Persisting or recurrent sore throat can indicate a number of conditions, most of which are very curable. Acute pharyngitis is a sore throat that appears and can last up to a month before fully resolved. It is usually the result of infection – viral, bacterial, or rarely fungal (candida yeast). Acute pharyngitis might be tested to make sure it is not Streptococcal, which needs antibiotic treatment to prevent possible rheumatic fever. Viral pharyngitis is usually allowed to run its course, treating only with comfort medications. The rare sore throat or mouth caused by a yeast infection needs further testing to make sure it is not a sign of something more serious.
Chronic pharyngitis is often more difficult to treat. When a sore throat last more than a few weeks it should be investigated by an Ear Nose & Throat doctor. The most common cause is a persistent infection of the tonsils (if they are still there of course!). Usually a prolonged antibiotic course is prescribed to try and “really kill the infection.” When this doesn’t work, and when the sore throats are interfering with the patient’s life enough, surgery may be considered to remove the tonsils and greatly improve the problem.
Another cause of chronic sore throat is cancer, which I know is very scary to think about. Smoking as well as human papillomavirus infections (HPV) are associated with tonsil and throat cancers. They can usually be found by the doctor’s exam or perhaps a simple endoscopy procedure.
A newer diagnosis undergoing a lot of research lately is eosinophilic esophagitis, an allergy-like inflammation in the esophagus that can lead to chronic sore throat and acid-reflux-like symptoms. Often food is a trigger to the allergy. This usually requires a careful exam and endoscopy to diagnose.
Finally, probably the most common cause of mild chronic sore throat is acid reflux from the stomach up to the throat, called laryngo-pharyngeal reflux. This leads to a feeling of a “lump in the throat”, fluctuating hoarseness, and chronic throat clearing. Often an acid blocking medication may be given for a 6-week trial to see if the symptoms resolve. Of course, good dietary choices have a lot to do with stomach acid flare ups.
Sore throat in the morning only may result from overnight acid reflux, or even snoring / sleep apnea. In fact we will often see frank uvulitis (edema of the uvula) and throat pain after a night of bad snoring!