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Throat (Sore Throat, Strep & Tonsils)

Most sore throats are caused by viruses and get better on their own within about a week, but a sore throat with trouble breathing, noisy breathing, drooling or being unable to swallow saliva, swelling of the lips or tongue, or a stiff neck with a high fever needs emergency care. Strep throat is a bacterial infection that needs a test and antibiotics, and a hoarse voice or sore throat that does not go away should be checked.

Call 911 (or go to the nearest emergency room) if a sore throat comes with any of these:

  • Difficulty breathing, or a high-pitched noisy sound when breathing in (stridor). The NHS lists both, along with being unable to swallow, drooling, and severe symptoms getting worse quickly (NHS). Epiglottitis (swelling of the flap that covers the windpipe) is a medical emergency; breathing may be easier leaning forward, a child may not want to lie down, and the person should stay upright until help arrives (NHS).
  • Drooling, or being unable to swallow even your own saliva — especially in a child. The NHS lists this as an emergency sign (NHS, NHS). MedlinePlus says a child who has trouble breathing, starts drooling or has a lot of trouble swallowing needs emergency care right away (MedlinePlus).
  • A severe sore throat that quickly gets worse, with swelling inside the mouth and throat, difficulty speaking, difficulty opening your mouth, or not being able to swallow. The NHS says these are signs of quinsy (a peritonsillar abscess, a pocket of pus beside a tonsil) (NHS). A review found most people recover well after the abscess is drained and antibiotics are given, though occasionally the infection spreads through the neck or chest (Klug et al., 2020).
  • Sudden swelling of the lips, mouth, tongue or throat, a tight throat or trouble swallowing — possible anaphylaxis (NHS).
  • A stiff neck with a high fever, a very painful headache, confusion, dislike of bright lights, or a rash that does not fade when pressed — possible meningitis (NHS).

See a clinician the same day if a sore throat comes with a rash (the NHS describes scarlet fever as a sore throat and high temperature followed by a rough, sandpaper-like rash 12 to 48 hours later; NHS), a very high temperature, signs of dehydration, pus-filled spots on the tonsils, a throat so painful that eating or drinking is difficult, or a weakened immune system, for example from diabetes or chemotherapy (NHS, NHS). CDC adds blood in saliva or phlegm and joint swelling and pain, and says to call a provider right away for a fever of 100.4°F (38°C) or higher in a child under 3 months (CDC).

The NHS is the UK’s health service, so in the U.S. call 911 where its pages say 999. No herb, adjustment, needle or massage treats these emergencies.

What is a sore throat?

MedlinePlus uses the medical term pharyngitis and says a sore throat has many causes, most often colds and flu, and also allergies, mononucleosis, smoking, strep throat and tonsillitis (MedlinePlus). The NHS says sore throats are usually caused by viruses or smoking, only occasionally by bacteria, and normally get better within a week; typical symptoms are pain on swallowing, a dry scratchy throat, redness, bad breath, a mild cough and swollen neck glands (NHS). See our Colds and Flu guides.

Viral sore throat or strep throat?

Strep throat is a bacterial infection of the throat and tonsils caused by group A Streptococcus. CDC says viruses cause most sore throats, and only around 1 in 10 adults and 3 in 10 children with a sore throat have strep. Strep starts 2 to 5 days after exposure, with fever, painful swallowing, red swollen tonsils, a sudden sore throat, tender neck glands, tiny red spots on the roof of the mouth, and white patches or pus on the tonsils. It is most common at ages 5 to 15, rare under 3, and spreads through close contact (CDC). A cough, runny nose, hoarseness or pink eye points toward a virus (CDC). Clinician guidance says clear viral symptoms mean no strep test is needed, but otherwise an exam alone cannot reliably tell the two apart (CDC, clinician guidance).

Tonsillitis

The tonsils are lumps of tissue at the back of the throat that help trap germs; tonsillitis is their inflammation. It is usually viral, sometimes strep, is most common in children over 2, and is less common in adults. Symptoms include a severe sore throat, red swollen tonsils, a white or yellow coating, swollen glands and fever (MedlinePlus). The NHS says it usually goes away in 3 to 4 days but can last longer (NHS).

