What is Odynophagia?
Odynophagia is the medical term for pain when swallowing. The pain may stem from the mouth, throat (pharynx) or esophagus (gullet). At times, odynophagia may also be related to pathology within the larynx. The mechanism of swallowing is both voluntary and involuntary and starts in the throat and extends to the eosphagus as discussed under the Swallowing Reflex. While pain during swallowing may be felt in the mouth or throat (oropharyngeal causes), esophageal causes of odynophagia may present as chest pain.
Signs and Symptoms Accompanying Odynophagia
Pain when swallowing may present along with dysphagia (difficulty swallowing) or exist on its own despite a normal swallowing reflex and absence of regurgitation. At times odynophagia may also be a feature of stomatodynia, which is pain in the mouth. In this case, the pain is exacerbated upon swallowing. Many of the inflammatory causes of mouth pain (stomatodynia), especially those extending to the throat, will present with an exacerbation of pain during ingestion, mastication (chewing) and swallowing.
Pain when swallowing may also be noticed upon consuming certain foods, like hot foods or drinks. At other times, swallowing may present with some discomfort and mild pain that is most pronounced in the morning after awakening and eases during the course of the day. The modalities are important indicators for a possible cause.
Hot drinks and foods that result in pain upon swallowing is indicative of lesions in the throat, like an ulcer. Morning odynophagia may be related to severe gastroesophageal reflux disease (GERD) which causes reflux pharyngitis. A persistent sore throat in the morning is another complaint in reflux pharyngitis.
Odynophagia that presents with dyspnea (difficulty breathing) or dysphonia (hoarse voice, whispering voice) may be indicative of pathology within the larynx or trachea or a partial obstruction of the throat.
Causes of Painful Swallowing
Acute or chronic infectious stomatitis (mouth), tonsillopharyngitis (tonsils, throat), epiglottitis (epiglottis) and esophagitis (esophagus) may result in odynophagia. It is more pronounced in severe infections and in certain cases, dysphagia (difficulty swallowing) may also be present. Many patients with an infection of the mouth, throat or esophagus will only report odynophagia as the main symptom in chronic infections.
These infections may cause sores, ulcers, abscesses or diffuse inflammation in the related structure. Some of the infectious causes of odynophagia include :
- Oral candidiasis
- Primary HIV infection as well as opportunistic upper alimentary tract infections
- Cytomegalovirus (CMV)
- Epstein-Barr (EBV)
- Any infectious cause of an acute or chronic sore throat
- Herpes simplex virus (HSV)
Foreign bodies lodged in the lining of the throat or esophagus, as well as objects partially or completely obstructing these areas, may lead to odynophagia. An obstruction of the throat will also affect breathing. Small and sharp foreign bodies that pierce the lining of the throat, tonsils or esophagus, like fish bones, are common causes.
Inflammation, Sores and Ulcers
There are a number of non-infectious causes of inflammation and ulceration within the alimentary tract. Inflammation of the larynx may also result in odynophagia, due to the role of the larynx in the swallowing reflex.
The causes may be related to trauma (after diagnostic investigations, hot foods/drinks, caustic substances), autoimmune diseases, radiation, acid (GERD) and inhalation of toxic gases.
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An abscess or ulcer in the throat or esophagus will also result in odynophagia.
Cancer of the mouth, throat, larynx, thyroid, neck, and esophagus may result in odynophagia. This should be considered as a possible cause in high risk patients like cigarette smokers, especially if it is accompanied by dysphagia and unintentional weight loss. Metastases should always be a consideration in a cancer patient reporting odynophagia and/or dysphagia.
The following conditions affecting mainly the esophagus may present with odynophagia. Pain in the chest is usually present as a result of esophagus pain. Patients often, quite incorrectly, report the symptoms as pain after swallowing, although it is related to the involuntary esophageal stage of swallowing.
- Esophageal spasms – diffuse or nutcracker syndrome
- Esophageal tears/perforation
- Esophageal ulcers
- Esophageal webs
- Zenker’s diverticulum