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CHAPTER 74 ■ SORE THROAT CHRISTINA LINDGREN, ANDREW M FINE INTRODUCTION Sore throat refers to any painful sensation localized to the pharynx or the surrounding areas Because young children, particularly those of preschool age, cannot describe their symptoms as precisely as adults, the clinician who evaluates a child with a sore throat must first define the exact nature of the complaint Occasionally, young patients with dysphagia (see Chapter 56 Pain: Dysphagia ), which results from disease in the area of the esophagus or with difficulty swallowing because of a neuromuscular disorder, will verbalize these feelings as a sore throat Careful questioning and examination usually suffices to distinguish between these complaints Although a sore throat is less likely to portend a life-threatening disorder than dysphagia or the inability to swallow, this complaint should not be dismissed without a thorough evaluation Most children with sore throats have self-limiting or easily treated pharyngeal infections, but a few have serious disorders such as retropharyngeal or lateral pharyngeal abscesses Even if the reason for the complaint of sore throat is believed to be an infectious pharyngitis, several different organisms may be responsible Symptomatic therapy, antibiotics, antiinflammatory drugs, or surgical intervention may be appropriate at times Most children experience no adverse consequences from misdiagnosis and inappropriate therapy, but a few may develop local extension of infection or sepsis, chronically debilitating illnesses such as rheumatic fever, or lifethreatening airway obstruction DIFFERENTIAL DIAGNOSIS Infectious Pharyngitis Infection is the most common cause of sore throat and is usually caused by respiratory viruses including adenoviruses, coxsackievirus A (various serotypes), influenza, or parainfluenza virus (see Chapter 94 Infectious Disease Emergencies and Tables 74.1 to 74.3 ) Viruses are the causative agents of infectious pharyngitis in 70% to 85% of patients, especially in adolescents and in children younger than years of age Several of the respiratory viruses produce easily identifiable syndromes, including hand–foot–mouth disease (coxsackievirus) and