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Dr. Andrew Rynne

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Smoker. Suffering from sore throat and lack of sleep. What treatment should be done?

Answered by
Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

Answered : 2395 Questions

Posted on Thu, 13 Dec 2012 in Ear, Nose and Throat Problems
Question: Hi there,

I am a 36 year old female, suffer from lack of sleep (I'm a mother!) but in general good health otherwise. Don't drink much alcohol or coffee, but I do smoke approx 10 cigs a day.

I had strep throat back in early September, treated with 7-day course of Amoxicillin. It came back a week later and was put on another 7-day course of the same. Over the period of the next 6 weeks, I had 3 sore throats with painful swollen glands. On Sunday last week I woke up with the same swollen glands, a hard, sore pea-type lump right by my jaw bone, sore throat and general malaise. Saw my doctor who said I had 'some sort of virus' and sent me away. He did a swab and still no results. No treatment.

By Wednesday the pain and sore throat was significantly worse had a constant fever of around 101, no appetite whatsoever, complete lethargy, earache and pain spreading to the other side, plus I had missed 2 days of work already. When the doctor looked he said he saw no pus. My tonsils are significantly swollen, but if I 'close my throat', I can clearly see a large area (approx. 2cm x1.5cm) of white pus in behind the left tonsil, slightly smaller on the right side. I am treating the symptoms, but after 5, nearly 6 days, it's not getting any better. My husband tells I sound like I'm talking with a golf ball in my mouth (sure he'd love that)!

In the last day I have also developed a sore inflammation in my gum - I'm not sure if this is related to my general infection or if it would be resolved by treating the throat issue. I am concerned that I am getting this issue repeatedly and it's getting worse, and am also worried about passing this on to my 18 month old child. Please let me know what you think this is, and if I should insist on another course of treatment because I feel like my doctor is 'flogging a dead horse', so to speak. Thanks for your help!
Answered by Dr. Naveen Kumar 52 minutes later

Thanks for the query and a detailed history.

I feel the root cause of all your problems is smoking. Smoking causes damage to mucosa of the throat making it susceptible for infections. Also, constant damage to the mucosa of the throat causes enlargement of the lymphoid follicles in the throat and neck causing difficulty while swallowing and turning the neck.

The whitish pus like thing you have noticed is the coating over the tonsil following infection and dehydration. It is accumulation of the dead cell debris and the food material in the crypts of the tonsils.

Secondly, any acid reflux from the stomach into the esophagus and throat can present with similar complaints which will not respond with antibiotics. Acid when it regurgitates from the stomach into the throat, causes burning of the mucosa of the throat leading to inflammation of the throat. Inflammation of the mucosa in turn induces swelling in the mucosa of the throat giving rise to foreign body sensation.

The causes of reflux of acid are many, medicines, obesity, stress, food habits, smoking, alcohol, etc. Identifying the causative factors and avoiding them can give you relief from this problem.

My advice to you is:
1. Reduce or better to abstain from smoking.
2. Drink plenty of warm water, this keeps the mucosa hydrated as well as improves the blood circulation in the throat thus reducing the discomfort and the chances of infection.
3. Avoid chilled food/beverages, coffee and alcohol.
4. Use povidone iodine throat spray 3-4 times a day after food.
5. Suitable antibiotic such as a combination of amoxycillin and clavulanic acid or cefuroxime for 10-12 days.
6. A proton pump inhibitor such as omeprazole or pantoperazole for controlling silent acid reflux.

With all of the above measures you will definitely be alright. Meanwhile, get a complete blood examination done to rule out other causes such as infectious mononucleosis, lymphomas, etc.

Hope I have answered your query; I will be available for the follow-up queries.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Naveen Kumar 43 minutes later
Thanks for your response, but I do not currently (nor have previously) suffer from acid reflux, so I don't think this is an issue.

I will try to quit smoking and follow the other advice you provided.

In the meantime, should I be worried about passing this on to my young child or the rest of the family?

Answered by Dr. Naveen Kumar 50 minutes later

Thanks for writing back

There are possibilities that the present situation could be infective, hence maintain complete hygienic conditions. Rest, follow as per my advice, you will definitely recover soon.

Wish you good health.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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