Other causes worth knowing about

When to see a clinician (not an emergency)

CDC suggests contacting a provider about a sore throat, since they may test for strep, and seeking care if symptoms do not improve within a few days or get worse (CDC). The NHS says to see a GP if a sore throat lasts more than a week, keeps coming back, or comes with a lump in the mouth or neck or a mouth ulcer lasting over 3 weeks (NHS).

Children and medicines

CDC says never to give aspirin to children (Reye’s syndrome risk); under 6 months only acetaminophen is recommended, and from 6 months acetaminophen or ibuprofen. It advises avoiding over-the-counter cough and cold medicines under age 4 and not giving lozenges to children younger than 4 (CDC). We do not list doses; follow the label and your clinician. See our medication safety guide; see our Children guide.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Rest, fluids and pain relievers for most sore throats; a strep test when strep is suspected, with antibiotics only for confirmed bacterial infection; urgent treatment for abscesses and airway problems; tonsil removal for selected people; ENT evaluation for lasting hoarseness. Cost estimate being researched. Most sore throats improve on their own within about a week. Antibiotics help strep throat and reduce complications but give only a modest benefit for sore throats in general.
Chiropractic No proven role in sore throat, strep or tonsillitis. We found little research on chiropractic care for throat infections. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation. Not a substitute for testing or treatment, and never for the warning signs above. Neck manipulation has rare, serious risks.
Acupuncture Needle treatments sometimes used for sore throat pain and for pain after tonsil removal. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. One small trial found a single treatment no better than sham for sore throat pain; reviews for pain after tonsil surgery are more positive but rest on small studies.
Herbal medicine Honey for cough, sage or echinacea sprays, Pelargonium, licorice and slippery elm are among the products people use; some have small trials, none replaces testing for strep. Cost estimate being researched. A Cochrane review could not recommend any Chinese herbal formula for sore throat because the trials were of poor quality. Licorice can raise risks for some people, and honey must never be given to babies under 1 year.
Massage therapy Gentle massage for tension and relaxation; we found little research on massage for sore throat. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. May help you rest, but is not a treatment for infection. Avoid pressing on swollen glands.
MBHA Wellness Coach Everyday habits that support recovery and prevention: fluids and rest, not smoking, hand-washing, finishing prescribed antibiotics, voice care, reflux and allergy habits, and a simple symptom log. Cost estimate being researched. Supports — never replaces — medical care, and helps you notice when it is time to call a clinician.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the cause. The sections below cover Strep throat: testing, antibiotics and complications, Home care and pain relievers, Tonsil removal (tonsillectomy), Hoarseness and the voice box and Throat cancer warning signs. In short:

Check the leaflet or ask a pharmacist, since some medicines are not safe for everyone, for example in pregnancy (NHS).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care is not a treatment for a sore throat, strep or tonsillitis. In our PubMed searches we found little research on chiropractic care for throat infections, so we cannot say that adjustments help.

Where chiropractic may fit

If neck pain or headache lingers after the throat symptoms clear, see our Neck guide. But the throat comes first: a sore throat with a stiff neck and high fever can mean meningitis (NHS). One published case describes a man whose severe neck pain did not respond as expected to chiropractic treatment and was eventually found to be a deep neck infection (retropharyngeal abscess) (Fogeltanz and Pursel, 2006). It is a single case, but a reason to seek medical care if neck pain comes with fever, trouble swallowing or a sore throat.

Safety

NCCIH reports that mild side effects such as more pain, stiffness or headache often follow spinal manipulation and usually go away within 24 hours; serious problems are very rare, and neck-focused manipulation has been linked to small tears in neck artery walls (NCCIH).

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and about $90 to $200 for a first appointment (The Pricer). Medicare covers only spinal adjustments to correct a subluxation, not other services or tests a chiropractor orders (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture does not treat an infection and is not a substitute for a strep test. Two kinds of throat pain have been studied.

