Itchy Throat

Getting the tickle out

So you woke up this morning with an ominous little tickle in the back of your throat. Does it mean you're coming down with something serious?

The bad news: a scratchy throat is a common forerunner to a full-blown cold. The good news: being aware that you may be on the brink of a cold is the perfect opportunity for you to take good care of yourself to minimize your symptoms.

A scratchy throat might not just be an indicator of an approaching cold. It might stem from another form of irritation, such as allergies, pollution, dry air, or acid coming up from your stomach. Once you identify the source of your scratchy throat, proper treatment can begin.

You can minimize your scratchy throat while your body mounts a natural response to its underlying cause. Many over-the-counter medicines can help ease your scratchy throat. Many herbal and self-help therapies are available too.

Detailed Description

Postnasal drip, or PND, is frequently the cause of a scratchy throat. Healthy sinuses normally produce about a quart of clear, thin mucus daily. It cleans, warms, and humidifies air before you pull it into your lungs. Normally, you swallow this mucus without ever noticing it. But when it thickens as a result of irritation or infection, it greatly irritates your throat.

The common cold, flu, and other upper respiratory tract infections can all cause disturbances of the postnasal mucus and, in turn, throat scratchiness. The throat often becomes aggravated as a result of throat infection, or pharyngitis.

Scratchy throat is a common side effect of air conditioning or heating. The dry air that circulates in an air-conditioned or heated room can cause the mucus of the nasal passages to thicken, thus irritating the throat. Cigarette smoke irritates the back of the throat as well, causing throat itchiness for smokers and passers-by alike. Pollution aggravates the throat in much the same way.

Interestingly, a bad case of heartburn can bring on a scratchy or sore throat. Heartburn happens when acid from the stomach creeps up the esophagus toward the throat. If the acid reaches the delicate skin of the throat, it can cause a tickling or burning sensation. Persistent heartburn is also called reflux esophagitis.

Possible Underlying Causes

A scratchy throat happens when the mucus produced behind the nasal area thickens and causes a sensation of slight touch on the throat. It can also happen when acid from the stomach creeps up the esophagus and irritates the throat (a phenomenon known as reflux esophagitis). The continued aggravation from coughing or constant clearing of the throat, especially after an upper respiratory or throat infection, can also cause a scratchy sensation.

Triggers of Scratchy Throat

    • Pharyngitis
    • Laryngitis
    • Cold or flu
    • Allergies
    • Smoking and secondhand smoke
    • Air conditioning or heating
    • Heartburn/reflux esophagitis
    • Yelling or screaming/excessive talking

Diagnosing the Underlying Cause

Many factors can cause throat scratchiness. While it may irritate you, a scratchy throat is usually harmless. If you believe that none of the following causes applies to you and you are concerned about your symptoms, talk with your family doctor to rule out the possibility of a more serious problem.

Here are several possible causes of the typical scratchy throat:

Scratchy throat:

    • Allergies Inflammation of the nasal passages caused by allergic reaction, resulting in postnasal drip.
    • Smoke Aggravation of the nasal passages due to smoking or exposure to secondhand smoke.
    • Air conditioning and heating Dry air can deplete the nasal passages of its normal moisture, resulting in irritation of the nasal passages and postnasal drip.
    • Throat irritation from coughing This can happen especially after a recent illness involving a cough. A sensation of something foreign in the throat causes constant throat-clearing, even though the throat is clear.

Scratchy throat after meals:

    • Acid reflux Stomach acid travels to the esophagus and irritates the skin at the back of the throat.

Scratchy throat accompanied by cough, headache, or fever:

Consult your doctor if your scratchy throat is accompanied by cough, headache, or fever. You could possibly have one of the following:

    • Viral infection such as the common cold or flu
    • Pharyngitis (inflammation of the throat)
    • Tonsilitis (inflammation of the tonsils)
    • Sinusitis (infection of the sinuses)
    • Vocal chord polyps, nodules, or ulcers
    • Mumps (an infectious viral disease)
    • Viral pneumonia
    • Mononucleosis (an infectious viral disease)
    • Strep throat (a bacterial infection)

Diagnostic Procedures

If your physician believes that a significant underlying condition or disorder is causing your scratchy throat, he or she may perform diagnostic tests as appropriate to determine the cause of your throat irritation.


