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Interviewer: Throat symptoms like dryness, soreness, and itchiness can often be difficult to interpret. What do they mean? How can you find relief, and when should you go see a doctor?
Today, Dr. Breanne Schiffer, who's a laryngologist, which means she's an expert in throat issues, will walk us through some of the common throat symptoms that people experience, explain what they might indicate, and provide tips that could help you feel better.
What Does a Dry Throat Feel Like?
Dr. Schiffer, let's go ahead and start here with the number one symptom, dry throat. First of all, what does that feel like for somebody who has a throat issue, but they're like, "Do I have a dry throat or something else?"
Dr. Schiffer: So for dry throat, in general, we're thinking about somebody who might maybe express that they have like a rough or a sandpapery sensation in their throat. Oftentimes it could be associated with feeling like they need to drink a lot of water or maybe that they're not adequately hydrated. And that's what they'll often describe to me.
Common Causes of Dry Throat
Interviewer: All right. And what could a dry throat mean?
Dr. Schiffer: There could be several things that a dry throat could mean. Number one overall could be just dehydration in general. This is something that we can assess. Also, we tend to see dry throat more in dry environments, so, for example, here in Utah, or at higher altitudes. And we also can see this occasionally in patients who may be mouth breathing more, perhaps during sleep or during the day, during exercise. And it can also be a side effect of medications that people may notice once they've started something new.
Finding Relief from Dry Throat
Interviewer: All right. And if somebody has a dry throat, what could they do to get some relief?
Dr. Schiffer: So some of the initial things that you can try, if you feel like you do have a dry throat, is to increase your hydration. In general, this would involve drinking more water or trying to increase your hydration with non-caffeinated beverages, like herbal teas or other things of that sort. You can assess your surroundings and see if you do live in a dry environment, increasing humidification or moisture in your environment could be helpful, so, for example, a humidifier in your bedroom or other parts of your house. And then you can also assess if there may be some other causes. For example, if you've started a new medication, perhaps evaluate what the side effects of those medications could be and see if that's something that might be temporary or longer lasting.
When to See a Doctor for Dry Throat
Interviewer: All right. And when it comes to dry throat, when would you want to see a doctor, not only if the things that you've suggested don't work, or could it possibly be a symptom of something more serious?
Dr. Schiffer: I think it's helpful to see a physician if those symptoms have been lasting for a longer period of time, usually somewhere beyond six to eight weeks or so, particularly if they're not really associated with a particular environment or things like that. In addition, if you've noticed that you're having other symptoms, like dry eye, maybe salivary gland swelling, or things of that nature, or if it's associated with difficulty swallowing, it would probably be a good idea to see a provider to discuss those concerns further.
Interviewer: All right. And what could those concerns possibly be? What would be something that somebody might want to research more about?
Dr. Schiffer: Although it's not common, there can be certain autoimmune disorders that can have associations with dry eyes, dry mouth, and dry throat. Certainly, if it is a side effect of a medication, you would want to discuss if that medication was an appropriate dosage for you or if there were other adjustments that could be made.
Itchy or Scratchy Throat?
Interviewer: The next symptom somebody might be experiencing: an itchy or scratchy throat. Do you find that people confuse this with dry throat a lot, or do they have a pretty good idea of the difference between the two?
Dr. Schiffer: I think oftentimes people will have a little bit of overlap between the two symptoms. But when somebody describes more of an itchy or scratchy throat, oftentimes they can pinpoint a little bit more maybe where they feel that location in their throat. And it's often associated with an urge to cough or to clear their throat or something along those lines.
Interviewer: Kind of a tickling or irritating sensation, perhaps?
Dr. Schiffer: Yes, exactly.
Common Causes of Itchy or Scratchy Throat
Interviewer: Okay, and what could an itchy or scratchy throat mean?
Dr. Schiffer: Usually when someone has an itchy or scratchy throat, I think a little bit more about irritation in general. Some of the more common causes of irritation could be sinus or allergy symptoms, potentially some type of inhalant or other irritant in the environment that could be adding to the itchy or scratchy throat.
Interviewer: What about postnasal drip or sinus problems, does that contribute to an itchy or scratchy throat?
Dr. Schiffer: They can contribute. I think that a lot of patients will have some degree of postnasal drip or drainage from sinus issues or allergies that contribute. And so that is something to consider.
Remedies for Itchy or Scratchy Throat
Interviewer: And if somebody has an itchy or scratchy throat, what are some ways they could find relief?