  • Sore throat: in a German trial of 60 people with acute tonsillitis and pharyngitis, one acupuncture treatment was compared with sham laser acupuncture. Pain on swallowing fell more in the acupuncture group, but the difference was not statistically significant, and the study ended early for lack of patients (Fleckenstein et al., 2009). A European guideline calls the evidence for herbal treatments and acupuncture inconsistent (ESCMID Sore Throat Guideline Group, 2012).
  • Pain after tonsil removal: a 2019 systematic review of 12 studies concluded acupuncture can help reduce complications around children’s tonsillectomy (Pouy et al., 2019), while a 2014 review of 24 studies of non-drug approaches said there were too few studies per category to make recommendations (Fayoux and Wood, 2014). Promising but unproven; talk with the surgical team first.

Safety

NCCIH says relatively few complications have been reported, mostly from nonsterile needles or improper treatment, which can cause infections, punctured organs and injury to the central nervous system (NCCIH). Choose a licensed practitioner.

What it costs

The Pricer lists about $90 to $185 per follow-up visit, with community acupuncture around $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

The research on herbs for sore throat is mixed, mostly small and short, and none of it replaces a strep test or the care above.

  • Chinese herbal formulas: a Cochrane review of 12 trials (1,954 people) found some formulas beat the comparison treatment, but ten of the 12 studies were poor quality, and the authors could not recommend any formula (Huang et al., 2012).
  • Sage and echinacea: in a trial of 286 people with viral pharyngitis, a sage spray reduced throat pain more than placebo in the first two hours, with only mild side effects (Hubbert et al., 2006). In 154 people, an echinacea and sage spray worked about as well as an antiseptic and numbing spray (Schapowal et al., 2009). NCCIH says echinacea may slightly reduce the chance of catching a cold, and some people have severe allergic reactions (NCCIH).
  • Pelargonium: in 143 children aged 6 to 10 with non-strep sore throat, an extract reduced a symptom score more than placebo (Bereznoy et al., 2003); we found only this one throat trial. The NHS says evidence for herbal medicines for cough is limited, and some are not safe for everyone, for example in pregnancy (NHS).
  • Licorice: NCCIH says there is not enough high-quality evidence to support licorice for any condition, though a gargle before surgery might lessen sore throat after a breathing tube (NCCIH); a trial of 236 patients found it roughly halved that problem (Ruetzler et al., 2013), and a network meta-analysis agreed (Singh et al., 2020). That is a sore throat from a tube, not an infection. NCCIH warns that glycyrrhizin can cause serious problems such as irregular heartbeat, especially in large amounts; even small amounts have been linked to severe effects in people with high blood pressure or heart or kidney conditions, large oral amounts are unsafe in pregnancy, and interactions with corticosteroids have been reported (NCCIH).
  • Slippery elm: a government drug-safety database entry says the inner bark is used by mouth for sore throat, is generally recognized as safe, and has no evidence of liver injury (LiverTox). That describes use and safety, not proof it works; we found little research testing it for sore throat.
  • Honey: the NHS lists hot lemon and honey for coughs, notes limited evidence, and says it is not suitable for babies under 1 year (NHS). CDC says honey can relieve cough in children at least 1 year old and adults (CDC). A 2021 meta-analysis of 14 studies found honey improved cough and combined symptom scores in upper respiratory infections compared with usual care, mostly cough rather than sore throat (Abuelgasim et al., 2021). Never give honey to a child under 1 year old; it can contain the bacteria that cause botulism (CDC).

Safety

NCCIH reminds us that supplements can interact with medicines or pose risks with certain conditions or before surgery, and that “natural” does not always mean safe (NCCIH). Tell your doctor and pharmacist about every product you take. We don’t list doses.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

We found little research on massage for sore throat. It will not treat an infection, but a gentle shoulder, scalp or back massage may help you relax and rest, which the NHS recommends (NHS).

Safety

  • NCCIH says the risk of harm appears low, but rare serious problems such as a blood clot, nerve injury or bone fracture have been reported, some after vigorous deep-tissue massage (NCCIH).
  • MBHA suggests skipping massage of the front or sides of the neck while glands are swollen or tender or you have a fever. A swollen, painful neck with trouble swallowing or breathing is an emergency.
  • After mono, providers recommend avoiding contact sports and intense exercise for about a month (MedlinePlus); asking your clinician before deep abdominal bodywork is MBHA’s suggestion, not that source’s.

