Sore throat and cough that won't go away

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Genie

Sore throat and cough that won't go away

Post by Genie » Thu Mar 30, 2017 12:22 pm

I had a cold last month and seemed to be getting better, but the cough never went away. Last week, I had a bad sore throat (which everyone around me seemed to have also - thanks friends!) but they got better and I still have a sore throat. Sometimes it seems worst in the morning and other times it seems worst at night. Usually it is better at times during the day but it never goes away. At times it feels like my throat is really thick, especially in the back. In the past, I've always gotten over a sore throat in a few days. It has never last this long before. Any suggestions on what this could be?


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DrDave
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Re: Sore throat and cough that won't go away

Post by DrDave » Thu Mar 30, 2017 11:30 pm

First of all, that I do not intend to provide specific medical advice or recommendations. I am not your physician and even common sounding things on the internet may be uncommon things if there is more to the story that you didn't mention. If you have an emergency go to the emergency room. If you are having ongoing medical issues, you should consult with your primary care doctor.

Having said all of that, you don't mention if you have any fever, chills, sweats, shortness of breath, recent travel, or several other types of things that a primary care doctor would ask you about. Assuming you have no other issues - just a lingering sore throat and a cough, a few things are common and your doctor will consider. Without a fever and WITH a cough, strep throat less likely, but can not completely rule it out. There have been a ton of studies trying to predict strep throat and for the most part, it seems like they aren't too accurate for kids. It would be great if doctors could predict with high accuracy at least some of the people who have strep throat, without having to do a culture. At this point, it seems most recommendations suggest doing a culture and only treating if it is positive.

Bottom line (to me at least) is that if you have had an unusual sore throat for a week without relief, you probably should get a throat culture to make sure it isn't strep. Untreated strep can have serious complications such as rheumatic fever.

The following paragraph is likely more than you wanted to know, but I found it interesting. As for the strep test itself, there is a nice study here which had some interesting statistics. I like statistics, so I'll share some. Their final sample was 787 people with sore throats and the doctor thought a culture was necessary. Of those 787 people, the final culture was positive in 29% - 228 people (34.1% of children tested and 21.9% of adults). A rapid strep test was positive in 194 people with a sensitivity of 82.9% and a specificity of 99.1%. What that means is that if the rapid test is positive, it is accurate about 99% of the time. If the test is negative, it is only accurate 82.9% of the time. These numbers are the basis for why many doctors will treat a positive result and not bother with a confirmation test, but will order a confirmation culture for a negative test.

Once strep has been ruled out, there are several common causes for a sore throat with cough. If you feel crummy overall, it could be a virus. Viruses suck. They don't improve with antibiotics. Unless it is influenza, there isn't even an antiviral that you can take (at this point, that I am aware of at least). Usually a viral sore throat part doesn't last more than a week, but some people are unlucky and some viruses are just nastier than others for particular people. The cough from a virus can sometimes last much longer with the AVERAGE duration being 18 days.

Another common cause for a sore throat and cough lasting more than a week is acid reflux. It seems that multiple people I know who have had recurrent coughs that don't seem to resolve are told to try treatment as if it is acid reflux. The acid can also irritate the throat causing a sore throat. The main symptoms of GERD (gastroesophageal reflux disease) are heartburn, regurgitation, and an acid taste in the mouth. Additional symptoms can include hoarseness, laryngitis, chronic dry cough (especially at night), feeling like there is a lump in your throat, and sore throat. Typically the treatment is taking anti-acid medications, often the powerful proton pump inhibitors. Sometimes, in treating sore throat and cough associated with GERD, the doctor may prescribe higher doses of the proton pump inhibitors. Again, it is best to consult with your primary care doctor to see how they want to approach treatment. There are some other interventions to help reduce GERD, such as avoiding caffeine, avoiding alchohol, avoiding citrus juice, and avoiding tomato juice. Some people also find it helpful to not eat for a few hours before bedtime and elevate the head of the bed 6-8 inches.

The last cause for sore throat and cough I want to mention is postnasal drainage. Everyone has mucus that is produced in the nose, nasal passageways, and sinuses. That mucus typically drains down the throat without any issues. For some people, they chronically have thickened mucus. Other people, the mucus tends to get thicker when they have colds or allergy issues. The symptoms people experience tend to be very similar to GERD with regards to sore throat, cough, and problems swallowing. Things that help the sore throat associated with postnasal drip include gargling salt water, drinking extra water throughout the day, or drinking honey in non-caffeine tea. Some people like lemon in their honey tea and find that helpful.

To deal with the nasal passages and sinuses associated with post-nasal drip, sore throat, and coughing, there are a few things that help. If the doctor thinks there is a bacterial infection contributing to the problems, antibiotics will be prescribed. If the issues seem to be more allergy related, the newer non-sedating antihistamines can help, along with nasal steroid sprays. Other general measures that are helpful for sore throat from post-nasal draining include drinking extra water throughout the day and eliminating caffeine. Many people also find nasal irrigation to be very helpful. The simplest way to do nasal irrigation is with a saline nasal spray. You can spray multiple times per day and this will help keep your nasal passages and sinuses moist. Other people like more aggressive approaches to nasal irrigation, such as Neti-pots, or squeeze bottles. There are even some more elaborate devices like water piks with special attachments or dedicated devices for power washing your sinuses.

Interestingly, GERD may actually cause irritation that leads to post-nasal drip. So, you are back to treating the GERD.

Finally, many people find it helpful to increase the room humidity. Adding a room humidifier to keep the humidity high can potentially help the sore throat related to post-nasal drainage.

If your symptoms are not getting better, I would suggest you talk to your doctor. The above issues are definitely not exhaustive, but they are common enough issues that some people may find the information helpful.

Disclaimer: This post contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

Genie

Re: Sore throat and cough that won't go away

Post by Genie » Mon Apr 03, 2017 9:19 pm

Thank you so much for the detailed response. I did see my doctor over the weekend. She didn't think it was strep, but did a throat culture anyway. The rapid strep test was negative, but she also sent a full culture just to be sure. She said it was suspicious for gastric reflux but also said my nasal passageways are irritated, so it could be post nasal drip combined with a healing viral infection. She made a few suggestions which seems to cover pretty much every base. First, omeprazole for the gastric reflux - suggested I take it for 2 months. For the post nasal draining, she suggested guaifenesin (the active ingredient in plain Robitussin) to thin the secretions and help it drain and also to use a saline nasal spray, like Ocean Spray, as often as I want to keep my nasal passages moist. I asked about Neti pots, and she said those can sometimes be pretty harsh for people, but other people find it helpful. She said I should keep my room humidity at around 40-50% as winter dryness makes sore throats worse.

I've done everything she suggested and I am starting to feel better. I think using the saline nasal spray every few hours helped the most, but I can't say for certain that the omeprazole and guaifenesin aren't helping too. Also, I think it was a virus of some form on top of things that has finally run its course. Obviously it is hard to say for sure.

Thanks again for the quick reply. I did post another question asking about nasal irrigation to see if you have any knowledge or suggestions in that area.


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