Swallowing Pain (Odynophagia) – Causes and Symptoms

The medical term for pain felt during swallowing is odynophagia. The pain felt in odynophagia may have its origin in different parts of the upper alimentary canal: the mouth, the throat (also known as the pharynx), the esophagus (also called the food pipe), and the larynx (also known as the voice box). Since the act of swallowing is central to eating and drinking, pain during swallowing can affect normal food and water intake.

At first thought, swallowing seems to be a simple passive process where food in the mouth falls down into the esophagus. However, swallowing is a complex act, with both voluntary and involuntary components. A number of tissues take part in executing the act of swallowing. The actions of the various tissues in the act of swallowing is coordinated by the nervous system, through a mechanism known as the swallowing reflex.

Signs and Symptoms

Pain during swallowing can occur in a variety of conditions and exhibit different signs and symptoms. For example, unlike the causes in the mouth or throat (technically referred to as oropharyngeal causes), esophageal causes of odynophagia may manifest as chest pain. The following are some of the signs and symptoms associated with swallowing pain:

  • Pain during swallowing may occur without any effect on the normal swallowing reflex. Swallowing pain may not be accompanied by regurgitation of food.
  • In some cases, pain during swallowing may cause difficulty in swallowing (technically known as dysphagia).
  • Swallowing pain may be accompanied by pain in the mouth (technically referred to as stomatodynia). In these cases, swallowing also increases the pain in the mouth. Stomatodynia caused by inflammatory conditions may extend to the throat, and may worsen the pain during ingestion of food, mastication of food, and swallowing of food.
  • Pain during swallowing may be precipitated upon consumption of hot and spicy foods or drinks. Such pain indicates the presence of some lesion (like ulcer) in the throat.
  • Swallowing pain may occur in the mornings upon waking up from sleep. This type of pain may ease up as the day progresses. This type of morning odynophagia may be due to gastroesophageal reflux disease (commonly abbreviated as GERD) causing reflux pharyngitis. A common symptom of reflux pharyngitis is persistent sore throat in the mornings.
  • Pain during swallowing may also be accompanied by difficulty in breathing (technically referred to as dyspnea) or a hoarseness in voice (technically referred to as dysphonia). Simultaneous occurrence of these conditions indicate the presence of some pathology in the larynx or trachea. There may even be a partial obstruction of the throat.

Causes of Swallowing Pain

There are a number of different causes of odynophagia and some of the more common causes are discussed below.

Infections

A variety of infections in the mouth, throat, epiglottis, and esophagus may cause pain during swallowing. These infections can manifest as ulcers, abscesses, sore, or inflammation in the structures of the oral cavity and the throat. Examples of infections of the mouth that cause swallowing pain include acute infectious stomatitis and chronic infectious stomatitis. An example of a throat infection that can lead to pain during swallowing is tonsillopharyngitis. Both the tonsils and the throat are affected in tonsillopharyngitis.

Inflammation of the epiglottis (technically known as epiglottitis)and inflammation of the esophagus (technically known as esophagitis) may also cause pain during swallowing. The intensity of pain during swallowing is more pronounced when the infection is severe. Other symptoms such as difficulty in swallowing (dysphagia) may also be present along with odynophagia. However, in many cases of chronic infections of the mouth, throat and esophagus, patients report difficulty in swallowing as the only main symptom.

Some of the pathogens responsible for infections that result in swallowing pain include HIV, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, and yeast (causing oral candidiasis). Bacterial infections of the throat may also cause sore throat and pain during swallowing.

Read more on strep throat.

Foreign body

Pain during swallowing may also be caused by a foreign body that getss lodged in the throat or the esophagus. These foreign objects may block the passage of food either partially or completely. Obstruction of throat due to the presence of a foreign body could also affect the passage of air, leading to difficulties in breathing. Sharp foreign bodies may also pierce the lining of the throat, tonsils, or esophagus, resulting in injuries that make swallowing painful. Foreign bodies that get lodged in the throat are typically small and sharp objects such as fish bones.

Inflammation, sores or ulcers

Presence of non-infectious inflammation, sores or ulcers in the upper part of the alimentary canal could also lead to pain during swallowing. However, inflammatory conditions resulting in odynophagia are not limited to the alimentary canal. Inflammation of the larynx could also result in swallowing pain. This is because larynx is a part of the swallowing reflex, in which food is prevented from getting into the respiratory tract.

Some examples of inflammatory conditions associated with swallowing pain are mouth sores, pharyngitis, laryngitis, and esophagitis. Odynophagia may also result from an ulcer or abscess within the throat or the esophagus. Inflammation, sores, and ulcers in the mouth, throat, larynx, and esophagus may be caused by different factors. Potential causes include regurgitation of stomach acid in gastroesophageal reflux disease (abbreviated as GERD), intake of hot foods or drinks, radiation therapy, inhalation of toxic gases and autoimmune disorders.

Read more on GERD.

Tumors

Pain during swallowing may also be caused by the presence of tumors in the mouth, throat, larynx, neck, thyroid gland, and esophagus. Cancer should be considered as a putative cause of swallowing pain in patients who indulge in high-risk behaviors such as cigarette smoking. This is especially important if pain during swallowing is also accompanied by difficulty in swallowing, and sudden weight loss. In cancer patients who report difficulty or pain during swallowing, metastasis should be a consideration.

Esophageal disorders

A number of conditions that affect the esophagus may cause pain during swallowing. A characteristic feature of the involvement of esophagus is pain in the chest region. Pain reported by patients with esophageal conditions is related to the involuntary esophageal stage of the swallowing process. Esophageal conditions that may cause odynophagia include ulcers, esophageal webs, esophageal spasms, achalasia, esopheageal tears or perforation, gastroesophageal reflux disease, and Zenker’s diverticulum.

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