Sore Throat and Tonsillitis

What is Sore Throat?

A sore throat is pain, scratchiness or irritation in the throat, often worse when swallowing, and it usually comes from inflammation of the pharynx (pharyngitis) or the tonsils (tonsillitis).^{[1, 2]} Most cases are caused by viruses and get better with supportive care, while a minority are caused by bacteria, most often group A Streptococcus.^{[1, 2]}

Common symptoms

The main symptom is throat pain, which is often worse when swallowing. Tonsillitis commonly adds swollen tonsils, sometimes with white patches (exudate).^[2]

• Fever and swollen, tender glands in the neck
• Hoarseness, cough, runny nose or red eyes, which point toward a virus rather than strep^[1]
• Difficulty swallowing

Causes and risk factors

Viral infections cause most sore throats, and non-infectious causes also exist.^[1] Group A Streptococcus is the leading bacterial cause. Less often, other bacteria, including some sexually transmitted infections, are responsible.^[1] In the United States, only about 10 percent of adults who seek care for a sore throat have strep throat.^[3]

Strep throat is more likely in children aged 3 to 15 years, and school-age children have the most tonsillitis.^{[2, 3]} Close contact with infected people is the main route of spread.

How it is diagnosed and treated conventionally

Doctors use your symptoms and an exam, sometimes with scoring rules such as the Centor criteria, to decide who needs a strep test.^{[1, 3]} Examination alone cannot reliably identify strep, so a rapid antigen test, a molecular test or a throat culture is used when bacterial infection is possible.^[1]

Without red-flag features, an acute sore throat usually clears on its own, in about 7 days on average.^[4] Treatment of viral cases is supportive, with pain relief and fluids.^[2] Ibuprofen and naproxen are recommended for symptom relief in a German guideline.^[4]

Antibiotics are used when strep is confirmed or likely. A Cochrane review found they modestly shortened sore throat symptoms and lowered the risk of complications such as quinsy (abscess beside the tonsil) and rheumatic fever. It also found that most people not given antibiotics were symptom-free within a week.^[5] Penicillin or amoxicillin are first-line choices for strep, and surgery to remove the tonsils is considered only after repeated episodes.^[3]

Why Sore Throat calls for a whole-person approach

Most sore throats are caused by a single infection, and treatment aimed at that infection comes first. Recurrent or lingering throat symptoms are different, and several factors can be involved at once.

Care that supports comfort, sleep and general health is a reasonable addition to medical care. It is not a substitute for finding out whether the infection needs antibiotics.

Infection and who is at risk

Whether an infection is viral or bacterial changes what treatment is needed, and strep that goes untreated can lead to complications such as abscess or rheumatic fever.^[1] This is why testing matters more than any other step.

Inflammation and pain

Pain in pharyngitis comes from inflammation of the throat lining. Laboratory work on classical Chinese herbs, for example, studies inflammatory signaling pathways in cells and animals, but this is early research and has not been shown to apply to people.^[6]

Persistent or non-infectious causes

Chronic sore throat usually has non-infectious causes.^[4] These can include irritation, allergy, dryness or reflux, so a throat that stays sore for weeks needs a medical assessment rather than repeated home treatment.

Rest, hydration and symptom relief

Viral tonsillitis is treated with rest, fluids and pain relief.^[2] These basics matter for any complementary therapy used alongside them.

Acupuncture for Sore Throat

What the research shows

Acupuncture may reduce sore throat pain, but the evidence is limited and mixed. A 2023 meta-analysis of 19 randomized trials with 1,701 patients with acute throat infections found a higher response rate and shorter duration of sore throat with acupuncture than with antibiotics. The authors urged caution because of the limitations of the studies and called for higher-quality trials.^[7] The comparison was with antibiotics, not with a placebo needle, and the review does not tell us whether the effect is more than a placebo response.

Two smaller trials point in different directions. In a pragmatic trial of 54 adults in a US family medicine clinic, ear acupuncture added to standard care was linked to lower pain for 24 hours and less pain medicine use for up to 48 hours. This trial was not blinded.^[8] A sham-controlled trial of 60 patients with tonsillitis or pharyngitis tested a single treatment on the arm and found no significant difference from sham laser acupuncture 15 minutes later. It was stopped early for lack of suitable patients.^[9]

How acupuncture may work

The mechanism of acupuncture for sore throat has not been well studied. The meta-analysis reported that acupuncture shortened sore throat and improved a blood marker of immune inflammation (white blood cell count), but not other markers such as C-reactive protein.^[7] The sham-controlled trial's authors suggested that part of the pain relief could come from the intense touch of palpating the acupuncture area, not only from the needles.^[9]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. Points may be on the neck, hands, arms, legs or ears, and several visits are usual with reassessment along the way. The sham-controlled trial above tested a single treatment, and the ear acupuncture trial followed patients for 48 hours after treatment.^{[8, 9]}