Goals of Treatment

A scratchy throat can be one symptom of a number of medical problems.

If a postnasal drip is causing your scratchy throat, several over-the-counter medications are available to reduce or thin the mucus of the nasal passages. This treatment may be best suited for throat scratchiness associated with other illnesses, such as the common cold or allergies.

If irritants such as pollution or cigarette smoke are causing your scratchy throat, try to decrease your exposure. If you believe acid reflux is the culprit, try an nonprescription antacid or H2 blocker (for example, Tagamet) or consult with your doctor about your condition.

Treatment Options

Drugs most commonly used

    • Throat lozenges, gargles, washes
    • Guaifenesin (Robitussin, etc.)
    • Nasal saline spray
    • Antihistamines (for allergy relief)

Second choices

    • Antacids or H2 blockers (for acid reflux)

Dietary modifications

Adapt your diet according to the underlying problem. If a cold or flu is causing your scratchy throat, you might switch to a diet high in vitamin C for a while, as this may help boost your immune system. If you suspect that your scratchy throat is related to acid reflux, you might attempt eating smaller, less fatty meals, and cutting down on alcohol consumption.

Consider limiting your caffeine and alcohol intake, as these diuretics can dry the nasal passages. If you continue to consume them, compensate by drinking plenty of water. The following fluids may also help soothe a scratchy, irritated throat:

    • Herbal teas
    • Fruit juices
    • Clear soups or broths


Supplements

    • Vitamin C: If your scratchy throat is due to a cold, try taking vitamin C (500 mg four times a day). In one study, Finnish researchers analyzed 21 vitamin C studies and found that the vitamin reduced average symptom scores 23%. [1]
    • Zinc: If your scratchy throat results from an oncoming cold, suck on zinc lozenges. Several studies show that they may significantly shorten the duration of a cold. [2,3]

Herbs

    • Echinacea: If your irritated throat is due to any upper respiratory infection, try echinacea, which stimulates the immune system. [4] Take one teaspoon of tincture in juice three times a day.
    • Licorice root: To help soothe an irritated throat, add a pinch of powdered licorice root to any beverage tea or drink licorice root tea.

1 Hemila, "Does Vitamin C Alleviate Symptoms of the Common Cold?" Scandinavian Journal of Infectious Diseases (1994) 26:1.

2 Eby, G. et al. "Reduction in Duration of Common Colds by Zinc Gluconate Lozenges: A Double-Blind Study," Antimicrobial Agents and Chemotherapy (1984) 25:20.

3 Godfrey, J.C. "Zinc Gluconate and the Common Cold: A Controlled Clinical Study," Journal of International Medical Research (1992) 20:234.

4 Hoheisel, O., et al. "Echinagard Treatment Shortens The Course of the Common Cold: A Double-Blind, Placebo-Controlled Clinical Trial," European Journal of Clinical Research (1997) 9:261.


Preventing Scratchy Throat

It is not likely that you can prevent yourself from ever getting a scratchy throat. But by following the suggested treatment options, you may be able to minimize the severity of a scratchy throat once you do get it.

Self-Care Measures

The following suggestions may help ease that scratchy throat and prevent it from getting any worse.

    • Don't smoke -- it's a major throat and respiratory irritant.
    • Avoid other respiratory irritants, including dust, chemical fumes, and any fine particulates.
    • Suck on sore throat lozenges or hard candies, which have a soothing effect.
    • Drink plenty of hot liquids -- they also soothe a sore throat.
    • Gargle with warm water. Some people prefer warm salt water (one-quarter teaspoon per four ounces of water).

