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Sore Throat (not due to Tonsillitis)

 

Background

Usually viral in aetiology, but if prolonged consider infective mononucleosis. Non-infective causes include excessive mouth breathing due to nasal obstruction, laryngopharyngeal reflux and steroid inhaler usage.

 

Indication & route of referral

Severely systemically unwell or severe complications (i.e. systemic infection, complete dysphagia or significant dehydration):

  • Discuss with on-call ENT for same day admission

 

Systemically well patient with unexplained persistent (>4 weeks) sore or painful throat (especially with otalgia): 

 

Systemically well patient with intermittent sore/painful throat or throat discomfort:

 


Primary care assessment prior to referral

A careful history and examination of the neck, oropharynx, nose and ear are required to rule out alternative or underlying pathology.

No investigations are required or recommended prior to referral.

 

 

Management options prior to referral

  1. Provide patients with the Throat Symptoms Patient Information Leaflet

  2. If suspicion of an infective cause click here for NICE guidance

  3. Consider treatment for possible underlying laryngopharyngeal reflux. Typically, we would prescribe:

    - Omeprazole 20mg twice a day for 2 months AND

    - Gaviscon Advance 10mls four times a day to be taken after meals and before bedtime for 3 months

                If symptoms worsen when coming off medication they may need to be taken for longer.

  4. For other causes, treat the underlying cause

 

 

Red flags

Refer via 2WW if: 

  • Previously un-investigated, unexplained PALPABLE lump in the neck (including thyroid, parotid and submandibular glands)
     
  • Unexplained persistent (>4 weeks) sore or painful throat (especially with otalgia)                                                                                           
    (NOT for globus or throat discomfort)
     
  • Persistent (>3weeks) unexplained hoarseness and age ≥ 45yrs

 

 

References

NHS Kernow Commissioning Policies 2021-22- click here

NICE Guideline 84: Sore Throat (acute): antimicrobial prescribing. Jan 2018 - click here

 

 

Review Date                December 2021

Next Review Date        December 2022

GP Sifter                      Dr Laura Vines

Contributor                   Mr Venkat Reddy

Version                        2.0