Can Coughing Give You A Sore Throat

There are five cardinal hallmarks of inflammation. In pathology (the study of sickness and how disease comes to be) lingo, these are referred to as colour, dolour, rubor, tumour, and function. They respectively mean heat, pain, redness, swelling and loss of function. Inflammation is your body’s response to an external or internal disturbance in your body’s structural integrity and functioning. It is your body’s response to anything it perceives to be dangerous. It should be no surprise, then, that sore throat is most often the result of inflammation in your throat. But can coughing give you a sore throat? Is the act of coughing enough of a disturbance in and of itself to lead to inflammation in your throat to give rise to sore throat pain? Or does a sore throat more often merely go hand-in-hand with a cough? We’ll find out now.

As stated, a sore throat is caused by inflammation in the region that defines the throat, but the feeling of a sore throat is produced by inflammation in areas that also include the tonsils and the larynx. The cause of inflammation in these areas is most commonly a viral infection, but inflammation can also be caused by mechanical irritation or trauma. Consistent coughing can have a chronic, irritative effect on your throat, leading to inflammation, which could cause the feeling of sore throat pain in and of itself. 

If you’re coughing and you have a sore throat, you may be inclined to wonder whether your throat is sore because you’re coughing or you have a condition that causes both sore throat and coughing. How you may be able to tell the difference is oftentimes simple, and the ability to distinguish between the two can be greatly valuable for reasons we will go into detail. Let’s find out more. 

What causes coughing?

Although every tissue in your body responds to injury by inflammation, external stimuli that do not lead to tissue damage do not elicit this response. If tissue in your body needs to be able to respond to such stimuli, it will have receptors. These can be thought of as tiny sensors that send signals to other cells, which can produce a response; this is known as a reflex. And your upper respiratory system has a reflex of its own, too. It’s called coughing. It’s generally a bad thing to have foreign bodies in your airways as they can get stuck and lead to infection. This is why your body needs to get rid of even the tiniest foreign bodies that enter your airways before they settle in, which it achieves by coughing. Inhaling dust or smoke or aspirating water (when water gets in your airways instead of your oesophagus) all activate these sensors, and the result is that you cough until these sensors stop firing, indicating that the offending dust particles or water droplets are cleared. Coughing helps to keep your lungs healthy and free from foreign bodies. The problem occurs when these sensors fire in the absence of things that need to be coughed out.

This happens for various reasons. These biological sensors aren’t foolproof and can misinterpret certain stimuli. For instance, sudden exposure to cold and dry air can activate these sensors. Inflammation of the airways, such as bronchitis or pneumonia, will also cause these sensor cells to be activated, leading to a dry cough. In the case of pneumonia, pus produced by bacteria themselves will also activate these receptors, however the pus actually does need to be cleared, leading to a productive cough. Another similar case happens with allergies. One of the most common allergy symptoms is the presence of a postnasal drip, where you feel the flow of mucus from the back of your nose down your throat, often leading to reflexive throat clearing. This flow continues all the way down to the inside of your larynx, and as the inner larynx is part of your airways, receptors will begin to fire, leading to a cough. The same happens with reflux, where acid from your stomach travels upward. Sometimes, this acid may go all the way up your oesophagus and reach your throat, which will similarly cause the receptors to fire and lead to a cough, often in conjunction with stomach pain. This is called laryngopharyngeal reflux and is particularly associated with nighttime cough.   

Remedies

After an in-depth dive into the causes of coughing, you may wonder what you should do to relieve a cough. In the vast majority of cases, it’s either useless or sometimes even dangerous to try and treat a cough. In many illnesses, coughing will help you get rid of secretions, thereby helping with healing. For example, in bacterial infections like pneumonia, the pus that develops is filled with toxins and swarming with both dead and alive bacteria, and preventing it from being coughed out is a bad idea. Even in viral infections, the act of coughing may help clear the airways of dead cells that were destroyed by viruses, which will also aid in healing. The best way to treat a cough due to infection, therefore, is to treat the infection (or wait it out for minor URIs).

