Chronic Pharyngitis

Also known as a persistent sore throat, chronic pharyngitis differs from acute pharyngitis in that it lasts for a considerably longer time and does not respond to treatments for acute pharyngitis. Pharyngitis is an inflammatory condition of the back of the throat, the pharynx.

Acute pharyngitis is more common, and symptoms usually resolve within ten days. 1 Treatment for acute pharyngitis is usually focussed on treating the symptoms. Most cases of acute pharyngitis are viral, but some are bacterial.

Antibiotics are only helpful if bacterial infection is the cause for acute pharyngitis. But even if it clearly is bacterial, which can sometimes be hard to tell, antibiotic treatment is not necessarily recommended for all patient groups. However, chronic pharyngitis can be caused by a number of different factors besides infection.

In chronic pharyngitis, the soreness either does not go away or recurs frequently. Pharyngitis may be chronic if the sore throat lasts for more than a few weeks. There are several underlying causes for chronic pharyngitis, and treatment depends on what the underlying cause is.

The symptoms of chronic pharyngitis resemble those of acute pharyngitis, and include: 2 3

• Discomfort or pain in the throat
• Cough
• Hoarseness
• A tickling sensation in the throat
• A sensation of something stuck in the throat
• Difficulty swallowing
• A tired voice, more common among people who sing or speak for a living
• Headache
• Fever

The Ada app can help you check your or someone else's symptoms. Download the free app or find out more about how it works.

Chronic pharyngitis has many potential underlying causes, and if a sore throat does not clear up even after a course of antibiotics, it is best to seek further medical advice. Chronic pharyngitis may be caused by factors such as:

• Smoke or environmental pollutants
• Infection
• Allergies or allergic reactions, such as eosinophilic esophagitis
• Acid reflux
• Throat cancer, in rare cases

Smoke contains fine particles of solid, gas and liquid matter carried in air, and may include harmful chemicals as well as fragments of burnt material. 4 Smoke may be generated by burning tobacco, wood, grass, coal, plastic, structures, burn pits, landfill fires, traffic exhaust, industrial exhaust or almost any other combustible material or activity that involves carbon combustion. 5

The exact chemicals and particles carried in smoke depend on what is producing the smoke. Fine particle pollution is a common problem in urban areas as well as in households and undeveloped areas that rely on wood and coal fires for heat and/or cooking.

The degree to which smoke and other airborne environmental pollutants can cause throat pain and lung problems varies from person to person, but, when problems occur, they commonly manifest as a dry, sore throat, runny nose and coughing. 6 Long-term or frequent exposure to smoke can cause persistent pharyngitis.

Another common cause of persistent sore throat is an infection of the structures in or surrounding the throat. In people who still have their tonsils, these are the structures most often affected. This is known as tonsillitis, and other symptoms that may be present include: 7 8

• Cough
• Fever
• Nausea and vomiting
• Painful swallowing
• Swollen lymph glands
• Headache
• Abdominal pain

Allergic rhinitis is also known as hay fever and is a condition in which the body’s immune system responds aggressively to harmless particles such as pollen, mold or pet dander. Depending on what triggers the immune response, allergic rhinitis can cause symptoms seasonally or all year. 9

In allergic rhinitis, the body responds to the allergen by releasing histamines, which cause the lining of the sinuses, eyes and nostrils to become inflamed. Nasal congestion, sneezing, postnasal drip and an itchy throat are all common symptoms of allergic rhinitis. 10 See this resource on hay fever for more information.

Good to know: In postnasal drip, the mucus glands of the nose and throat produce excessive amounts of thick mucus, which can cause the pharynx to feel swollen and irritated. 11Postnasal drip and the itchy, painful throat associated with allergic rhinitis can both cause a recurring or constant sore throat.

Laryngopharyngeal reflux (LPR) is a disorder associated with gastroesophageal reflux disease (GERD), in which reflux of digestive acids from the stomach reaches the back of the throat and the nasal airway. In adults, the symptoms include: 12

• Burning sensations or pain in the throat.
• Hoarseness.
• Postnasal drip.
• Difficulty swallowing.
• A sensation of something stuck in the throat.

