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:
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Routine ENT OPD, OR
-
Urgent Throat Symptoms Assessment Clinic
- Available as an alternative referral pathway on the ENT 2WW form
- ENT will aim to see these patients within 4 weeks
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
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Provide patients with the Throat Symptoms Patient Information Leaflet
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If suspicion of an infective cause click here for NICE guidance
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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.
- For other causes, treat the underlying cause
Red flags
Refer via 2WW if:
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Previously un-investigated, unexplained PALPABLE lump in the neck (including thyroid, parotid and submandibular glands)
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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