Painful swallowing, medically known as odynophagia, is discomfort or pain experienced when food, liquid, or even saliva moves through the mouth, throat, or esophagus. Pain can range from mild soreness to sharp, burning, felt anywhere from the mouth down to the chest. It is a symptom associated with various underlying health conditions. It is distinct from dysphagia, which describes difficulty swallowing, though they can occur together.
Common Infections and Inflammations
Infections frequently cause painful swallowing. Viral infections, such as the common cold, influenza (flu), and mononucleosis (mono), cause a sore throat and painful swallowing. They often present with symptoms like a runny nose, cough, fatigue, and mild fever, usually resolving within 7 to 10 days.
Bacterial infections also cause significant throat pain. Strep throat, caused by Group A Streptococcus bacteria, results in sudden, severe throat pain, painful swallowing, and red, swollen tonsils that may have white patches or streaks of pus. Swollen, tender neck lymph nodes and a fever, often above 101°F (38.3°C), are also common.
Tonsillitis, an inflammation of the tonsils, is caused by viral or bacterial infections, including strep throat. Tonsillitis causes swollen, red tonsils, often with white or yellow coatings, and significant pain or difficulty swallowing. Fever, bad breath, and enlarged, tender neck glands frequently accompany tonsillitis. Pharyngitis, a general throat inflammation, is most often due to viral infections.
Irritants and Environmental Factors
Beyond infections, various irritants and environmental elements contribute to painful swallowing by inflaming the throat lining. Dry air, particularly from heating or air conditioning systems, dehydrate throat mucous membranes, leading to a scratchy sensation and discomfort when swallowing. Environmental allergens also trigger post-nasal drip, where excess mucus drains down the back of the throat, causing irritation and soreness.
Acid reflux disease, or GERD, is a common non-infectious cause of painful swallowing. This occurs when stomach acid flows back into the esophagus, irritating its lining and causing inflammation known as esophagitis. The pain can feel like heartburn or a burning sensation in the chest and throat, worsening with swallowing.
Inhaled irritants, such as smoke from cigarettes or vaping products, directly irritate the throat and respiratory passages, leading to chronic inflammation and pain when swallowing. Minor physical irritants, like accidentally swallowing a piece of sharp food or sustaining a small scratch from a hard food item, also cause temporary localized pain.
Less Common Medical Conditions
While infrequent, certain medical conditions lead to painful swallowing and often require specific medical attention. A peritonsillar abscess is a collection of pus behind the tonsils, typically a complication of tonsillitis, causing severe, localized pain making swallowing extremely difficult. Epiglottitis, an inflammation and swelling of the epiglottis (a flap that covers the windpipe during swallowing), is a medical emergency rapidly blocking the airway, causing severe pain with swallowing and breathing difficulties.
Fungal infections, such as oral thrush (candidiasis), manifest as white patches in the mouth and throat, leading to pain when swallowing. Structural issues within the esophagus, the tube connecting the throat to the stomach, also cause odynophagia. These include esophageal spasms, which are abnormal muscle contractions, or esophageal strictures, which are narrowings often due to chronic acid reflux and scarring.
Esophageal diverticula, which are small pouches that bulge outwards from the esophageal wall, trap food and cause painful swallowing, regurgitation, and a feeling of food being stuck. In rare instances, tumors in the throat or esophagus cause persistent painful swallowing as they grow and obstruct the passage. Nerve damage affecting the muscles involved in swallowing also result in pain or difficulty, though this is less common.
When to Seek Professional Help
Painful swallowing often improves on its own, especially when associated with common viral infections. However, certain symptoms warrant prompt medical evaluation. Consult a healthcare provider if the pain is severe and prevents liquid intake, or if it persists for more than a few days without improvement.
Immediate medical attention is necessary for “red flag” symptoms. These include difficulty breathing, drooling, a high fever, significant voice changes, or the feeling of a lump in the neck or throat. Other concerning signs include unexplained weight loss, persistent pain lasting longer than one week, a rash, or the presence of blood in saliva or vomit.