Dr. Schiffer: I think, again, one of the key components is to take stock of when it seems to be happening to you. Are there any particular instances or triggers that make it worse? And then when you have identified those things, you can address them more thoroughly. So, for example, if it seems like you have a tendency to have more sinus drainage, sinus infections, or nasal allergy symptoms, like runny nose, sneezing, or things of that nature, you can use nasal sprays or potentially allergy medications to treat those things. If it's more of an exposure to environmental irritants, then you could consider using a mask in an appropriate environment to limit inhaling environmental irritants. You can also consider using air purifiers to help clean the air, whether that's in your house or in other sort of limited locations you may be in. And then some people will use warm teas or other types of lozenges to help soothe an itchy throat and try to avoid the coughing or throat clearing that can come along with it.
Interviewer: All right. And do lozenges generally work?
Dr. Schiffer: Lozenges can be helpful. In general, we typically recommend trying to use lozenges that are a little more soothing, that may avoid menthol lozenges, just because those can potentially dry your throat out a little more. Those can be a helpful first step to try and see if it helps.
When to See a Doctor About Itchy Throat
Interviewer: When would you want to see a doctor about an itchy or scratchy throat? Both, again, you know, if doing the things you've tried, you've suggested don't work, or it could be something more, you know, insidious.
Dr. Schiffer: Yeah. So, in general, I think, again, if it's lasting longer than about four to six weeks, it's probably very reasonable to see a physician at that time to discuss your concerns. Certainly, if it's impacting your ability to breathe or swallow, or you're noticing voice changes associated with this, then that is something that I would also recommend seeing a provider for.
Interviewer: Okay, and what could that possibly mean?
Dr. Schiffer: In general, we would want to ensure that there's no evidence of any throat infection, or tissue changes that could be a result of medications or other potential inhaled irritants. And then we're, of course, always looking at consideration of whether there's any possibility of head or neck cancer. Although, typically, an itchy or scratchy throat is less likely to be a presenting cause, but something that we definitely want to rule out if that seems like it could be contributing.
Understanding a Sore Throat
Interviewer: All right. How about if the symptom of your throat issue is a sore throat? What does that feel like?
Dr. Schiffer: Yeah. So a sore throat typically tends to be, in general, just more painful. Patients will describe that. And it typically tends to be painful for the most part around the clock. So it kind of lasts longer than we would . . . It doesn't come and go, I should say. Most people will describe either pain in a certain location, potentially tenderness when they're swallowing, talking, or things of that nature. And that's what I typically would consider to be a sore throat.
What Causes a Sore Throat?
Interviewer: What could a sore throat possibly mean? I think most of us have a pretty good idea of this, but I'd like to hear the comprehensive list.
Dr. Schiffer: Sure, yeah. So probably the most common cause for a relatively acute onset sore throat would be something like an infection. And that could be anything from a viral infection, the common cold, or an upper respiratory infection. It could also include bacterial infections, which include strep throat, or other types of pharyngitis, which means sore throat. You could also have a sore throat with swollen salivary glands or submandibular glands.
But not all sore throats are infectious. Some individuals can have sore throats simply from vocal strain, excessive talking, excessive voice use, or things of that nature. And so it is helpful to sometimes pinpoint when the sore throat starts, what kind of symptoms are associated with it, and then maybe what tends to make it worse.
Interviewer: Right. So if you don't have those kinds of cold or infection symptoms, perhaps it's vocal strain is what you're suggesting, it sounds like.
Dr. Schiffer: Correct.
Relief Options for a Sore Throat
Interviewer: If somebody has a sore throat, what can they do to find relief on their own?
Dr. Schiffer: So if it seems like it's more of an infectious etiology, you know, maybe a sore throat that started after an upper respiratory infection or a virus, most of the time you would use relatively conservative measures. So you want to make sure that you're staying hydrated. Over-the-counter medications, like Tylenol or ibuprofen, are generally safe. Of course, you want to make sure that that's something that's okay for you personally to take with your health history. Other individuals will use over-the-counter throat sprays. For example, there are some that you can use that just help kind of numb the throat a little bit. Those can be helpful for short-term, temporary relief. And then the other component of things is if it does seem like using your voice or straining is a cause that makes your sore throat worse, you may want to consider a few days of voice rest and see if that improves your symptoms overall.
Interviewer: And when it comes to throat sprays, are there any particular ones you recommend? Is there something somebody should look for?
Dr. Schiffer: In general, the ones that are available over the counter are relatively safe first-line medications to go to. You do want to read those carefully and just make sure that you're using them as recommended, that you are not using them more frequently than you should, and that you're not mixing them with any other medications that you should not.
