Understanding Pain When Swallowing: Causes & Solutions

Odynophagia (painful swallowing) localizes to oropharynx, hypopharynx, or esophagus. Common causes:

Infectious/Inflammatory

• Pharyngitis/tonsillitis: viral (adenovirus, EBV), bacterial (GAS), fungal (candidiasis).
• Peritonsillar abscess: unilateral severe pain, trismus, uvular deviation.
• Epiglottitis: medical emergency; drooling, stridor, tripod position.

Esophageal

• GERD / EoE: heartburn, regurgitation, food impaction.
• Pill esophagitis: NSAIDs, bisphosphonates, doxycycline taken without water.
• Infections: HSV, CMV, Candida (immunocompromised).

Structural/Neoplastic

• Esophageal stricture, rings, webs.
• Esophageal cancer: progressive dysphagia → odynophagia, weight loss.
• Foreign body (fish bone).

External Compression

• Thyroid mass, mediastinal nodes, vascular anomalies.

Evaluation

History → laryngoscopy → barium swallow / endoscopy ± biopsy. Treat underlying cause; analgesics, viscous lidocaine, PPIs as needed.