Dyclonine

The sensation is a familiar one. It hurts to swallow and there's a scratchy sensation way in the back of the mouth. The whole area feels raw. All signs point to a sore throat, that universal complaint, usually associated with the winter months.

It's not surprising that the throat is the target of pain. It is, along with the nose, the body's first defense against invading organisms. Anything that comes in via the nose or mouth must pass through this area, known technically as the pharynx. Pharyngitis--i.e., throat inflammation--is one of the most common complaints that bring people to see a doctor. And it's the cause of 100 million days of absence from work each year.

A sore throat is a symptom of some underlying problem, the body's way of signaling that something is wrong. And there are a host of reasons why the throat becomes sore.

Infectious diseases caused by viruses, bacteria and fungi have sore throat as a primary symptom. A sore throat may be an early sign of aplastic anemia (a serious form of anemia) and acute leukemia and is also a manifestation of pharyngeal gonorrhea and an advanced stage of syphilis.

Some throat problems come from eating irritating foods. In the June 1984 American Family Physician, two Canadian physicians told of a sore throat epidemic among students from Saudi Arabia. The illnesses were traced to their overzealous use of an unfamiliar hot sauce on their food.

A sore throat can also result from excessive nasal secretions (popularly called postnasal "drip"), injury from a bone or sharp object unintentionally swallowed, inhaled noxious fumes, and allergies. Together with fever, a sore throat is also a rare side effect of some prescription drugs.

Dental and surgical procedures, such as tonsillectomy or biopsy, can leave the patient with varying degrees of throat pain.

Of the lot, viral and bacterial infections are the most frequent causes of acute sore throat.

Among the viruses that effectthe throat are the coxsackie-viruses, Group A. Any one of the 23 varieties of these viruses may cause herpangina, an illness that occures mostly in the summer and mainly affects children. A fever that comes on suddenly, sore throat, headache and loss of appetite are characteristic symptoms. There is no specific treatment for herpangina, which usually clears up on its own in a few days.

High fever, sore throat and swollen glands are the mark of infectious mononucleosis, a familiar problem on college campuses. Caused by the Epstein-Barr virus, which is one of the herpes viruses, this illness is spread through close contact, mainly by the oral-respiratory route. Called the "kissing disease," mononucleosis usually lasts one to four weeks, but it can drag on for as long as three months. Treatment of uncomplicated cases includes bed rest, aspirin or other analgesics for headache, and gargles for throat pain.

About 4 to 5 percent of upper respiratory infections are caused by the adenoviruses, named for the adenoids from which they were first isolated. Adenoviruses are responsible for a number of acute respiratory diseases seen primarily in children, including one that affects the throat and eyes. Rest in bed is the usual treatment.

Influenza is an all too familiar viral disease (see "Flu/Cold: Never The Strain Shall Meet," in the September 1983 FDA Consumer). The fluw ranges from a barely noticeable infection to full-blown pneumonia, but the typical case is one accompanied by cough, headache, fever, malaise, loss of appetite and often nausea, vomiting and, of course, a sore throat.

The parainfluenza viruses are linked to a number of usually mild respiratory ills, including an influenza-like pneumonia, but the most common is a febrile (feverish) croup seen in young children. Initially, the child has a fever and cold-like symptoms. A moderate sore throat and dry cough develop early on. Horseness and a harsh cough often follow.

And then there is the most common cause of sore throat, the common cold, considered by many experts to be the greatest cause of sickness in the United States. Throat discomfort, sneezing, runny nose and generalized aches and pains are the characteristic features of this aptly named illness. More prevalent during the winter months, colds can be blamed on hundreds of different viruses, including the influenza and parainfluenza varieties, adeno-and coxsackieviruses, and the rhino-, corona- and certain echoviruses. At this time, there is no cure for the common cold, which usually runs its course in four to 10 days.

Throat pain that is a symptom of a viral illness valid disappear as the condition improves; the best treatment is simply bed rest, an analgesic for fever, and a warm saltwater gargle. (Children with viral illnesses such as flu or chicken pox should not be given aspirin because of its association with a rate but serious condition known as Reye syndrome.) Sore throats due to injuries or irritants also will heal by themselves with time.