For cases of irritative cough, like a postnasal drip caused by allergy or reflux, treating the underlying problems is key. Allergic rhinitis (also known as hay fever) and laryngopharyngeal reflux are best treated by consulting an ENT doctor, though avoiding identified allergens and adopting lifestyle changes for reflux are easily achievable lifestyle modifications and disease control measures that can be of great benefit.

There are cases, however, where it might be beneficial to treat a cough. One good reason is when an acute cough is accompanied by a sore throat, where the act of coughing can lead to discomfort and pain. There are certain medications that can help. Throat sprays or throat lozenges may alleviate the pain experienced when coughing, which can provide enough symptom relief. Cough suppressants (also known as antitussives) are another class of cough medicines, and although they are very effective, they are powerful medicines with side effect profiles, and the decision to inhibit coughing is a careful decision that must only be made by a healthcare professional. Chronic cough is another reason for a visit to your healthcare provider, as conditions like asthma and COPD can respond well to treatment, and their treatment may, in turn, prevent life-threatening situations. Though there are certain diseases that can lead to hyperacute cough of life-threatening magnitudes, such as whooping cough and organophosphate poisoning, they are beyond the scope of this article. Just make sure to note that when nonstop coughing interferes with the act of breathing or is accompanied by profuse vomiting or turning pale, a visit to the Accidents & Emergency is imperative.

What to avoid?

The best way to avoid getting a nasty cough is to practice disease control against viral infections. This involves simple hygiene measures and social distancing. As coughing is also a COVID-19 symptom, wearing a mask is a good idea when surrounded by coughing people. It is also best to avoid taking cough suppressants (including cough drops) without professional guidance, as they may cause more harm than good.

What is a sore throat?

A sore throat is a symptom of throat inflammation. Depending on what region of the throat is inflamed, it will be accompanied by various signs and symptoms.

Causes

Inflammation in the tonsils, nasopharynx, oropharynx, laryngopharynx and the larynx will lead to a sore throat. The tonsils are the two almond-shaped masses to the sides of your throat. The nasopharynx is the back of your nose (where they take COVID PCR swabs from), the oropharynx is the part of your throat that is visible when you open your mouth, and the laryngopharynx is the area surrounding your larynx and the opening to your oesophagus. 

Symptoms

Inflammation of the tonsils is called tonsillitis and will usually lead to the most severe level of sore throat pain. Tonsillitis caused by the bacterium streptococcus pyogenes is called strep throat, though tonsillitis is more often caused by viral infections (including glandular fever or infectious mononucleosis caused by the Ebstein Barr virus). The level of soreness caused by tonsillitis can be so severe that even the act of swallowing food may become excruciatingly painful. Moreover, tonsillitis can lead to a condition called peritonsillar (Quinsy) abscess, which requires drainage and even life-threatening complications in the form of parapharyngeal and retropharyngeal abscesses, though these are rare. 

Inflammation of the nasopharynx is called nasopharyngitis, and this is almost always viral. In fact, nasopharyngitis almost always occurs together with viral rhinitis and the combination of these two is what the common cold actually is. So, cold symptoms such as a runny nose or nasal congestion are partly due to nasopharyngitis.

When the larynx is affected, it’s called laryngitis, and since the larynx contains your vocal folds, acute laryngitis will lead to hoarseness. Since the inside of your larynx contains cough receptors, laryngitis can also cause acute cough along with sore throat. 

Inflammation of the oropharynx is often simply referred to as pharyngitis. This is the most typical form of viral sore throat and by itself has no associated symptoms, though pharyngitis very commonly presents together with nasopharyngitis, laryngitis and/or acute bronchitis, and the various combinations of these present as common URI symptoms. Even if pharyngitis is not directly involved, the cough of acute bronchitis can occasionally be strong enough to elicit mechanical inflammation in the pharynx, leading to sore throat. 