When to Call the Doctor

Seek medical attention if:

    • Your postnasal drip is thick, colored, and lasts for more than one week
    • You have a fever
    • You have facial pain
    • Your are coughing up mucus from the lungs
    • Your throat scratchiness is accompanied by a sore throat, throat clearing, or hoarseness
    • You have difficulty breathing or swallowing

Websites & Organizations

Allergy and Asthma Network
2751 Prosperity Avenue, Suite 150
Fairfax, VA 22031
Phone: 800-878-4403
Fax: 703-573-7794

Allergy Information Referral Line
611 Wells St.
Milwaukee, WI 53202
Phone: 800-822-2762

American Association For Respiratory Care
11030 Ables Lane
Dallas, TX 75229
Phone: 214-243-2272

American Public Health Association
1015 Fifteenth St., NW
Washington, DC 2005
Phone: 202-789-5600

National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
Phone: 301-565-4167 or 800-336-4797
Fax: 301-984-4256
Email: nhicinfo@health.org

National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Sinuses.com

Sources & Further Reading

Books

Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.

Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.

Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw Hill, 1996.

Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.

Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.

Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.

Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.

Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.

Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.

Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.

Articles

Eby, G. et al. "Reduction in Duration of Common Colds by Zinc Gluconate Lozenges: A Double-Blind Study. Antimicrobial Agents and Chemotherapy (1984) 25:20.

Facino, RM, MC, GA, LS, PP, PM. "Echinacoside and Caffeoyl Conjugates Protect Collagen from Free Radical-Induced Degradation: A Potential Use of Echinacea Extracts in the Prevention of Skin Photodamage." Planta Med. 61(6):510-4. Dec 1995.

Godfrey, J.C. "Zinc Gluconate and the Common Cold: A Controlled Clinical Study," Journal of International Medical Research. (1992) 20:234.

Hanson, DG, Kamel, PL, Kahrilas, PJ. "Outcomes of Antireflux Therapy for the Treatment of Chronic Laryngitis." Ann Otol Rhinol Laryngol. 104(7):550-5. Jul 1995.

Hemila, "Does Vitamin C Alleviate Symptoms of the Common Cold?" Scandinavian Journal of Infectious Diseases (1994) 26:1.

Hoheisel. O. et al. "Echinagard Treatment Shortens The Course of the Common Cold: A Double-Blind, Placebo-Controlled Clinical Trial," Europ. J. of Clinical Research (1997) 9:261.

Lau, YL, Karlberg, J. "Prevalence and Risk Factors of Childhood Asthma, Rhinitis and Eczema in Hong Kong." J Paediatr Child Health. 34(1):47-52. Feb 1998.

Macknin, ML, MP, CC, JJ, EW. "ZincGluconate Lozenges for Treating the Common Cold in Children: A Randomized Controlled Trial." JAMA. 279(24):1962-7. Jun 24, 1998.

Mendell, MJ, Fisk, WJ, Deddens, JA, Seavey, WG, Smith, AH, Smith DF, Hodgson, AT, Daisey, JM, Goldman, LR. "Elevated Symptom Prevalence Associated with Ventilation Type in Office Buildings." Epidemiology. 7(6):583-9. Nov 1996.

Nott, MR, PDN, MP. "Reducing the Incidence of Sore Throat with the Laryngeal Mask Airway." Eur J Anaesthesiol. 15(2):153-7. Mar 1998.

Philp, EB. "Chronic Cough." Am Fam Physician. 56(5):1395-404. Oct 1,1997.

Serrano, E, Percodani, J, Woisard, V, Braun, F, Clement, O, Flores, P, Pessey JJ. "Efficacy of Partial Inferior Turbinectomy in the Treatment of Nasal Obstruction. Retrospective Study Apropos of 71 Patients." Ann Otolaryngol Chir Cervicofac. 113(7-8):379-83. 1996.

Steinhoff, MC, MKA, NK, SHH, AO, HF, MK. "Effectiveness of Clinical Guidelines for the PresumptiveTreatment of Streptococcal Pharyngitis in Egyptian Children." Lancet. 350(9082):918-21. Sep 27, 1997.

Stratelak, PA, WW, DW. "The Effect of Glycopyrrolate Premedication on Postoperative Sore Throat." AANA J. 64(6):545-8. Dec 1996.

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