5 causes of a sore throat that comes and goes and how to treat it - Insider

• A sore throat that comes and goes is a nuisance but usually not a serious cause for concern. 
• Allergies, smoking, infections, and heartburn can all cause an intermittently chronic sore throat. 
• A chronic sore throat can be a sign of throat cancer if it comes with other tell-tale symptoms.

A sore throat happens when the pharynx — a tube located between your tonsils and voice box in the back of your throat — becomes inflamed. This causes your throat to feel swollen and tender, and can even make it difficult and painful to swallow or talk. 

Sore throats, aka pharyngitis, are fairly common, and not typically cause for concern on their own. While they usually improve within a week or two, some people experience a sore throat that comes and goes over time.

A recurring sore throat can be caused by a variety of different issues including infections, like tonsillitis, and muscle strains. Allergies are also common culprits, says Brianna Crawley, MD, academic laryngologist and co-director of the Voice and Swallowing Center at Loma Linda University Health.

Understanding what may be causing your recurring sore throat is key to figuring out the best course of treatment. Here are some common culprits to know about.

1. Allergies

Allergies can trigger a sore throat for several reasons: 

• They lead to nasal congestion that eventually turns into post-nasal drip where mucus drains into the throat, leading to irritation and soreness.
• Allergies can sometimes cause a cough, which can then irritate your throat over time
• People with allergies often clear their throat to try and get rid of excess mucus, and Crawley says this alone can cause or exacerbate irritation, leading to a sore throat.

If you're experiencing other symptoms like sneezing, a runny nose, and a tickling sensation in your throat, that can suggest that allergies are causing your sore throat. 

How to treat it: Crawley says the best over-the-counter remedies for environmental allergies, like animal dander and pollen, include nasal steroid sprays, oral antihistamines, and nasal rinses. 

When over-the-counter remedies don't work, you may also want to consider allergy shots to get rid of your upper respiratory symptoms that can lead to sore throats. 

Regardless of what course of treatment you choose, limiting your exposure to the allergen as much as possible is crucial to minimizing sore throats and other symptoms.

2. Infection

Both viral and bacterial infections can cause a sore throat. Some of these include:

• Viral infections: The flu, common cold, mono, and COVID-19
• Bacterial infections: Strep throat and Streptococcus pneumonia

Viral infections cause sore throats more often than bacterial infections. However, regardless of the source, Crawley says a sore throat from any infection will usually resolve once your body fights it off. 

While allergies are more likely to cause a recurring sore throat than an infection, there's an easy way to tell which is bothering you: Look for other telltale signs of an infection like a fever, muscle aches, swollen lymph nodes, fatigue, and chills. 

Additionally, Crawley says an infection can affect the whole throat, whereas the throat soreness and discomfort may vary in location when it's caused by allergies or acid reflux.

How to treat it: If your sore throat is caused by a viral infection, Crawley says the recommended treatment typically includes getting plenty of fluids and sleep and treating pain and discomfort with ibuprofen. You can also relieve the pain by gargling warm salt water.

On the other hand, if a bacterial infection is causing your sore throat, your doctor may prescribe antibiotics to kill the bacteria and prevent it from spreading. 

If you are prescribed antibiotics , Crawley says your sore throat will likely improve significantly within a couple of days.

3. Smoking

While having a cigarette here and there won't usually cause a recurring sore throat, chronic smoking can, says Crawley. 

There are several reasons why smoking can lead to a sore throat:

• Smoking frequently can cause throat dryness, and Crawley notes that your throat may feel sore when it's dry.
• Toxins in cigarettes slow the movement of cilia, hair-like cells that sweep out mucus and foreign particles. This can lead to a mucus buildup in the nasal passages and eventually "smoker's cough", which may cause a sore throat.
• Exposure to secondhand smoke can also cause irritation that leads to a sore or scratchy throat, says Crawley.

How to treat it: Ultimately, quitting smoking is the best option for getting rid of these chronic sore throats. Some tips to help you get started include using exercise to cope with stress and anxiety and manage cravings, finding new hobbies to keep your hands and mouth busy, and identifying and avoiding your triggers, and then cutting back gradually.

Keep in mind, too, that a 2022 study found people who vape tend to exhale through their nasal passages, which could lead to irritation in the nose and throat, so these symptoms are not just limited to smokers. 

