What Causes Chronic Pharyngitis (Sore Throat)?
skynesher / Getty Images
Medically reviewed by Benjamin F. Asher, MD
Chronic pharyngitis—also known as a chronic sore throat—lasts longer than a common sore throat. Though most sore throats last five to 10 days, the chronic form can last up to 12 weeks or longer. It can also occur as a sore throat that comes and goes.
A chronic sore throat can appear as a common symptom of a viral or bacterial infection. It can also be related to other causes like allergies, pollution, or tumors.
Treatment of a chronic sore throat depends on the cause of the problem. You may be advised to use certain drugs, remove triggers, or have surgery to treat the problem.
This article describes chronic pharyngitis causes and treatments. It also includes the risks of leaving certain types of chronic sore throats untreated.
skynesher / Getty Images
Causes: Why Does Chronic Pharyngitis Linger?
The following conditions are the most common causes of chronic pharyngitis that lingers:
1. Viral Infections
Viral infections are diseases that occur when a virus enters the body of a living host and invades normal cells. The virus uses these cells to multiply and produce other viruses like themselves. Examples of viral infections that can cause chronic pharyngitis include the following:
2. Bacterial Infections
Bacterial infections result from harmful types of bacteria, which are single, complex cells that invade your body. Bacteria can survive inside or outside your body and without the need for a host. Bacterial infections occur when there are too many harmful bacteria for your immune system to fight.
Examples of bacterial infections that can cause chronic pharyngitis include the following:
Epiglottitis (swelling and inflammation of the epiglottis, the structure at the back of your tongue that prevents food from entering your trachea—also known as the windpipe—when you eat)
3. Allergies
Allergies occur when your body encounters a substance that it identifies as threatening your well-being. Even if the substance is harmless, your immune system produces antibodies to fight them. The antibodies release chemicals that result in allergic reactions.
The following allergies can cause symptoms that include chronic pharyngitis:
Animal dander
House dust
4. Irritation
Certain internal and external factors can cause irritations that lead to chronic pharyngitis. These factors can cause chronic pharyngitis until you are no longer encountering the substance or condition that caused them.
Factors that can trigger chronic pharyngitis include the following environmental factors;
Auto exhaust
Dry heat
Pollutants
Cigarette smoke
Chronic pharyngitis can also occur when your throat is irritated due to the following physical conditions:
Chronic stuffy nose
Laryngitis (overuse of your voice box)
Thyroidectomy (removal of your thyroid)
Tonsillitis (inflammation of your tonsils)
Pharyngitis (inflammation of the pharynx—also known as the throat)
5. Laryngopharyngeal reflux (LPR)
Laryngopharyngeal reflux (LPR) is a condition in which your upper esophageal sphincter is damaged. When this occurs, it allows the acid that has flowed back into your esophagus to enter your throat and larynx (voice box). The acidic substance irritates your throat, causing chronic pharyngitis.
6. Tumors
Chronic pharyngitis can occur as a symptom of benign (non-cancerous) or malignant (cancerous) tumors. Tumors that can cause a sore throat typically include throat, tongue, and larynx tumors.
Viral vs. Bacterial Infections
Chronic pharyngitis can occur as a symptom of a viral or bacterial infection. Both conditions can cause severe throat pain and other symptoms ranging from mild to life-threatening.
However, these diseases differ in the types of germs that cause them. Viruses cause viral infections, while bacteria cause bacterial infections. The difference is vital to getting the right treatment.
Antibiotics only treat bacterial infections like strep throat and whooping cough. These drugs do not work on viruses. Using antibiotics to treat a viral infection is useless and can leave you vulnerable to the side effects of these drugs without the benefits.
Accompanying Chronic Sore Throat Symptoms
Accompanying sore throat symptoms can vary based on the cause of the problem. The condition commonly causes a scratchy, prickly throat with a raw or piercing sensation. It can affect your quality of life as it persists. The degree of pain can vary by person and type of illness.
Other symptoms of a chronic sore throat can include the following:
Throat pain that worsens with chewing, swallowing, or talking,
Pain that radiates to your ears and temporomandibular joint (TMJ)
Fever (over 101 degrees Fahrenheit)
Dysphagia (difficulty swallowing)
Difficulty breathing
Difficulty opening your mouth
Swelling of your face or neck
Red and swollen tonsils
Swollen lymph nodes in the front of your neck
Tiny red spots on the roof of your mouth
Earache
Throat redness
Joint pain
Blood in saliva or phlegm
Lump in neck
Hoarseness
White patches on your tonsils
Is Treatment for Chronic Pharyngitis Optional?