The Ada app can help you check your symptoms. Download the free app or find out more about how it works.

LPR can be caused by dietary problems, abnormalities of the sphincters of the esophagus and being overweight. In many cases, certain foods may be associated with LPR. These include: 13

• Alcohol
• Caffeine
• Fatty foods
• Spicy foods

Stress and smoking can also cause LPR. It is possible to have LPR without having GERD, or to have GERD without having LPR.

Eosinophilic esophagitis is a disorder of the esophagus, in which allergic reactions cause the esophagus to become irritated and sometimes to narrow. 14. This irritation may result from food allergies or environmental allergies.It is not possible to diagnose eosinophilic esophagitis using standard allergy tests, and it is difficult to pinpoint which foods are causing the problem, as allergic reactions are often delayed in this disorder. 15

Symptoms of eosinophilic esophagitis include: 14 15

• Throat pain
• Heartburn
• Difficulty swallowing, especially dry or dense foods.
• Painful swallowing
• Recurring abdominal pain
• Nausea and vomiting
• Food becoming lodged in the narrowed esophagus.

Children with this disorder may refuse to eat, fail to thrive or vomit after meals, in addition to the above symptoms.

Food becoming lodged in the esophagus (food impaction) is a medical emergency in children and adults, and if it occurs, medical help should be sought immediately.

Throat cancer is a fairly rare cause of chronic sore throat, but is nevertheless quite serious should it occur. Throat cancer generally begins in the larynx (voice-box) or the pharynx, 16 and throat pain is only one of a number of symptoms. Other symptoms include: ref14 17

• Difficulty swallowing
• Sore throat
• Shortness of breath
• Chronic cough
• Changes in the voice/hoarseness
• Feeling of something stuck in the throat
• Lumps in the neck or throat
• Swelling of the neck
• Bleeding in the mouth or nose
• Unplanned, unexplained weight loss

The most important risk factors for throat cancer are smoking and alcohol consumption. 16 17

Chronic pharyngitis often indicates the presence of an underlying problem, and treatment to relieve it includes treating the underlying cause.

To relieve the sore throat itself, people with chronic pharyngitis can gargle with warm saline solutions, stay well-hydrated, avoid smoking and manage pain with over-the-counter medication such as acetaminophen/paracetamol. However, the underlying cause must be addressed.

In cases of chronic pharyngitis caused by smoke or environmental pollutants, the person must be removed from the environment where the smoke is present.

Tonsillitis is generally treated with an intensive course of antibiotics. If the disorder recurs often, or is particularly severe, tonsillectomy may be considered. A tonsillectomy is a relatively minor surgical procedure and is not associated with much postoperative pain. 7 For more information, see this resource on tonsillitis.

Allergic rhinitis is often treated with nasal sprays, saline sprays and over-the-counter allergy medications. 18 In more severe cases, an ear, nose and throat (ENT) specialist should be consulted. For more information, see this resource on allergic rhinitis.

Laryngo-pharyngeal reflux can be treated with lifestyle changes to remove triggers, such as stress and excess weight, dietary changes and medication. Proton-pump inhibitors, such as esomeprazole or omeprazole are often the first-line medications used to treat LRP in cases where lifestyle changes do not seem to be sufficient. 19

People whose LPR is the result of physical abnormalities in the esophagus may need surgery to alleviate the disorder.

Eosinophilic esophagitis is usually diagnosed by a gastroenterologist or an ENT specialist and is treated with elimination or elemental diets to isolate and then remove the food triggers. Alongside the diet plan, symptoms may be treated with corticosteroids, 14 and proton-pump inhibitors. 15

Throat cancer treatment depends on the type of cancer, its location, and how advanced it is. 16

If a diagnosis of throat cancer is confirmed, treatment options include surgery, radiotherapy and chemotherapy. Surgery results in cure for up to eight in ten cases of early-stage throat cancer 20, while radiotherapy is also often successful. In some cases, surgery and radiotherapy may be used in combination. ref19