Pain when swallowing, medically termed odynophagia, is a common symptom that ranges widely in intensity, from mild discomfort to sharp, severe pain that discourages eating or drinking. This sensation is often felt in the throat, but it can also be localized in the chest or behind the breastbone as food travels toward the stomach. Understanding the cause of odynophagia depends on whether the symptom is acute (developing suddenly) or chronic and persistent.
Common Infections and Irritations That Cause Pain
The majority of acute cases of painful swallowing are caused by infections that trigger inflammation of the mucosal lining in the throat. Viral infections are the most frequent culprits, including those responsible for the common cold, the flu, and even COVID-19. These infections cause pain because the immune response leads to swelling and redness in the pharynx, making the muscular act of swallowing painful.
Viral sore throats typically feature a gradual onset, often accompanied by other upper respiratory symptoms like a cough, a runny nose, and a hoarse voice. Any fever present is usually low-grade, and the throat may look red and swollen without significant white patches. These symptoms generally resolve on their own with supportive care within a week or so.
Bacterial infections, such as streptococcal pharyngitis (strep throat), are often more severe. The pain is frequently sharp and sudden, often accompanied by a high fever (above 101°F or 38.3°C). A key sign is the presence of white patches or streaks of pus on the tonsils; a cough or runny nose is usually absent.
Non-infectious factors can also irritate the throat by breaking down the protective mucosal layer. Environmental irritants, such as dry air, smoke, or pollution, can cause chronic dryness and irritation. Post-nasal drip, where excess mucus flows down the throat, also leads to persistent soreness and discomfort when swallowing. Minor physical irritations, such as scraping the throat with sharp food, can cause temporary, localized odynophagia.
Reflux and Esophageal Issues
When painful swallowing becomes chronic, the cause often shifts from acute infection to issues involving the digestive tract, particularly the esophagus. Gastroesophageal Reflux Disease (GERD) occurs when the lower esophageal sphincter does not close properly, allowing stomach acid to flow backward. This acid irritates the sensitive lining of the esophagus, causing inflammation (esophagitis), which manifests as a burning sensation or pain when swallowing.
A related condition is Laryngopharyngeal Reflux (LPR), sometimes called silent reflux, where the acid travels even higher, reaching the throat and voice box. This area is particularly vulnerable to damage from stomach acid, and pain when swallowing is a common symptom, sometimes without the classic heartburn sensation associated with GERD. LPR can also cause a persistent feeling of a lump in the throat, chronic throat clearing, or hoarseness.
Certain medications can induce a sudden and painful form of esophagitis, known as pill esophagitis. This injury occurs when a pill, often a large tablet or one with a caustic property, gets lodged in the esophagus and dissolves, causing a chemical burn or ulceration. Taking medications without enough water or lying down immediately after ingestion increases the risk. The resulting pain is typically sharp and can feel like it is coming from the mid-chest or back.
Warning Signs Requiring Immediate Medical Care
While most cases of painful swallowing are related to minor viral illnesses, certain accompanying symptoms signal a need for immediate medical attention. Any sudden and severe difficulty breathing or the inability to swallow liquids or even saliva is an emergency. If excessive drooling is present, particularly in children, it may indicate a severe blockage or swelling that is compromising the airway.
A high fever (above 101°F or 38.3°C) that accompanies painful swallowing suggests a serious or spreading infection. Swelling or tenderness in the neck, especially if localized to one side, can indicate an abscess or deep tissue infection that requires urgent intervention. Any pain that is so intense it prevents hydration should be evaluated quickly.
Look for signs of bleeding, such as blood in the saliva, phlegm, or vomit. Painful swallowing that persists for more than seven days without improvement warrants a medical consultation, even if the symptoms are not initially severe. These signs could point to a condition beyond a common cold, requiring prompt diagnosis and treatment.