Acute Sore Throat


Question 1: What can the patient swallow?

  • Odynophagia with absolute aphagia implies admission for fluid and antibiotic therapy, regardless of diagnosis; note that patients who cannot swallow their own saliva will drool or spit
  • Absolute aphagia is rare and should make you suspicious that there is a serious illness
  • Patients able to swallow saliva and small sips of fluid may do alright at home if this is the first visit and they have not had any medication yet; equally, patients struggling despite a few days of analgesia and rest may need admission
  • Patients able to swallow good amounts of fluid and a small amount of soft diet should be managed at home


Question 2: Is there voice change?

  • Hoarse, weak or croaky voice (as if they had been shouting themselves hoarse) is a worrying sign of epiglottitis or a deep neck space abscess 
  • 'Hot potato' or snoring voice (like someone with a low GCS or doing a Mr Bean impression) suggests pharyngeal inflammation from a severe tonsillitis or peritonsillar abscess


Question 3: Is there trismus?


Overuse of antibiotics is a massive problem: please calculate the Centor score before you consider prescribing them! The majority of sore throats are viral and self-limiting.

Remember, hoarseness with severe sore throat and dysphagia should set your Spidey sense tingling.

Moderate sore throat for six weeks or more is a red flag symptom for urgent outpatient referral on the suspected cancer pathway. 

For a visual representation, please download our Sore Throat flowchart.




Page last reviewed: 23 September 2016