Dr. Bob: My kindergartner has recurrent sore throats. I go to the doctor frequently for these and only one time was it a strep throat. When should I consider having his tonsils removed? His older sister also has frequent sore throats, but she seemed to grow out of it.
Answer: Sore throat is the common term for the medical term, pharyngitis or an -itis (inflammation) of the pharynx. Sore throat can be a direct symptom of a possible pharyngitis or can be what we call referred pain from something else in the ear, nose and throat region, so it is appropriate to seek medical attention. A good look into the nose, ears and throat is necessary. Experience can be quite useful here since infections that go untreated can have serious consequences.
Believe it or not, there are a fair number of things in the back of the throat that can cause “pharyngitis” or sore throat. The back of the throat is lined with a slick layer (mucosa) that tries to repel infections. There are also islands of lymph tissue (immune-providing cells) and larger clumps of lymph tissue – tonsils and adenoids. The back of the palate offers an entry (or exit) from the nasal passages. The upper reaches of the voice box (at the base of the tongue) has a flap of strong tissue, the epiglottis. All of these tissues can get inflamed leading to a sore throat. I have also seen children inadvertently swallow a foreign body (like a fish bone) that leads to throat pain.
Let’s review some of the more specific things to be checked.
- Strep throat. Caused by Group A Strep bacteria, strep throat can cause significant discomfort along with fever and rash. This is diagnosed with a throat culture and, when positive, treated with antibiotics. Untreated strep infections uncommonly can lead to more serious heart or kidney problems so medical attention is appropriate early in the course of the illness. The throat culture is key, so unnecessary antibiotics are not used. School-age children tend to be more susceptible.
- Upper respiratory infections with excess mucus production. In my experience, this is a very common scenario. This excess mucus irritates the back of the throat causing pain. As the congestion subsides, the painful episodes also decrease. Warm showers with steam production tend to help this. Since URIs are so common in children (especially young children in daycare or school settings), this might explain why your daughter had frequent sore throats that got better over time.
- Viral pharyngitis. Many viruses can cause the immune tissue in the back of the throat to be inflamed. That is why we do throat cultures to avoid treating a viral infection that is not a strep infection. The Epstein-Barr virus in particular can cause pharyngitis and most people know that problem as infectious mononucleosis or “mono.” Viral pharyngitis is treated with symptomatic therapy like gargling, throat lozenges, cool liquids and ibuprofen.
You asked about possible tonsillectomy for strep infections. There are various reasons to remove the tonsils if strep is a cause. If there are recurrent documented (by culture) episodes of pharyngitis due to strep, your doctors will consider recommending ENT referral and/or tonsil removal. When I was very young, my tonsils were removed. No one would do that now without proper documentation of strep plus strep tends to be far less common under three years of age.
So, the good news is that most sore throats are not caused by strep and will subside. If strep is present, medicine will help. Seek the help of your pediatrician.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.