Painful Swallowing (Odynophagia)

Swallowing is a complex process that most people take for granted until they experience discomfort or pain. Pain while swallowing, also known as odynophagia, can be a distressing symptom that affects your ability to consume food and liquids and your overall quality of life. This condition can arise from various underlying causes, ranging from minor throat irritations to more serious medical ailments. Understanding the potential causes, manifestations, and treatment options is crucial for managing this issue effectively.

Causes of Pain When Swallowing

Pain while swallowing can stem from a variety of factors, including:

• Infections:
  • Strep throat (streptococcal pharyngitis)
  • Viral infections
  • Tonsillitis
  • Oral thrush (candidiasis)
  • Oesophageal infections (candidiasis, herpes simplex virus)
• Inflammation:
  • Esophagitis (inflammation of the oesophagus)
  • Gastroesophageal reflux disease (GERD)
  • Eosinophilic esophagitis (an allergic condition)
• Structural abnormalities:
  • Oesophageal strictures (narrowing of the oesophagus)
  • Oesophageal rings or webs
  • Schatzki ring (a ring-like narrowing in the oesophagus)
  • Killian’s dehiscence
• Injuries or trauma:
  • Accidental ingestion of caustic substances
  • Radiation therapy for head and neck cancers
  • Oesophageal surgery or instrumentation
• Other conditions:
  • Muscle disorders (e.g., achalasia, scleroderma)
  • Tumours or masses in the oesophagus or surrounding structures
  • Oral lesions or mouth sores

Symptoms associated with Painful Swallowing

The symptoms associated with painful swallowing can differ based on the underlying cause. Common signs and symptoms may include:

• A burning or stinging sensation when swallowing
• A feeling of something stuck in your throat
• Difficulty or inability to swallow
• Pain that worsens with certain foods or liquids (e.g., hot, spicy, or acidic)
• Drooling or excessive saliva production
• Regurgitation or vomiting
• Weight loss (in severe cases)

It's important to note that some people may experience additional symptoms, such as fever, sore throat, or difficulty breathing, which can provide clues about the underlying condition.

Complications

If left untreated, painful swallowing can lead to various complications, including:

• Dehydration and malnutrition: If you cannot consume adequate fluids and nutrients due to the pain, you may become dehydrated or malnourished, which can have severe consequences for your overall health.
• Aspiration pneumonia: Difficulty swallowing can increase the risk of food or liquids entering the lungs, potentially leading to aspiration pneumonia, a serious lung infection.
• Oesophageal strictures or narrowing: Prolonged inflammation or damage to the oesophagus can cause scarring and the formation of strictures, further complicating the swallowing process.
• Oesophageal perforation: In rare cases, severe trauma or ingestion of caustic substances can lead to perforation or tear in the oesophagus, which is a medical emergency requiring immediate treatment.

Diagnosis

To determine the underlying reason for your painful swallowing, your doctor may recommend the following diagnostic tests:

• Physical evaluation: Your doctor will likely examine your throat, mouth, and neck for any visible signs of inflammation, lesions, or abnormalities.
• Endoscopy: This procedure includes inserting a thin, flexible tube with a camera (endoscope) through your mouth or nose to examine the oesophagus, stomach, and surrounding structures visually.
• Barium swallow study: This imaging test involves swallowing a contrast material (barium) and taking X-rays to visualise the oesophagus and identify any structural abnormalities or obstructions.
• Oesophageal manometry: This test measures the pressure and motility (movement) of the oesophagus during swallowing, which can help diagnose conditions like achalasia or oesophageal spasms.
• CT or MRI of Neck and Thorax 
• Laboratory tests: Your doctor can prescribe blood tests or cultures to check for infections or other underlying conditions.

Depending on the findings, additional tests or consultations with specialists may be necessary to establish an accurate diagnosis.