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Sore Throat

The Ayurvedic view

Ayurveda describes tonsillitis as Tundikeri.^[11] Classical texts relate throat conditions to imbalance of Kapha and Pitta. In this traditional framework, a sore throat is understood through the person's constitution and the qualities of the illness. These are traditional categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, such as warm fluids, light meals and rest
• Warm salt-water or herbal gargles
• Herbs that have been used traditionally for throat problems, such as guggulu-based formulas, prescribed individually
• Pratisarana, a traditional practice of applying a herbal paste to the throat or tonsils^[11]

Panchakarma procedures are not appropriate during pregnancy, during acute illness such as a fever or active infection, or in frailty. They are not used for an ordinary sore throat.

What the research shows

The research on Ayurveda for sore throat is very limited. A 2023 systematic review of complementary therapies for tonsillitis in children found only five studies in all, one of them Ayurvedic. It concluded that quality and quantity were too low to judge whether the treatments work.^[12] That Ayurvedic study enrolled 31 children aged 5 to 16 and gave Kanchnara Guggulu tablets with or without a paste of Tankana (borax) and honey applied to the tonsils. Most children improved, but there was no placebo or untreated group, and this study was in children.^[11]

Because most sore throats improve on their own within about a week, studies without a comparison group cannot show that a treatment caused the change.^[4]

Herbal medicine for Sore Throat

Herbs and formulas that have been studied

Chinese herbal formulas have been used for sore throat for centuries, including Jiegeng decoction, which combines licorice root with platycodon root.^[6] Other plants studied include licorice (Glycyrrhiza) and mangosteen, and Andrographis, a bitter herb also used in Ayurveda.^{[13, 14]}

What the research shows

The evidence is limited. A Cochrane review of 12 trials with 1,954 participants found that some Chinese herbal formulations performed better than the comparison treatment for sore throat, but 10 of the trials were of poor quality. The authors concluded that no Chinese herbal formulation could be recommended as an effective remedy.^[15]

A 2023 trial of 60 adults with viral pharyngitis compared an Andrographis spray with a chamomile spray. Both groups improved, and the Andrographis group responded about half a day faster. There was no placebo group.^[14]

Laboratory studies add some background. In test-tube experiments, ethanol extracts of licorice and mangosteen inhibited the growth of bacteria that cause pharyngitis. These results have not been shown to carry over to people.^[13]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reviews describe interactions with warfarin, aspirin and other prescribed drugs, some of which led to bleeding or other serious effects.^[16] Tell us about all medicines and supplements you take.

Licorice deserves a specific caution. In a meta-analysis of 18 studies, regular intake of products containing glycyrrhizic acid raised blood pressure and lowered potassium, which matters for people with heart disease or high blood pressure.^[17] About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic, so herbs should come from tested sources.^[18] Tell us if you are pregnant or breastfeeding or have liver or kidney disease. A transdermal herbal preparation applied to the skin is also possible, but we know of no trials of it for sore throat.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes a sore throat as wind-heat or heat toxin affecting the throat, and some formulas are classed as clearing heat. Researchers studying such formulas look at anti-inflammatory signaling in cells and animals, and at antibacterial activity of related plants in laboratory tests.^{[6, 13]}

In Ayurveda, an aggravated Kapha or Pitta in the throat describes swelling, heat and mucus.^[11] No study has shown that a dosha corresponds to a particular biological process.

How this care fits with your medical care

Integrative care for sore throat is complementary. Keep your physician or pediatrician involved, get tested for strep when it is suspected, and do not stop or change prescribed medicines, including antibiotics, without your prescriber. Untreated strep can lead to complications, so complementary care should never delay testing.^[1]

Please bring your diagnosis or strep test result, a full list of medicines and supplements, and details of how often the problem has recurred.

When to seek urgent medical care

Some throat symptoms point to a serious infection or a blocked airway and need prompt medical care.^[1]

• Trouble breathing, noisy breathing or drooling because swallowing is too painful
• Inability to swallow fluids, or signs of dehydration
• A stiff neck, trouble opening the mouth, or a muffled "hot potato" voice, which can signal an abscess
• Swelling of the face, tongue or neck
• High fever that does not settle, or symptoms that worsen after starting antibiotics or are still present 5 days into treatment^[3]
• Sore throat that lasts more than a week or keeps returning

For trouble breathing, drooling, inability to swallow, or swelling of the face, tongue or neck, call 911 or go to the nearest emergency department. For the other symptoms, contact your doctor promptly.