Sore Throat a Cold, Strep Throat, or Tonsillitis? Available at: https://www.webmd.com/cold-and-flu/sore-throat-cold-strep-throat-tonsillitis