Key points

Throat infections are among the most common reasons to see a primary care physician, along with other complaints of the ear, nose, and throat such as respiratory infections and otitis media. These result in substantial cost for outpatient visits and for the treatments prescribed, such as antibiotics. Indirect costs associated with throat infections (eg, missing school or work for the patient or caregiver) can be high as well. Although sore throats are a common reason for patients to seek medical care, it is estimated that 4 to 6 times as many people suffering sore throat do not seek medical care. Sore throat often improves spontaneously, but the associated discomfort may be a reason for some to seek complementary and integrative medicine (CIM) approaches for treatment. Musculoskeletal complaints are the most common reason for patients to seek CIM therapies; however, head and chest colds, of which sore throat may be a primary symptom, were a common reason in a study by Barnes and colleagues, although the incidence of seeking these therapies decreased between 2002 and 2007. This article discusses conventional treatment of adenotonsillar disease and focuses on research looking at CIM options for treatment of this disease process and primary symptom.

Physiology and anatomy

Throat infection is defined as sore throat caused by viral or bacterial infection of the pharynx, palatine tonsils, or both, which may or may not be culture positive for group A Streptococcus . Watchful waiting for recurrent throat infections if there have been fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years, or fewer than 3 episodes per year in the past 3 years is the current recommendation to clinicians.

Good documentation during each episode of the symptoms, physical findings, culture results, days of school absence, and quality of life issues are helpful to the otolaryngologist when making treatment recommendations. In addition, a 12-month period of observation is recommended before consideration for tonsillectomy as an intervention, given a tendency for these infections to improve over time. In the meantime, treatment of patients with sore throat and tonsillitis is essentially geared toward pain management and often antibiotic therapy.

Physiology and anatomy

Throat infection is defined as sore throat caused by viral or bacterial infection of the pharynx, palatine tonsils, or both, which may or may not be culture positive for group A Streptococcus . Watchful waiting for recurrent throat infections if there have been fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years, or fewer than 3 episodes per year in the past 3 years is the current recommendation to clinicians.

Good documentation during each episode of the symptoms, physical findings, culture results, days of school absence, and quality of life issues are helpful to the otolaryngologist when making treatment recommendations. In addition, a 12-month period of observation is recommended before consideration for tonsillectomy as an intervention, given a tendency for these infections to improve over time. In the meantime, treatment of patients with sore throat and tonsillitis is essentially geared toward pain management and often antibiotic therapy.

Medical treatment approaches and outcomes in sore throat

The role of antibiotic therapy in treating a sore throat is not clear, as patients generally recover within 3 to 4 days (although some develop complications). In a Cochrane review of the use of antibiotics for sore throat, antibiotics were found to shorten the illness by an average of about 1 day and to reduce the chance of rheumatic fever in communities where this complication is common. Analysis showed that sore throat and fever were reduced with the use of antibiotics by about half, and the greatest difference was seen by 3 days of illness. In a comparison of Streptococcus -positive and -negative throat swabs, antibiotics were more effective against symptoms at day 3 for patients with Streptococcus -positive swabs. The authors concluded that antibiotics confer benefits in the treatment of sore throat, but the absolute benefit was modest. Many will require treatment with antibiotics to protect against nonsuppurative and suppurative complications of sore throat for one to see a benefit. It is up to the clinician to educate patients about the option to avoid antibiotic usage when treating sore throats.

Surgical treatment approaches and outcomes for sore throat and tonsillitis

The mainstay of surgical treatment of tonsillitis is tonsillectomy if the frequency criteria described by Paradise are met (7 tonsillitis infections in 1 year, 5 infections each year for 2 years, or 3 infections each year for 3 years), and there is documentation in the medical record for each sore throat of

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  Temperature >38.3 ^° C

  
  
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  Cervical adenopathy

  
  
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  Tonsillar exudate

  
  
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  Positive test for group A beta-hemolytic streptococci

Supportive clinical documentation may include

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  Absence from school or work

  
  
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  Spread of infection within the family

  
  
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  Family history of rheumatic heart disease or glomerulonephritis

Other variables may favor surgical intervention, including

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  Antibiotic allergy or intolerance

  
  
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  Periodic fever, aphthous stomatitis, pharyngitis, and adenitis

  
  
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  History of a peritonsillar abscess

Studies have shown that patients suffered fewer infections following surgery, resulting in fewer antibiotics and physician visits, and an overall improved quality of life. Nonetheless, the risks of tonsillectomy, including postoperative hemorrhage, dehydration, postoperative pulmonary edema, and velopharyngeal insufficiency, need to be considered when making recommendations.