What it costs

One national chain’s membership runs about $70 to $90 a month on a 12-month term (The Pricer). Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn these steps into a routine and notice when to call a clinician — alongside, never instead of, medical care.

Comfort and recovery

The NHS suggests plenty of water, cool or soft foods, rest, and avoiding smoking and smoky places (NHS). CDC lists a clean humidifier or cool mist vaporizer and warm drinks (CDC).

Stop the spread

CDC advises washing hands often, covering coughs and sneezes, and not sharing cups, utensils or food with sick people (CDC). For strep, stay home until the fever is gone and at least 12 to 24 hours after starting antibiotics (CDC, clinician guidance). For mono, the NHS says not to share cups or cutlery or kiss others (NHS).

Antibiotics, voice, reflux and allergies

MedlinePlus stresses finishing antibiotics even if you feel better (MedlinePlus). NIDCD lists not smoking, staying hydrated, resting your voice and using a humidifier as voice care (NIDCD); see our Smoking guide. For reflux the NHS suggests smaller meals, not eating 3 or 4 hours before bed, avoiding trigger foods and raising the head of the bed with blocks rather than extra pillows (NHS); for hay fever, showering after being outdoors and keeping windows shut (NHS).

Keep a simple log

If infections keep coming back, the tonsil guideline asks that each episode be documented with at least one of: a temperature above 101°F, swollen neck glands, pus on the tonsils or a positive strep test (Mitchell et al., 2019). A coach can help you keep those notes.

What it costs

Cost estimate being researched.

Another approach

Strep throat: testing, antibiotics and complications

Testing

Providers can diagnose strep with a quick clinic test or a throat culture (CDC). Both use a swab of the tonsils and throat; the rapid test gives results in minutes, the culture takes days but is more reliable (MedlinePlus). CDC’s clinician guidance says a culture should follow a negative rapid test in children older than 3, but is not routinely needed at other ages (CDC, clinician guidance). The European guideline says a culture is not needed after a negative rapid test, and that the Centor scoring system can help decide who to test (ESCMID Sore Throat Guideline Group, 2012). Guidelines differ, so ask your clinician. CDC notes that some people test positive without symptoms (carriers) (CDC).

Antibiotics: when they help and when they don’t

CDC’s clinician guidance says people of any age with a positive test need antibiotics, viral sore throat should not be treated with them, and penicillin or amoxicillin is the antibiotic of choice. Treatment shortens symptoms, reduces spread and decreases complications (CDC, clinician guidance). We give no doses or durations; take the antibiotic exactly as prescribed.

For sore throats in general the benefit is modest. A Cochrane review of 29 trials (15,337 cases) found antibiotics reduced sore throat at day three (number needed to treat less than six) but at one week the number needed to treat was 18, because 82% of people given placebo or no treatment were symptom-free by then. Most trials were from the 1950s, few separated viral from bacterial causes, and harms were poorly reported (Spinks et al., 2021). The European guideline recommends against antibiotics for people with few strep-like features (ESCMID Sore Throat Guideline Group, 2012).

Complications

CDC lists abscesses around the tonsils or in the neck, ear and sinus infections, a kidney disease (post-streptococcal glomerulonephritis) and rheumatic fever (CDC), which are more likely after an untreated infection (CDC, clinician guidance). In the Cochrane review, antibiotics reduced ear infection, quinsy and rheumatic fever, though rheumatic fever is now very rare (Spinks et al., 2021). The NHS says rheumatic fever appears 1 to 5 weeks after a bacterial throat infection, mainly in children, with fever, painful swollen joints, chest pain, breathlessness or jerky movements; most recover fully, but it can recur and cause lasting heart damage (NHS). See a clinician promptly if these follow a throat infection.

What it costs

Cost estimate being researched.

Another approach

Home care and pain relievers

For viral sore throats, comfort is the main treatment. The NHS suggests gargling with warm salty water (not for children), plenty of water, cool or soft foods, resting, and ice cubes or hard sweets (but nothing small and hard for young children, because of choking) (NHS). MedlinePlus adds warm liquids, popsicles and a bedroom humidifier (MedlinePlus). We did not review research on how well gargling works, so think of it as a comfort measure.

Pain relievers, by type

Avoid doubling up on products with the same ingredient; see our medication safety guide.

