The weather has changed all over India with the rains and resultant flooding. It has also ushered in the “sore throat” season, with frequent complaints of discomfort in the throat — a scratchy feeling, burning, difficulty in swallowing and pain. In some people, this may be accompanied by cough and fever.

Although people think otherwise, only 10 per cent of sore throats are actually due to infections. Many are due to viruses — particularly adeno and other viruses causing the common cold, infectious mononucleosis, measles and chickenpox. Another 10 per cent may be due to bacteria, especially streptococci. These statistics do not deter people from taking appropriate or inappropriate antibiotics. They either manage to get them with a prescription or simply purchase them over the counter (OTC).

Sore throats cause by viral infections are usually accompanied by a runny nose, low-grade fever, bodyache and cough. It may be part of flu. Bacterial infection produces high-grade fever, the tonsil may be enlarged, yellow pockets of pus may be seen in the tonsils and the lymph nodes in the neck may be clearly felt.

Allergies cause irritation, a scratchy feeling and, sometimes, difficulty in swallowing and pain. There is no fever. It may be due to pollen, cockroach or mite dander, room fresheners, mosquito repellents, exposure to cigarette smoke (active or passive), dust or exhaust fumes from vehicles. This is not sporadic or seasonal but fairly constant all round the year.

Sometimes, people may develop acid reflux. This is common if people are overweight or lie down too soon after eating. Acid and food regurgitate into the oesophagus and cause a sour taste and a burning sensation in the throat.

Some people have a deviated nasal septum, polyps, adenoids or tonsils. All these cause the nose to be blocked. The person is forced to breathe through the mouth, especially at night. This can result in a chronically inflamed, painful throat.

The tonsils are situated on either side of the throat. They appear large in children and may cause recurrent attacks of tonsillitis, with fever, pain, swelling, difficulty in swallowing and a hoarse voice. It is often tempting to consider tonsillectomy but the tonsils have a protective function. They help localise the infection to the throat and prevent it spreading into the lungs. Tonsillectomy, with or without adenoidectomy, is not to be taken lightly. It is indicated if there are more than five to seven attacks of tonsillitis a year, obstructive sleep apnoea, recurrent ear infections and speech impairment.

Figuring out the cause of a sore throat and removing the provocation is the best way to tackle it. Gargling twice a day with warm salted water will ease the pain as will mild analgesics such as ibuprofen and paracetamol. Throat lozenges are helpful. Steam inhalations will reduce nasal congestion. Gargling and inhalation need to be done twice a day as preventive measures. Achieving ideal body weight, avoiding large meals, not lying down immediately after eating and taking prescribed medication can treat acid reflux. Smoking and alcohol aggravates throat pain from any cause.

Taking the flu vaccine every year can prevent flu.

Bacterial throat infection is diagnosed by taking throat swabs and culturing it. Untreated streptococcal infection can cause rheumatic heart disease and post-streptococcal glomerulonephritis (kidneydisease).