Treatment for Painful Swallowing

The treatment approach for painful swallowing will depend on the underlying cause and severity of this condition. Some common treatment modalities include:

• Medications:
  • Your doctor may recommend various medicines according to the underlying causes, such as:
  • Antacids or proton pump inhibitors for acid reflux or esophagitis
  • Antibiotics for bacterial infections
  • Antifungal medications for fungal infections
  • Corticosteroids to reduce inflammation
  • Pain relievers or numbing agents for temporary relief
• Dietary modifications:
  • Avoiding hot, spicy, or acidic foods that may exacerbate the pain
  • Consuming soft, blended, or liquid foods until the condition improves
  • Staying hydrated by drinking plenty of fluids
• Endoscopic procedures:
  • Dilation (stretching) of oesophageal strictures 
  • Removal of oesophageal rings or webs
  • Injection of botulinum toxin for achalasia or oesophageal spasms
• Surgery:
  • Doctors recommend oesophageal surgery for severe or persistent cases, such as removing tumours or repairing structural abnormalities.
• Lifestyle changes:
  • Avoiding smoking and alcohol, which can irritate the oesophagus
  • Maintaining good oral hygiene to prevent infections
  • Doctors tailor the specific treatment plan according to your needs and the underlying cause of your painful swallowing.

When to Call Your Doctor

While minor irritations may cause occasional discomfort or pain when swallowing, it's essential to seek medical attention if you experience any of the following:

• Severe or persistent pain that interferes with your ability to swallow
• Difficulty breathing or a feeling of something stuck in your throat
• Drooling or excessive saliva production
• Unexplained weight loss
• Fever or other signs of infection
• Vomiting or regurgitation of blood or dark-coloured material
• A history of radiation therapy or oesophageal surgery

Home Remedies for Pain While Swallowing

While home remedies should not replace professional medical treatment, some natural remedies may provide temporary relief for mild cases of painful swallowing:

• Saltwater gargle: Gargling with lukewarm salt water can help diminish swelling and promote healing in the throat area.
• Warm liquids: Sipping warm beverages like herbal tea, lukewarm water with honey, or warm broth can help soothe the throat and ease discomfort.
• Cold fluids: Sucking on ice chips or sipping cold beverages can help numb the pain and diminish inflammation.
• Lozenges or hard candies: Sucking on lozenges or hard candies can temporarily numb the pain and stimulate saliva production, which can help in swallowing.
• Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) may temporarily relieve pain and inflammation.

It's important to note that you should use home remedies cautiously, which may not address the underlying cause of your extremely painful swallowing. 

Conclusion

Pain while swallowing can be a distressing and potentially serious condition that should not be ignored. By understanding the possible reasons, symptoms, and treatment modalities, you can take proactive steps to manage this issue effectively. If you experience persistent or severe pain when swallowing, don't hesitate to schedule an appointment with your doctor. With the proper diagnosis and management plan, you can alleviate the discomfort and restore your ability to swallow comfortably.

FAQs

1. Why does it hurt when I swallow food?

There are several potential reasons why swallowing food might hurt. Some common culprits include infections like strep throat or tonsillitis, gastroesophageal reflux disease (GERD), or physical obstructions such as swallowed objects or tumours. Inflammation or injury along the throat or oesophagus may also contribute to discomfort. Certain medications or allergies can exacerbate this sensation. 

2. What do I do if swallowing hurts?

If you experience pain or discomfort while swallowing, here are some steps you can take:

• If you have an ulcer in your throat avoid hot, spicy, or acidic food products and beverages, as they irritate the affected area further. Avoid hot, very salty and spicy food.
• Try sipping warm liquids, such as herbal tea or warm water with honey. It can decrease throat irritation.
• Gargle with lukewarm salt water can reduce inflammation and promote healing.
• Suck on lozenges or hard candies to temporarily numb the pain and stimulate saliva production.
• Take over-the-counter pain relievers to alleviate discomfort.
• If the pain is severe or persists for more than a few days, seek advice from your doctor for proper diagnosis and treatment.

3. What causes pain in the throat when swallowing?

Several conditions can be the reason for pain while swallowing, including:

• Infections: Strep throat, tonsillitis, oral thrush, or oesophageal infections (candidiasis, herpes simplex virus)
• Inflammation: Esophagitis (inflammation of the oesophagus), gastroesophageal reflux disease (GERD), or eosinophilic esophagitis (an allergic condition)
• Structural abnormalities: Oesophageal strictures, rings, or webs
• Injuries or trauma: Accidental ingestion of caustic substances, radiation therapy, or oesophageal surgery/ instrumentation
• Muscle disorders: Achalasia or scleroderma affecting the swallowing process.
• Tumours or masses: Growths in the oesophagus or surrounding structures
• Oral lesions or mouth sores: Irritation during swallowing

Dr. Vijay Prakash

MBBS, MS (ENT- Head & Neck Surgery)
CARE Medical Center, Tolichowki, Hyderabad, CARE Hospitals, HITEC City, Hyderabad

To Book an Appointment, call:

+91 406 810 6585