Sore Throat No Fever with Nasal Congestion

TheresaK Asked :

I have been experiencing a persistent sore throat for 3 days, mainly in the morning when I wake up. It started after a late night out and I was out in the cold and drinking alcohol. At first I thought it was from the booze and weather and maybe I had caught a cold. But it is going on with no fever or tiredness like one would get with the cold or flu. I have often had problems with a blocked nose due to a deviated septum (or so my doctor says) but the sore throat was never a part of it. The throat feels swollen when I wake up like I swallowed something big or hard and even my voice sounds a bit gruff, not just nasally.  There is no pain, just an irritating swollen feeling. It settles down after a few hours though. Since it is going on for 3 days, I am wondering if I could have caused any damage to the throat because I also smoked a few cigarettes on that night but I am not a smoker.

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Dr. Chris Answered :

There are a number of reasons for a sore throat that may not be due to infectious  causes. However the lack of a fever should not exclude a possible infection immediately. In this case, however, it is likely that the soreness is due to mouth breathing since you currently have a blocked nose. Breathing through the mouth causes dryness of the mouth and throat and this can often lead to a sore throat. The effect is worse at night because you would not be drinking any water while asleep and saliva production reduces during sleep.

You could also be suffering with a post nasal drip. This is the drainage of the mucus from the nose and sinuses into the back of the throat. There may be no infection but this does irritate and inflame the tissue of the throat. Post nasal drip may not always be obvious. Sometimes you may only notice some mucus collecting at the back of the throat. At other times it may present with a constant itchy throat feeling or a persistent shallow cough to clear your throat. Post nasal drip is often aggravated in cold weather and results in a sore throat and hoarse voice.

Another possibility is that the alcohol and cigarette smoking may have caused or exacerbated gastroesophageal reflux (‘acid reflux’). When you sleep the gastric acid can rise to the back of the throat and cause inflammation of the tissue in this area. In this case, you will typically wake up with a sore throat in the morning that eases during the course of the day only to recur the next morning. Inflammation results in localized swelling which would explain the type of sore throat that you are experiencing and this can also affect the voice tone – hoarseness more than a nasal tone.

You should speak to your doctor about your symptoms. Any lymph node swelling in the area may be an indication of an infection although you would have noticed more pronounced symptoms like a constant sore throat throughout the day, mucus production, pain or a fever at this point. Your doctor will need to prescribe medication for your nasal congestion and this may help to ease your sore throat if it is due to mouth breathing. If this is not effective, then it would be advisable to assess if you are suffering with gastroesophageal reflux disease (GERD).

There are other causes of a persistent sore throat but these will only be considered once your doctor excludes more common causes as mentioned above.

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