Treatment and Support of a Sore Throat

A Sore Throat

You (or a healthcare provider) have determined that you do not have strep throat. Convinced that it is perhaps one of those sore throats that comes on before or with a cold (remember that cold symptoms like a cough or runny nose do not usually accompany strep!). Here are some approaches and ideas for symptomatic treatment

This is the kind of sore throat that may go away or get worse. You don't know where it is going, so you try to steer it off at the pass. There are numerous things you can do to calm it down. Here are some of the most common and most effective remedies: 

If you have known exposure to strep (for example, one of your kids), it is best to wait until you develop real symptoms: It takes at least a couple of days for it to show up, you may get tested too early, and you may initially test negative.

If you highly suspect that you have strep ("I have these symptoms of strep"), you may want to get tested by a healthcare provider. If you test positive for strep, your provider will treat you with antibiotics (there is no other known treatment for strep besides either time or antibiotics). Antibiotics may shorten the course of your illness by a couple of days and make you noncontagious after 24 hours. If you have strep, keep your distance from others. If you want to wait it out, strep is usually self-limiting but occasionally can leave other serious diseases behind, like rheumatic fever, kidney problems, and scarlet fever.   

If symptoms are VERY BAD (difficulty swallowing, drooling, "kissing" (touching) tonsils, a rash, and joint pain over time, along with a sore throat and do not respond to your treatment, it is time to see a healthcare provider. 

As with many other illnesses, use precaution and prevention always (especially during cold and flu season, if you are around sick people, kids, in the office, traveling). Any parent or teacher knows that kids love to catch things and share.

Below is a list of various treatments and support for sore throat symptoms. This is not inclusive of EVERY therapy or remedy for a sore throat; it mentions only some of the more common ones.

To help prevent a sore throat...

1. Wash your hands! 

2. Keep your distance from sick people. 

3. Do NOT share anything that comes in contact with someone's mouth.

4. Get plenty of rest (people try to keep driving and driving.) Getting enough sleep is very important in preventing and overcoming it. Many illnesses. It is thought to play an integral role in immunity and susceptibility to the common cold and other more acute and chronic diseases.

5. Stay well hydrated - Water's the best! It may not taste awesome (you can                  acquire a taste), but it helps flush bacteria and viruses out of your system and keeps your throat hydrated (less soreness). According to the Mayo Clinic, the ideal daily water intake is 11.5 cups for women and 15.5 for men (1 c = 8 ounces), but everyone has different factors that play into their needs. For example, how much a person exercises, one's environment, overall state of health, and age can affect a person's state of hydration. A good rule of thumb is to gauge the amount of water you should drink on the color of your urine: drink enough to turn your urine a light yellow. 

6. Avoid stress (I see a lot of sick accountants around tax time and students after

    finals.)

7. Avoid touching your face, nose, or eyes with unclean hands.

8. You may want to breathe more through the nose than the mouth around

    pollution and sick people because the nose is a better filter than the mouth.

Sore Throat - Conventional Over-the-Counter Medicine to Help Support Sore Throat Symptoms

Oral Medications

• Ibuprofen (common: Advil, Motrin) as directed over the counter (excellent anti-inflammatory

  or 

• Naproxen (common: Aleve) as directed over the counter (a good anti-inflammatory-lasts longer than Ibuprofen, so you do not have to take it as often)

  or

• Acetaminophen (Tylenol) is okay to use as a pain killer, but it is NOT an anti-inflammatory. So, it may not help with pain that is associated with inflammation. (Dose: over the counter as directed)

Ibuprofen, Naproxen, and acetylsalicylic acid (Aspirin) are good anti-inflammatories but come with risks - especially if you have ulcers, kidney disease, or if you use them too much over time.

If the sore throat is due to a postnasal drip, it may help to take an antihistamine (e.g., Claritin, Zyrtec, or Allegra), a decongestant (Sudafed), or a nasal steroid (Flonase, Nasonex). If you take an antihistamine or decongestant, stay hydrated so your sinuses do not dry you out too much!

GENERICS ARE EQUALLY GOOD AND ARE ALMOST ALWAYS CHEAPER. IF UNSURE WHAT TO PICK OUT, ASK THE PHARMACIST - THEY CAN SHOW YOU THE GENERIC

Sambucol and UNCKA (Pelargonium sidoides) extracts are new patented additions to the sore throat world. The NIH cites them as effective for sore throats, colds, and bronchitis.

LOZENGES

Cepacol, Chloraseptic, and Sucrets lozenges help numb the sore throat because they contain benzocaine, a numbing medicine. These are sold over the counter at most stores.

Horehound Lozenges (Claeys Horehound "Candy")

Grethers Pastilles - Pastilles are softer than lozenges. Grethers work differently than many over-the-counter lozenges because they contain glycerol, a demulcent. This produces a protective coating in the throat and pharynx, soothing it and decreasing inflammation. It also keeps the throat from drying out. Black current components are reputed to have antioxidant, immune-building, and antimicrobial properties against viruses. These get some good reviews. (This is not an advertisement).

If you choose to use these, you typically need to order them online. I suggest you preorder and have a stash on hand.

