When to See a Doctor for a Sore Throat: 11 Red Flags

Key takeaways:

• Most sore throats can be treated with home remedies and typically do not require a visit to a doctor or an emergency room.
• Some sore throats can be recurrent or chronic, which may require evaluation by an ear, nose, and throat (ENT) specialist.
• Some sore throats may present with urgent signs and symptoms that are better managed in an urgent care facility or an emergency room than at your doctor's office.

A sore throat, characterized by pain or irritation, is one of the most common symptoms people experience. In most cases, a sore throat is temporary and resolves without the need for medical attention. It may result from an infection such as the common cold, for example.

However, approximately one-third of childhood sore throats and over one-quarter of adult sore throats are caused by a well-known bacterial infection called group A streptococcus pyogenes, or strep throat. In fact, nearly 1% of all visits to emergency rooms, doctor’s offices, and urgent care clinics in the United States are for sore throats.

This article will cover the signs and symptoms of a sore throat that should prompt you to seek medical attention, as well as guidance on where to go for care. Knowing when to see a doctor for sore throat can help prevent the worsening of symptoms.

When to make a doctor’s appointment or see a specialist for a sore throat

A sore throat can range from mild to severe and typically occurs suddenly rather than gradually. It is a common indicator of worsening symptoms associated with an infection. There are various signs and symptoms to watch for, which may require contacting your doctor or an ear, nose, and throat (ENT) specialist.

1. Lengthy duration

If your sore throat has lasted more than three to five days, you might have strep throat. Common symptoms include increasing pain in your throat and ears, difficulty swallowing, headaches, nausea, vomiting, and abdominal pain.

During a physical examination, your doctor may find a fever and white or yellow patches at the back of your throat. Swollen and red tonsils and enlarged lymph nodes in your neck are also common.

To diagnose your condition, your doctor may take a throat culture to test for strep throat, COVID-19, and the flu. Your doctor may prescribe an antibiotic, such as amoxicillin with clavulanate, cephalexin, erythromycin, or clindamycin if you test positive for strep throat.

2. Breathing and swallowing difficulties, especially at night

If you are experiencing difficulty breathing and swallowing, particularly at night, you may have enlarged tonsils or soft palate.

Even if your sore throat has resolved, it’s important to have your doctor examine your throat to ensure that there is no chronic enlargement of the tonsils or any other abnormalities, such as a mass in the throat. Excessive snoring or breathing pauses during sleep could indicate sleep apnea, which may contribute to your sore throat.

3. Recurrent and chronic sore throats

You might think tonsil removal is only for children, but that's not true. While many people benefit from watchful waiting for recurrent throat infections, it's wise to consider having your throat and tonsils examined by your doctor or a specialist.

Chronic tonsillitis is poorly defined, and decisions are based on individual circumstances. The current medical guidelines for having your tonsils removed are:

• Seven infections in any one year
• Five infections a year for two years in a row
• Three infections a year for three years in a row

4. Persistent foul odor or taste that fails to respond to antibiotics

Halitosis (bad breath) is marked by a persistent foul odor or taste that does not improve with medications. Your sore throat could be caused by bacteria that are resistant to certain antibiotics, or you might have an unusual infection due to yeast or another type of fungus.

In rare cases, benign or cancerous growths cause persistent foul odor or taste. It is important to seek medical attention in these cases. You may need to consult an ENT specialist for a definitive diagnosis and appropriate treatment.

When to go to urgent care for a sore throat

If you're experiencing a sore throat, certain signs and symptoms may require urgent attention, but that doesn't necessarily mean you need to go to the emergency room. In these cases, it's important to seek more than just home remedies.

1. High Fever

In cases of high fever and a sore throat, an infection may be present. If your temperature remains significantly elevated, you need prompt medical evaluation and treatment. You might need antibiotics, steroids, or intravenous fluids to help control your temperature. This is especially important if you also experience severe headaches, a stiff neck, a rash, or confusion.

2. Dehydration

It’s easy to become dehydrated when you have a sore throat, especially since swallowing can be difficult. If you’re not able to eat or drink enough, dehydration can occur. In such cases, your doctor may recommend that you go to an urgent care facility for intravenous fluids and a thorough evaluation of your overall health. You may need assessments of your heart, lung, and kidney function.