Finally, chronic inflammation of the laryngopharynx and the larynx could be caused by laryngopharyngeal acid reflux as mentioned above (leading to chronic laryngitis), and chronic inflammation of the oropharynx could be caused by persistent post-nasal drip due to allergy, leading to chronic pharyngitis. These are both causes of both chronic cough and a chronic sore throat.

How is a sore throat diagnosed?

Since a sore throat is a subjective symptom and not an objective sign, the diagnosis of a sore throat is simply the report of the patient. That said, it is sometimes important to identify the cause of a sore throat. Tonsillitis can be diagnosed with a simple physical examination (through the presence of white spots and lines on the tonsils), and it may be important that throat cultures are taken in those cases, as untreated strep infections can cause long-term complications, including rheumatic fever and glomerulonephritis (a cause of acute kidney failure).⁷ Moreover, nontreatment can lead to severe fever or abscess formation, which requires admission into the hospital or even emergent surgery (in the case of parapharyngeal or retropharyngeal abscesses). Viral infection usually needs no diagnosis, though COVID PCR samples may be taken for community health. Chronic pharyngitis and chronic laryngitis due to allergy and reflux can be diagnosed through physical examination by an otolaryngologist. Though one of the most common presenting symptoms of throat cancer is a progressive and persistent sore throat, it is often associated with weight loss, palpable neck masses and/or difficulties in swallowing or breathing. The diagnosis of throat cancer is a complex topic, though it involves a combination of physical examination, CT/MRI/PET scans and biopsy.^8,9

Can a sore throat be prevented or avoided?

The ways to avoid a sore throat are almost exactly the same as the ways to avoid a cough, as they share many similar causes. One important thing to note is that pharyngitis can rarely be caused by gonorrhoea, which is a sexually transmitted infection, and gonorrhoea pharyngitis is a direct result of oral sex, so practising safe sex and paying importance to sexual health should not be forgotten.¹⁰

Treatment for sore throat

Treatment for sore throat depends on the cause. Viral throat infections do not require specific treatment, though throat sprays may help with the pain. Viral tonsillitis can be severe and even require hospital admission, but even in that case, treatment is supportive. Bacterial tonsillitis, on the other hand, almost always requires treatment with antibiotics.¹¹ As mentioned above, there’s the risk of developing autoimmune complications from untreated strep throat and these are lifelong conditions. Aside from rheumatic heart disease and glomerulonephritis, there are even neuropsychiatric, autoimmune complications such as Sydenham chorea and PANDAS syndrome (though the acronym is cute, the disease is anything but), which can lead to severe issues in mental health and mental development.¹² Treatment of reflux and allergies are the same as discussed above.

When to seek medical attention?

Persistent cough accompanied by unexplained weight loss, hoarseness, swallowing pain, an unexplained neck mass or ear pain may be caused by throat cancer and requires urgent evaluation.^7,8 That said, an acute sore throat with acute hoarseness and acute cough in a young, fit and nonsmoking person is more likely to be viral laryngitis, so no need to rush to the hospital if the symptoms are acute.

A sore throat in which the pain is so severe that eating becomes difficult must be evaluated. Even if the cause is viral tonsillitis, hospital admission and supportive treatment can be of great value. Antibiotics are usually necessary when confronted with bacterial tonsillitis (especially strep throat if confirmed through throat cultures), which usually also involves swollen glands in the neck and the presence of fever as common symptoms. Abscess formation may lead to difficulty breathing or the pooling of saliva due to blockage by the mass effect, which is an emergency and may require drainage under local anaesthesia or surgery. Any sore throat accompanied by difficulty in breathing, difficulty in swallowing, severe fever or drooling must, therefore, be evaluated, as also recommended by the Mayo Clinic.¹ 

Summary

We hope that this article has been informative about the causes of cough, the causes of sore throat and the relationship between the two.