How do I treat a sore throat, nasal congestion, and tingling in my ears?

Treatment of Viral Upper Respiratory Infection (Common Cold)

Your symptoms of sore throat, nasal congestion, and ear tingling represent a typical viral upper respiratory infection (common cold) that requires symptomatic treatment only—antibiotics are not indicated and cause more harm than benefit. 1

First-Line Symptomatic Treatment

For Sore Throat Pain

• Ibuprofen is the preferred first-line analgesic, showing slightly better efficacy than paracetamol (acetaminophen) for pain relief, particularly within the first 2 hours 2
• Paracetamol is an acceptable alternative if ibuprofen is contraindicated, though it may help nasal obstruction and rhinorrhea but does not significantly improve sore throat pain 1
• Both medications are safe for short-term use with low risk of adverse effects 2

For Nasal Congestion

• Oral or nasal decongestants (such as pseudoephedrine or oxymetazoline) provide small but positive effects on subjective nasal congestion 1
• Critical warning: Limit topical nasal decongestant use to 3 days maximum to avoid rebound congestion (rhinitis medicamentosa) 3
• Oral decongestants do not increase risk of adverse events in adults with short-term use 1

For Ear Tingling/Discomfort

• NSAIDs (like ibuprofen) produce significant benefits for ear pain through their analgesic effects 1
• The ear tingling likely represents eustachian tube dysfunction from nasal congestion, which improves as congestion resolves 4

Additional Symptomatic Options

• Nasal saline irrigation may provide modest benefit, particularly for reducing nasal secretions and breathing obstruction, though clinical significance is limited 1, 5
• Antihistamine-decongestant-analgesic combinations show some general benefit in adults but must be weighed against increased side effects 1
• Ipratropium bromide nasal spray effectively reduces rhinorrhea but does not help congestion 1

What NOT to Use

• Antibiotics are contraindicated: No evidence of benefit for common cold, with significant risk of adverse effects and antibiotic resistance 1
• Nasal corticosteroids are ineffective for symptomatic relief from the common cold 1
• Antihistamines alone have only limited short-term benefit (days 1-2) with no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing 1
• Zinc gluconate is not recommended due to conflicting efficacy and increased adverse effects 2
• Herbal treatments and acupuncture lack reliable evidence 2
• Steam or heated humidified air shows no benefits 1

Red Flags Requiring Urgent Evaluation

• Difficulty swallowing, drooling, or neck swelling suggests peritonsillar abscess, parapharyngeal abscess, or epiglottitis requiring immediate evaluation 6
• Severe unilateral throat pain with trismus and uvular deviation indicates peritonsillar abscess 6
• Persistent high fever (>3 days) or worsening symptoms after initial improvement may indicate bacterial superinfection requiring reassessment 1

Duration and Expectations

• Symptoms typically resolve within 7-10 days without treatment 1
• If sore throat persists beyond 5-7 days or worsens, consider bacterial pharyngitis and apply Centor criteria (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough) to determine if testing for Group A Streptococcus is warranted 6
• Only patients with 2 or more Centor criteria require testing with rapid antigen detection test 6

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on purulent nasal discharge alone—this is typical of viral infections and does not indicate bacterial infection 1
• Do not use topical nasal decongestants beyond 3 days, as this causes rebound congestion that is often worse than the original symptoms 3
• Do not assume ear symptoms require antibiotics—ear tingling/fullness from eustachian tube dysfunction is expected with nasal congestion and resolves with the cold 4