Vocalzone Pastilles - Vocalzone contains myrrh tincture, licorice extract, menthol, peppermint, and other basic components (sweeteners, starches, oils, and waxes). While menthols and peppermints may have good anti-inflammatory properties, others claim they tend to DRY OUT the throat and cause more irritation. They are advertised for those who strain their use their voices a lot (singers and speakers) and have been around for a long time. It may be worth a try. Vocalzone is not easily found over the counter. You may want to preorder online and keep on hand.

Fisherman's Friend Lozenges - These over-the-counter lozenges contain eucalyptus and menthol to help soothe the throat. You can find them on the shelves in various pharmacies.

Halls—Over-the-counter (made from beta carotene, eucalyptus oil, flavors, glucose syrup, honey, soy lecithin, sucralose, sucrose, water, and menthol,  an anesthetic typically peppermint or other mint oils. 

Ricola contains Some of the best herbal ingredients (Elderberry, Horehound, Hyssop, Lemon Balm, Linden Flowers, Mallow, Peppermint, Sage, Thyme, Wild Thyme, and menthol - as an anesthetic or painkiller). The good thing about Ricola as an herbal product is that it is easy to get on pharmacy shelves, whereas many other herbal medicines must be ordered online.

THROAT SPRAYS

Over-the-counter numbing sprays (Cepacol) contain benzocaine (numbing properties), which is good but temporary relief and often tastes poorly to people. You will likely get more mileage from a numbing lozenge (see above).

NASAL SPRAYS

Decongestant sprays like Oxymetazoline 12-hour (Afrin) nasal spray—Plain, original type—are only used if you have throat clearing or postnasal drainage that may be causing a sore throat. Sometimes, people complain of nasal burning when they use this.

This is one of my favorites for a sore throat due to a postnasal drip.  - It is a nasal decongestant - and stops most of the postnasal drainage from going down and irritating your throat, helping to relieve the throat pain. Beware: Afrin has a "bad" reputation because people use it for too long (more than three days) and get a rebound effect (cannot breathe WITHOUT IT)- but it is suitable for a couple of days and stops a very irritating postnasal drip helps with any congestion too. It can also increase your blood pressure.

Sore Throat - Natural/Herbal Remedies

There are many potential herbal remedies for sore throats. A few of the more common are listed below.

GARGLES (Many of these require dilution of essential oils)

Alum: Take half a tablespoon of alum (fitkari) and mix it in half a glass of very warm water. Gargle and spit. Some people say this does not taste very good.

Sage: Known for its anti-inflammatory. 1 c boiling water, 2 tsp sage – fresh or dried   ¼ oz salt

or 1–3 grams of dried sage is steeped in a cup of water - gargle and spit three times a day.

Myrrh gargle: This anti-inflammatory and analgesic may help your sore throat. Gargle with 5–10 drops of tincture in a glass of water three times daily.

Baking Soda Gargle—Baking soda is good for almost everything, including gargling. It soothes irritation and inflammation and has antiseptic and antifungal properties. Stir together 1 c water (warm) with ½ tsp baking soda. Combine, gargle, and spit a few times a day.

Thieves Oil - Mainly cinnamon and clove, this can be used as an anti-inflammatory and an analgesic/anesthetic. Add 2-3 drops of Thieves Oil to 1-2 tablespoons of water and gargle (some good patient reviews).

Eucalyptus has anti-inflammatory and antibacterial properties. Add one drop of eucalyptus essential oil to a cup of warm water and gargle. 

Apple Cider Vinegar—Try up to 2 tbsp in as little as half a cup of water. Gargle with this mixture once or twice an hour and spit or swallow the gargle when you are done.  

If you cannot buy a gargle, it is sufficient to gargle with a tea mixture.

TEAS

Many teas can be purchased from tea companies but can also be made from herbs, various plants/roots, extracts, and diluted food-grade oils.  

Add lemon and raw or (ideally) Manuka Honey to teas. Honey helps with inflammation and is an antimicrobial against at least 60 strains of bacteria, and lemon helps clear phlegm. 

Chamomile is a highly soothing herb. It boosts the immune system and has antibacterial, antifungal, and anti-inflammatory properties that fight colds. Germany's Commission E has approved it for inflammation. Chamomile tea is the most common form. It is available in stores, and tinctures and pills are also available online.

Horehound is an anti-inflammatory and has possible pain-reducing effects. It's hard to find tea bags with good reviews. Some complaints of taste.

Mallow Tea has anti-inflammatory and antimicrobial properties to help with a sore throat. It can be made into a soothing tea by steeping roots overnight in water and diluting to taste. This tea can be drunk as desired for symptomatic relief. Very safe.

Sage Tea—Like the gargle above, sage can also be used as a tea. One to three grams of dried sage is steeped in a cup of water three times daily. The equivalent dose of tincture or extract may also be used.

Licorice Tea—Licorice is an anti-inflammatory and an antibacterial (among other properties). RECIPE: Mix and boil 1oz of licorice and 5 cups of water, then strain.  