When to See a Doctor About Sore Throat
Interviewer: All right. And when it comes to a sore throat, then when is it time to go see a doctor? And I have a feeling that this is a recurring answer. If it lasts more than a certain amount of time, it could be one of the reasons.
Dr. Schiffer: Yes.
Interviewer: So how long would you want to wait on a sore throat?
Dr. Schiffer: Definitely if it's lasting longer than about four to six weeks, that's generally when it would be recommended to see a physician or an otolaryngologist, which is an ear, nose, and throat physician. However, if you're having some other symptoms associated with it, so you're having progressively worsening, difficulty swallowing, definitely any difficulty breathing, if you're having sudden voice changes, particularly associated with difficulty breathing, any neck swelling or things of that nature, or if you're coughing up or spitting up blood or anything along those lines, that would be something where I would recommend do not wait four weeks or longer. See your physician as soon as possible.
Interviewer: Right. And what could that be an indication of?
Dr. Schiffer: So sometimes that can be an indication of just a progressively worsening infection that might require antibiotic therapy or possibly hospitalization, depending on the cause or the severity. The other things that we are typically ruling out would be, again, any lesion or other abnormality in the throat. For example, cancer is always something that I'm considering in my patients who come see me with these symptoms for a longer period of time. And so those are not things that you want to just dismiss or wait on too long.
Dealing with ‘Gunk’ in the Throat
Interviewer: All right. The symptom: gunk in the throat. How do patients describe this?
Dr. Schiffer: I think gunk in the throat can mean a little bit of something different to everybody. Some patients really feel just persistent mucus kind of in the back of their throat or in or around the voice box level that they feel like they need to cough or clear. For some individuals, this is more of a lump or a burning or full sensation at a certain level of the throat. And that can be potentially worsened by certain activities. So, for example, some people feel like it's worse when they lay down at night to sleep, or they wake up in the morning and feel like they have a lot of "gunk in their throat." And so this can be a little harder sometimes to pinpoint exactly what is the cause. But there are a few things we think of when we hear this.
Potential Causes of Gunk in the Throat
Interviewer: Okay, and what could it mean then?
Dr. Schiffer: That could be, I think, for me, when I'm assessing somebody with these symptoms, I'm asking them kind of when they notice it. So if this is something that they notice as soon as they lie down, maybe shortly after eating a meal, possibly even just really first thing in the morning when they wake up, they feel like they have a lot of junk there, then I am thinking a little bit about the possibility of acid reflux or any type of regurgitation. And that may be one of the symptoms I'm considering.
Interviewer: All right. So waking up with gunk in your throat is not something that typically would be considered "normal."
Dr. Schiffer: I think, to a small degree, it can be considered normal. Typically, at nighttime, the air is drier. We're not drinking water throughout the night. A lot of people do not have a humidifier in their bedroom. Maybe they use a CPAP or oxygen at nighttime. Those things can certainly dry you out and make it more prone that you have mucus that's kind of settled or collected. But I think if this is happening really persistently after every meal, every time you lie flat, any kind of positional changes, or things like that, I would not consider that to be completely normal.
Self-Care for Gunk in the Throat
Interviewer: And then what should a patient do? What can they do on their own for gunk in the throat?
Dr. Schiffer: So certainly, some of the things that I would recommend just at baseline, going back a little bit to some of the things we've talked about earlier, I would certainly recommend assessing how much hydration you are taking in on a daily basis, increasing hydration, if possible, humidifying the air either in the bedroom or in other areas where you feel like you're more prone to this sensation. If you are somebody who has allergies or a history of sinus disease or other potential causes that could contribute to increased postnasal drip, then you want to address those factors with either appropriate allergy medications or potentially nasal or sinus rinses.
And then if we think that reflux is playing a role, many patients will consider a short course of over-the-counter reflux medications that can help to reduce acid production. And then there are also some behavioral components of things that can reduce acid production as well. Typically, these would include not eating late, so giving yourself about three hours between eating and then going to bed or taking a nap or things of that nature, and then reducing the number of spicy foods or other foods that can increase reflux.
When to Seek Help for Persistent Throat Symptoms
I think if you've tried the measures that we just discussed and you haven't seen resolution of your symptoms, and certainly if it's starting to interfere with your quality of life, where your sleep is disrupted, potentially eating or drinking or your swallow has been disrupted, or it's impacting your voice or becoming particularly uncomfortable, those are reasons where I would consider seeing a physician.