What it costs

Cost estimate being researched.

Another approach

Tonsil removal (tonsillectomy)

The NHS says it is very rare for someone to need their tonsils out, usually only after severe tonsillitis that keeps coming back (NHS). MedlinePlus lists three reasons for a child: repeated tonsillitis, bacterial tonsillitis that does not improve with antibiotics, and tonsils so large they cause trouble breathing or swallowing. Most children go home the same day; recovery takes a week or two (MedlinePlus).

What the guideline says about children

A 2019 U.S. guideline for ages 1 to 18 strongly recommends watchful waiting if there have been fewer than 7 throat infections in the past year, fewer than 5 a year for 2 years, or fewer than 3 a year for 3 years. At or above those numbers, with each episode documented, clinicians may recommend surgery. It also says to consider factors such as multiple antibiotic allergies, a condition called PFAPA (periodic fever with mouth sores, sore throat and swollen glands) or more than one peritonsillar abscess, and recommends tonsillectomy for children with sleep apnea documented by an overnight sleep study (Mitchell et al., 2019). See our Snoring and Sleep Apnea guides.

How much does it help?

The benefit is real but modest. A Cochrane review found children had about 3 sore throat episodes in the first year after surgery versus 3.6 without it; for adults the evidence (two small trials) was too limited for a firm conclusion. It notes a small but significant bleeding risk and that surgery is particularly uncomfortable for adults (Burton et al., 2014). A 2017 systematic review found fewer throat infections and missed school days in the first year, but benefits did not persist (Morad et al., 2017).

What it costs

Cost estimate being researched.

Another approach

Hoarseness and the voice box

Hoarseness means the voice sounds breathy, raspy or strained, softer or lower, and the throat may feel scratchy; it often signals a problem with the vocal folds in the voice box (NIDCD).

Short-term causes and voice rest

The NHS says laryngitis usually clears within 1 to 2 weeks; speak as little as possible, drink fluids, keep the air moist, and do not talk loudly or whisper, since both strain the voice (NHS). NIDCD says resting, using your voice less and drinking lots of water should help hoarseness from overuse, and suggests voice therapy for people whose jobs depend on their voices (NIDCD).

When hoarseness needs checking

Sources draw the line differently, so when in doubt call sooner. The NHS says to see a GP if laryngitis does not improve after 2 weeks (NHS). NIDCD says to see a doctor after more than three weeks of hoarseness, especially without a cold or flu, or sooner for coughing up blood, trouble swallowing, a neck lump, pain when speaking or swallowing, or difficulty breathing (NIDCD). A 2018 U.S. guideline recommends a scope exam if a voice problem has not resolved or improved within 4 weeks, or at any time if a serious cause is suspected, with faster evaluation after recent head, neck or chest surgery or intubation, a neck mass, stridor, or a history of tobacco use. It advises against routine antibiotics for hoarseness (Stachler et al., 2018).

Other causes

NIDCD lists reflux reaching the voice box, nodules and polyps, vocal fold paralysis, thyroid problems and nerve conditions, and notes hoarseness can be a symptom of laryngeal cancer (NIDCD). MedlinePlus says most voice problems can be treated successfully when found early (MedlinePlus).

What it costs

Cost estimate being researched.

Another approach

Throat cancer warning signs

NCI says head and neck cancers account for nearly 4% of all cancers in the United States, and lists symptoms that may include a lump in the neck, a sore in the mouth or throat that does not heal, a sore throat that does not go away, trouble swallowing, and a voice change or hoarseness. These can also come from less serious conditions, but NCI says to check with a doctor or dentist (NCI). For voice box cancer the NHS adds shortness of breath, and says finding it early may make it easier to treat (NHS).

The smoking link

NCI says alcohol and tobacco, including secondhand smoke and smokeless tobacco, are the two most important risk factors, especially for cancers of the mouth, lower throat and voice box, and using both raises risk more than either alone; cancer-causing HPV is a risk factor for cancers of the tonsils and base of the tongue (NCI). The NHS says quitting smoking and cutting down on alcohol can lower the chance of voice box cancer (NHS). See our Smoking and Cancer guides.

What it costs

Cost estimate being researched.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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