Why do we get sore throats and earache?

Cough, mucous, high temperature, feeling unwell, hoarse voice, pain when swallowing...don't worry, these are not symptoms of a new variant of the coronavirus. They are problems which have been around forever, and are related to the throat, nose and ears.

Otitis, laryngitis, pharyngitis and rhinitis are the most common pathologies of the upper respiratory tract, in children as well as adults. After all, who hasn't had a hoarse voice, sore throat or earache at some point in their life?

"They are so common that one out of every four consultations we receive in pharmacies is related to these, and those have increased a great deal in the pandemic because it has become more difficult to make an appointment with your GP," says María Isabel de Andrés, the national spokesperson on Sight and Hearing of the General Council of Pharmaceutical Colleges, which has just launched a campaign to raise awareness of health problems that affect these three organs.

"As well as providing information about those, we can also help to identify risk situations which should be treated by a specialist," she says.

Dr Isabel García López, the general secretary of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL CCC), has some advice about the main disorders that affect the ears, throat and nose, and what can be done about them.

Otitis is an inflammation of the ear which is generally caused by an infection, and there are two types: external and middle or acute. "The first type is typically what happens after spending time in a swimming pool," says Dr García López.

The ear becomes infected by fungus because of the dampness that remains in the ear duct and it can be painful but mostly itches.

"To prevent this from happening, you should try not to get your ears wet, or at least make sure you dry them properly once you get out of the water," she says.

"External otitis can also be caused by a bacterial infection, caused by anything from a small wound in the duct to a tiny hair that becomes cyst-like, like a boil," the doctor explains.

This type of otitis is normally treated with ear drops, although in some cases, such as more serious infections, people with diabetes and those whose immune systems are suppressed, oral antibiotics may be needed. The condition will normally improve after a couple of days.

In the case of middle otitis, and unlike the external variety, the infection does not come from the outside but enters from the inside of the ear, from the Eustacian tube.

There are also two types of middle otitis: serious and infectious. "The first type is the classic one that children usually get. Actually, this isn't really an infection. What happens in these cases is that the eardrum, which under normal circumstances contains nothing but air, fills with mucous and stops you hearing properly. These patients need specific treatment with nasal decongestants and occasionally can even need surgery (drainages)", explains Dr García López.

When this mucous accumulates over many days in the ear cavity it usually becomes infected (normally from bacteria) and turns into acute otitis, which in most cases is very painful and can lead to fever.

"So now the ear isn't full of mucous, it is full of pus, and that is more dangerous because the infection can spread to other parts of the head. It is always treated with antibiotics," says Dr García López.

To prevent this type of otitis, frequent nasal washes are recommended. "It is important for the nose to be kept clean and well ventilated," she says.

When it comes to throat problems, laryngitis and pharyngitis are the most common. "The larynx and pharynx are very close to each other, but they are two completely different organs. The larynx is the conduit through which air and food passes, where our voice comes from," explains Dr García López.

When the inflammation affects the vocal chords (as it does in most cases of laryngitis in adults) the patient usually sounds hoarse. If the laryngitis is caused by catarrh or flu for a couple of days there is no need to see a doctor. Just rest your voice, drink plenty of liquid and take an analgesic," she says.

In children, laryngitis is more complicated because it normally affects the area which is above the vocal chords (epiglottis) and if that area becomes inflamed it can restrict their breathing.

"That usually happens at night and it scares many parents because the child goes to bed as usual with no symptoms and then suddenly wakes up finding it difficult to breathe and with a very characteristic barking cough. The first thing to do is give them an ibuprofen (which is anti-inflammatory) and open the window so the child can breathe cold air. If he or she doesn't improve, then go to the Emergency Department," says Dr García López.

With pharyngitis, what happens is that there is an infection of the mucous membranes around the tonsils, nearly always caused by a virus. In this case, the most common symptom is pain when swallowing.

"When it is viral in origin, it can be controlled with anti-inflammatories, while if the infection is caused by bacteria it will need antibiotic treatment," says the doctor.

There are also differences between the viral and allergic types of rhinitis.

"With viral rhinitis there is mucous, sneezing... the classic symptoms of a common cold, although it is true that it can become complicated by a bacterial infection (green mucous) or sinusitis (rhinosinusitis), which is the most common infectious condition," says Dr García López.

"Allergies, which are becoming increasingly common, tend to be seasonal and the symptoms vary, depending on the allergen which is causing the reaction, although in most people who suffer from this type of rhinitis there is itching, sneezing and the mucous is more liquid and clear," she says.