Treatment for chronic pharyngitis is optional based on the cause of the problem. Chronic pharyngitis caused by a viral infection is typically self-limiting and improves within one week. Though antibiotics will not help cure chronic pharyngitis related to a viral infection, other treatments can help reduce symptoms.
When chronic pharyngitis is the result of a bacterial infection, it will not resolve on its own. Strep throat, a sore throat caused by group A Streptococcus bacteria, can often resolve in three to five days without treatment. However, antibiotics are often advisable to treat bacterial infections with the following goals:
Reducing the severity and duration of symptoms
Preventing acute and delayed complications
Preventing the spread of infection to others
How to Treat Chronic Sore Throat Without Fever
Treatment for a chronic sore throat without fever usually involves therapies to reduce pain and other bothersome symptoms. These therapies can include:
Taking over-the-counter pain medications, such as one of the following:
Tylenol (acetaminophen)
Aspirin
Increasing your fluid intake by consuming more water
Using a personal steamer or humidifier while you sleep
Gargling with a warm saltwater mixture (1/4 teaspoon salt to 1/2 cup water) several times daily
Using lozenges, hard candies, or anything that stimulates saliva production to offset throat dryness
Drinking warm tea with honey
Using cold liquids, ice chips, or popsicles for pain relief
Using over-the-counter throat sprays like Cepacol (benzocaine/glycerin) and Vicks Formula 44 (glycerin/phenol) can also help relieve your pain
If you have a sore throat for two weeks or longer without a fever, your sore throat may result from a factor other than a viral infection. Consult your healthcare provider for an accurate diagnosis. Therapies will vary to treat the cause of your pain and may include the following:
Avoiding identified external irritants or allergens
Taking one of the following antihistamines to control allergy symptoms: Zyrtec (cetirizine), Claritin (loratadine), or Allegra (fexofenadine)
Taking one of the following acid reflux medications to control sore throats caused by reflux conditions: Pepcid (famotidine), Prilosec (omeprazole), Prevacid (lansoprazole), or Nexium (esomeprazole)
Tonsillectomy (surgery to remove infected tonsils)
Surgery to remove a tumor irritating your throat
Learn More: The 7 Best Teas to Soothe a Sore Throat, According to a Dietitian
How to Treat Chronic Sore Throat With Fever
A chronic sore throat with fever requires medical attention for a proper diagnosis. Fever is often a symptom of many bacterial infections. Though a fever can occur in viral and bacterial infections, a high fever may indicate a serious bacterial infection.
If you have a chronic sore throat with a fever, your healthcare provider will likely use a rapid test or throat culture to diagnose whether your problem is caused by strep throat, a bacterial infection.
Treatment of strep throat includes the same types of symptom relief for treating chronic sore throat without fever. In addition, you will likely be prescribed one of the following antibiotics that treat strep throat:
Amoxil (amoxicillin)
Penicillins (class of drugs)
Clindamycin
Cephalosporins (class of drugs)
Biaxin XL (clarithromycin)
Azithromycin (also called a Z-Pak)
If your chronic pharyngitis is the result of another bacterial infection, another class of antibiotics may be prescribed.
Learn More: Choosing the Right Antibiotic for Bacterial Infections
Misdiagnosed Chronic Pharyngitis
Misdiagnosed chronic pharyngitis can delay treatment and allow symptoms to remain and possibly worsen, affecting your quality of life. Chronic bacterial pharyngitis misdiagnosed as chronic viral pharyngitis can allow the bacteria to reproduce and potentially spread to other parts of your body.
Because chronic pharyngitis can be a symptom of other conditions, it can be misdiagnosed as the following:
Chronic tonsillitis (infection of the tonsils)
Chronic laryngitis (inflammation of the larynx)
Pharyngeal tumors (tumors in the pharynx, or the neck and throat)
Laryngeal tumors (tumors of the larynx)
Cervical spondylosis (wear-and-tear arthritis of the spinal joint in your neck)
Summary
Chronic pharyngitis is a sore throat that lasts longer than most common coughs. It can also come and go in many attacks.
The problem can occur alone or as a symptom of another ailment. It is common for a chronic sore throat to be the result of a virus or bacteria. The problem can also occur from a range of other ailments, ranging from external factors to cancer.
Treatment can include drugs, changing your environment, or surgery. It may also involve treating symptoms while you allow the problem to resolve itself.
It's important to learn the source of chronic pharyngitis that endures without progress. Some causes, such as bacterial infections and cancer, can worsen with delays in treatment.