Ginger Tea—You can buy this in stores or online, or make your own: (2-inch ginger root, peel, slice in thin pieces, crush, add to boiling water, boil for 5 minutes, add honey to taste). Ginger has some anti-inflammatory properties.

Thieves Oil Tea—Thieves oil is primarily made up of cinnamon (anti-inflammatory) and cloves (analgesic and anesthetic). Add 1 drop of thieves oil and 1 drop of lemon essential oil to warm water, and drink as tea. Many patients seem to like Thieves' oil.

Throat Coat Tea - Several of my patients have raved about the helpfulness of this tea, and preliminary studies have shown it to be more efficacious than placebos.  It is relatively easy to get in stores, and it contains some herbs that are reputed to help throat inflammation: slippery elm, licorice, mallow (all of which are anti-inflammatories), and a small amount of peppermint—good tea for sore throat but some question about the taste. Throat coat tea is sold in stores and online.

Slippery Elm Tea is good for relieving sore throats (it coats the throat and decreases irritation that way). Tea is often made from bark or powder.

Cayenne Tea—This tea is made from Cayenne pepper. It has capsaicin, which is good for inflammation (it may initially burn when ingested). You Can buy it online or mix it yourself: Mix ½ tsp cayenne with 1/2 glass of hot water.  

"KITCHEN CURE-ALLS"

Looking for something around the house that might help?

Cloves - Chew on cloves (eugenol – natural painkiller). These are also somewhat antibacterial.

Salt Water - Gargle 1/2 tsp in 1 c of warm water.

Honey - As an anti-inflammatory. Drink two tablespoons in a glass of warm water or tea.

Others: Ginger, sage, baking soda, lemon, and cayenne (see above).

EXTRACTS

​Pelargonium sidoides - This herbal remedy recently went over the counter as UMCKA and Sambucol. It is reputed to help with colds, bronchitis, and sore throats.

THROAT SPRAYS

Sage Spray—Again, this has anti-inflammatory properties (as well as a whole host of other properties). It needs to be ordered online but may be worth having around.  It's tough to get, but it gets good reviews.

ClyorVoice37 (used to be Sprouts Voice Remedy)—Natural Ingredients—Non-alcohol based. This particular product uses slippery elm and horseradish, two things known to soothe and clarify! It's a little spendy, but it's supposed to be great if you use your voice often.

Vocal-Eze Throat Spray—Well-Liked. It is a proprietary blend of mallow root sha root, licorice root, echinacea purpurea root, seed and flower, propolis, ginger root, and Echinacea angustifolia root. Other Ingredients include aloe vera gel, vegetable glycerin (coats and lubricates), wildflower honey, and spring water. It might be something to order and keep on hand.

ESSENTIAL OILS - Use in carrier oil to diffuse

Most of the following claim to have not only likely anti-inflammatory properties but also possible properties that may help a person recover, such as antiviral or antimicrobial properties. If you want to know more, click on the link for the herb.

​Eucalyptus Oil - via diffuser - helps relieve symptoms (anti-inflammatory), stimulates immunity, and has antimicrobial properties. You can also use eucalyptus topically by applying 1-3 drops on your throat and chest (mix with a carrier oil like coconut, olive, avocado, grape seed, sweet almond, and others.

Lemon Oil (add 5-10 drops in a diffuser) - soothes and moistens throat.

Lavender Oil —With its anti-inflammatory and possibly antimicrobial effects, you can diffuse this to relieve a sore throat.

Clove Oil - Diffused as an anti-inflammatory -Helps to relieve a sore throat.

Oregano Oil - You can try to use this in a diffuser to decrease the inflammation of a sore throat. It has many other properties as well (antibacterial, antiviral, antioxidant, and antifungal)

Thieves Oil—Just as you can use this in a gargle (above), you can also use it as tea or as an anti-inflammatory. Add 2-3 drops to 2 tablespoons of water and gargle, or add one drop of thieves and one drop of lemon essential oil in warm water and drink as tea.

Hyssop Oil  - This is a potential anti-inflammatory.  To make tea, use 1 to 2 tsp of the dried herb in one cup of hot water.

Prescriptive Treatment and Support for a Sore Throat

When all else fails, you can go to your healthcare provider. They may prescribe a brief course of pain medication. The more likely treatment would be a special gargle called

• "Magic mouthwash" usually consists of a combination of three of the following: viscous lidocaine, diphenhydramine, prednisolone (a steroid), and Maalox (or a similar combination of medicines that soothe and numb your throat).

• Oral steroids/prednisone (or a shot of the same if swelling is bad) to decrease the inflammation. These are awesome anti-inflammatories, and they work pretty fast if you are in a pinch. Steroids are not without their potential problems—especially for people with underlying medical issues like diabetes, psychosis, high blood pressure, and ulcers—but when the show must go on, it must go on.

• Narcotics - These are rarely prescribed because there are other, better solutions to treatment. When they are prescribed, they are typically short-course, and low dose because of abuse potential. Opioids are painkillers such as oxycodone or hydrocodone, (combo opioids with Tylenol: Lortab, Percocet and Vicodin) and Tramadol (i.e. Ultram).