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Chronic Sore Throat
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A sore throat (pharyngitis) is pain or irritation of the throat that can worsen when swallowing. Infections of the throat by a virus, bacteria, or fungus are typically temporary and are relieved by appropriate supportive or medical therapy. A chronic sore throat usually lasts significantly longer and can have different causes than an acute sore throat.
Signs and Symptoms of a chronic sore throat may include pain, pain when swallowing, scratchiness of the throat, difficulty swallowing, swollen or sore glands in the neck, enlarged tonsils, white debris in the tonsils, hoarseness, cough, and nasal drainage.
Diagnosing the cause of a chronic sore throat may include an evaluation for allergies, gastroesophageal reflux disease (GERD), dryness, inhalational irritants, muscle strain, tumors, and cancer. 

Allergies – Seasonal allergies and ongoing allergic reactions can cause a sore throat from chronic irritation and postnasal drip.

Dryness – Dry indoor air can make your throat feel rough and scratchy. Breathing through your mouth because of chronic nasal congestion can also cause a dry, sore throat.

Irritants – Outdoor and indoor air pollution such as tobacco smoke or chemicals can cause a chronic sore throat. Chewing tobacco, alcohol, and eating spicy foods can also irritate your throat.

Muscle strain – You can strain muscles in your throat by yelling, talking loudly or talking for long periods without rest.

Gastroesophageal reflux disease (GERD) –  GERD is caused by stomach acids which can back up in the food pipe (esophagus) and throat. Other signs or symptoms may include heartburn, hoarseness, regurgitation of stomach contents, and the sensation of a lump or foreign body in your throat.

Fungal infections – chronic use of a steroid inhaler or someone with a compromised immune system can be susceptible to fungal infections of the throat.

Tumors – A tumor is an abnormal growth of tissue that can be found anywhere in the body, including in the throat. A tumor can be benign (not cancer) or malignant (cancer). Benign tumors can be due to a number of reasons and can cause a chronically sore throat. Cancerous tumors of the throat, tongue or voice box can also cause a sore throat. Other signs or symptoms may include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, and blood in saliva or phlegm. Smoking and excessive alcohol use increases the risk of cancer.

A physical examination for a chronically sore throat may include a thorough physical exam, a direct fiberoptic nasopharygolaryngoscopy, and possible radiographic imaging such as a CT scan or MRI.

Direct Nasopharygolaryngoscopy involves examining the nasal cavity, throat, and voice box using a flexible fibroptic instrument. The procedure is performed in the office under topical anesthesia along with a nasal decongenstant. The procedure is quick and well tolerated.

Treatment – Treatment for a chronic sore throat depends on the cause. It is important to be evaluated by a health care professional to help make the correct diagnosis and treatment plan.

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