3. Severe pain

The pain can become severe and unrelenting with some sore throats. Your doctor may suggest over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen sodium, but these may not provide adequate relief.

If your pain becomes unbearable and you find it difficult to swallow or breathe, seek medical attention at an urgent care facility. You might receive intravenous pain medications, steroids, or antiemetic medications that are not available at your doctor's office.

4. Muffled or “hot potato” voice

It is common to experience a muffled voice when you have a sore throat. However, if your voice has a “hot potato” quality—meaning it sounds especially thick or muffled—it is advisable to visit an urgent care facility for evaluation. This may indicate that your throat is in the early stages of severe swelling. At the urgent care facility, you may receive medications and intravenous fluids to help manage your symptoms before they worsen.

When to go to the emergency room for a sore throat

No matter your circumstances, federal law requires that you cannot be turned away from an emergency room. If you experience symptoms like those below, don’t wait to seek medical attention – the sooner you act, the better care you can receive.

1. One-sided sore throat, pain with opening your mouth, and ear pain

A sore throat that is more pronounced on one side is not uncommon. However, if the pain on one side intensifies to the point where you have difficulty opening your mouth, you may have trismus. Trismus is the inability to fully open the jaw, which can cause significant pain.

Another term associated with this condition is "lockjaw," which suggests inflammation and muscle spasms. You may also experience ear pain, which can occur as referred pain—meaning the discomfort is felt in the ear but originates from the throat.

The combination of a one-sided sore throat, trismus, and ear pain may suggest the presence of quinsy or a peritonsillar abscess. Those are indications of serious infection characterized by the accumulation of pus around one of the tonsils. The recommended treatment is a surgical incision and drainage, which can be performed in the emergency room under local anesthesia.

2. Difficulty breathing

If the swelling in your throat worsens, you may find it increasingly difficult to breathe, especially when lying down. It is crucial to seek medical attention immediately if your breathing becomes so compromised that you have trouble speaking or feel as though your airway is obstructed. The swelling may have spread lower in your throat to the epiglottis, a small, cup-shaped "lid" made of cartilage that covers your windpipe.

An infection of the epiglottis is called epiglottitis. This condition can deteriorate rapidly and become life-threatening without prompt medical treatment. You may start drooling and feel the need to sit upright because your airway is seriously compromised. You may also cough up blood or pus.

3. Neck mass or drainage

A sore throat can be accompanied by enlarged lymph nodes under your jaw. If you notice a lump in your neck or drainage from that area, it may indicate an abscess or a collection of pus, suggesting a severe infection or growth. It is essential to determine the cause of the neck mass as soon as possible.

Treatment may involve making an incision and draining the mass, along with conducting cultures or a biopsy for further evaluation. Additional procedures, such as a CT or MRI scan, as well as intravenous antibiotics, steroids, and other medications, may also be necessary.

Questions to ask your doctor about a sore throat

• Am I contagious?
• Do I need my tonsils out?
• Should I have a CT or MRI scan of my neck to find out what is wrong?
• What happens if I can’t swallow or breathe at all?

Summary

Not all sore throats require medical attention, but it’s important to recognize the signs and symptoms that might indicate a need for help. Some sore throats can signal severe or even life-threatening illnesses, while others may simply require a careful consultation with your primary care physician. Your doctor may refer you to an ENT specialist.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Pallabi Sanyal-Dey, MD.

Sources

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Sykes, Edward A, et al. “Pharyngitis: Approach to diagnosis and treatment.” Canadian family physician Medecin de famille canadien vol. 66,4 (2020): 251-257.

Dowdy, Regina A E, and Bryant W Cornelius. “Medical Management of Epiglottitis.” Anesthesia Progress vol. 67,2 (2020): 90-97. doi:10.2344/anpr-66-04-08

Long, Brit, and Michael Gottlieb. “Managing Peritonsillar Abscess.” Annals of Emergency Medicine vol. 82,1 (2023): 101-107. doi:10.1016/j.annemergmed.2022.10.023