But for those who can't wait, there are over-the-counter oral health-care products that may ease the pain until nature runs its course. A panel of experts, reviewing ingredients in OTC oral health-care products for the Food and Drug Administration, said relief can be found in anesthetic/analgesic lozenges and sprays containing ingredients such as benzocaine, dyclonine hydrochloride, hexylresorcinal, menthol and phenol. Astringents containing alum and zinc chloride can provide a protective coating over the throat, the panel said, while urea peroxide, hydrogen peroxide and sodium bicarbonate, in the form of a rinse or gargle, are useful in removing thick mucus or phlegm in the throat. Products containing elm bark, gelatin, glycerin or pectin also can sooth irritated areas of a sore throat, according to the panel.

The effectiveness of gargles in relieving sore throat discomfort is questionable, however, the panel noted. In the act of gargling, the tongue rises and the sides of the throat draw together, preventing any fluid from reaching the area of inflammation.

Some sore throat sufferers who are not satisfied with the relief provided by these over-the-counter products feel that what they need is a good healthy dose of antibiotics. What they often don't realize is that these overused drugs are of no help against viral illnesses and should only be taken when a doctor has determined that the cause of the sore throat is a bacterial infection.

"Strep throat," or Group A beta hemolytic streptococcal infection, is the most common bacterial infection involving the throat. Although it is less prevalent than virus-caused varieties, strep throat is justly feared, for if it is not properly treated, it can lead to rheumatic fever, which in turn may lead to serious complications involving the joints, brain, heart, subcutaneous tissues and skin.

The peak months for strep infections are November to May. Children between the ages of 5 and 15 are most susceptible to the infection. Strep germs do their dirty work by invading healthy tissue, usually the pharynx. Typical symptoms include sore throat, fever, a beefy-red pharynx, and pus on the tonsils. A runny nose and cough are not part of a strep infection. However, in many strep cases the patient may have no symptoms at all, or just fever and sore throat, or some other nonspecific symptoms. A strep throat develops rapidly, in contrast to other types that are slow to make their presence known.

In order to distinguish a strep throat from other types of sore throats that sometimes produce a similar appearance, the doctor takes a swab of the inflamed area for laboratory examination. In the past this procedure, called a throat culture, took 24 hours or more. Today there is a recently approved test being introduced that can produce results in the doctor's office in 10 minutes.

Strep throat, since it is a bacterial infection, is treated with antibiotics, usually penicillin. Treatment thwarts the development of complications and prevents spread of the infection, particularly among schoolmates. But it doesn't hurt to delay treatment for a day or two until the results of the throat culture are in, although some doctors prescribe antibiotics right away, just in case the infection is of the streptococcal variety.

Among other bacterial infections that cause sore throat are diphtheria and gonorrhea. Largely controlled by vaccination, diphtheria is still found in some parts of the United States, such as the Southwest and Northwest. Diphtheria is caused by an organism with the tongue-twisting name Corynebacterium diphtheriae. The organisms invade the tonsils or nasopharynx (see drawing), and as they multiply, they produce toxins that damage surrounding cells.

The characteristic feature of diphtheria is a dirty-gray, tough pseudomembrane that forms in the area of the tonsils. The lymph glands in the neck may alo be swollen. Complications can be severe if the disease is not treated promptly with antitoxin.

Gonorrhea, caused by the gonococcus bacterium Neisseria gonorrhoeae, is spread by sexual contact and its symptoms usually appear on the genital organs. However, thir organism can cause pharyngitis as a result of oral-genital contact, and the incidence of this type of illness is rising. As in other forms of gonorrhea, penicillin or other antibiotics are the preferred treatment.

The throat and mouth sometimes are affected by fungal diseases such as blastomycosis, sporotrichosis or actinomycosis. The most common, however, is thrush, caused by Candida albicans. Symptoms of thrush include white patches over the pharynx, tonsils and base of the tongue. Once seen almost exclusively in children and malnourished adults, thrush now occurs in people of all ages--thanks, surprisingly, to antibiotics. Prolonged use of these drugs destroys the organisms that normally live in the oral cabity, allowing the overgrowth of the everpresent Candida.

COPYRIGHT 1985 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group