4. Acid reflux

When it comes to severe acid reflux conditions, gastroesophageal reflux disease (GERD) is perhaps the most common. However, it's not as likely to cause a chronic sore throat as laryngopharyngeal reflux (LPR), says Crawley. 

With LPR, acidic stomach contents travel up the esophagus and spill into the throat, causing irritation and inflammation. Crawley notes that this may be accompanied by voice hoarseness, a chronic cough, and feeling like a lump is stuck in the throat. 

You may also experience a burning sensation in the back of your throat. But this is more common in people with GERD. That said, GERD and LPR are similar and can have overlapping symptoms. 

Risk factors for LPR include:

• Obesity or excess weight
• Overeating
• Lying down right after eating
• Eating very spicy or acidic foods
• Wearing clothing that's very tight around the abdomen

How to treat it: In order to get relief from severe acid reflux and resolve the sore throat, you may have to change some of your habits, especially related to eating. 

Crawley usually recommends not eating or drinking for three hours before lying down, and following a blander diet that eliminates or reduces spicy, acidic, and high-fat foods. 

You can also take over-the-counter antacids, H-2-receptor blockers, or proton pump inhibitors to help manage symptoms — just make sure to take them 30 minutes before eating. Most people will be able to get rid of the sore throat within two weeks of treating the acid reflux, says Crawley.

5. Throat cancer

Throat pain and discomfort that won't go away is one of the most common symptoms of throat cancer. 

In fact, a 2019 study found that a persistent sore throat combined with shortness of breath, problems swallowing, or earaches is a better predictor of throat cancer than just voice hoarseness alone.

When throat cancer is the culprit, a chronic sore throat is not only persistent but usually gets more painful over time, especially if the throat tumor grows in size, says Paul Walker, MD, an otolaryngologist at Loma Linda University Health. 

According to Walker, it may feel like a sharp and stabbing pain or dull and aching pain, and can sometimes radiate up to the jaw, neck, or ear as the cancer spreads. Some other common signs of throat cancer to look out for include:

• Stiff jaw
• Difficulty swallowing or opening your mouth
• Lump in the throat or neck
• Persistent bad breath
• Nosebleeds
• Coughing up blood

However, it's important to note that throat cancer is uncommon, only accounting for about 0.7% of all cancer diagnoses in the US. 

The two largest risk factors for throat cancer include smoking tobacco and drinking excess alcohol, says Walker, but people who have Epstein-Barr virus, HPV, or poor oral hygiene are also at a higher risk. People who both smoke and drink regularly have the highest risk of developing throat cancer.

How to treat it: The 5-year relative survival rate for throat cancer can range from 25% to 83%, depending on ​​which part of the larynx the cancer started in and how far it's spread, if at all. 

Keep in mind that your age and overall health can factor into your outlook as well — and as treatments are continually improving, people who are diagnosed today may have a better outlook than those studied in the National Cancer Institute database years ago. 

As for treatment — your doctor may recommend radiation therapy, chemotherapy, drug therapy, or surgery, depending on the location and stage of the cancer.

When to see a doctor

If your sore throat lasts more than two weeks or you're having difficulty breathing, Crawley and Walker strongly recommend seeing a doctor to determine the cause and ideal course of treatment.

Another sign that your sore throat requires medical attention, is if you lose your voice or your voice becomes hoarse for more than two weeks, says Walker. 

Be prepared that a healthcare provider will likely conduct a flexible laryngoscopy, which entails threading a scope with a tiny high-res camera through your nose and into your throat to look for signs of acid reflux, or take a biopsy sample if they see a tumor or suspect cancer. 

The doctor will typically apply a topical anesthetic and decongestant before doing the flexible laryngoscopy to minimize discomfort, says Crawley, and it usually takes no more than 10 minutes.

Insider's takeaway

Most of the time, chronic sore throats are caused by allergies, acid reflux, or infections, says Crawley, and will go away within two weeks once you start treating them. 

Throat cancer is rare and, if it's causing your sore throat, will very likely be accompanied by other symptoms like hoarseness or other voice changes, ear pain, and a lump in the throat or neck.

The cause of your sore throats will determine how you go about getting rid of them. Look for accompanying symptoms to assess the underlying issue. 

If your sore throats don't improve within two weeks of treating them, you start to have difficulty breathing, or you suspect a tumor, contact your doctor.

Rebecca Strong