Acute Sore Throat
Triage Questions
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
- Odynophagia with severe dysphagia or absolute aphagia suggests a very severe tonsillopharyngitis, peritonsillar abscess, or epiglottitis
- Odynophagia with moderate dysphagia suggests tonsillopharyngitis or glandular fever/viral sore throat
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?
- Limitation of mouth opening implies a collection of pus causing muscle spasm, usually present in peritonsillar abscess, dental abscess, and deep neck space abscess
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 to severe unremitting (usually unilateral) sore throat for three weeks or more is a red flag symptom for urgent outpatient referral on the suspected cancer pathway.
