Odynophagia

Odynophagia is pain in the throat that appears when swallowing and may make deglutition difficult.

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Symptoms and causes

Odynophagia is the sensation of pain when swallowing both solid foods and liquids, including saliva itself. Its intensity varies depending on the cause that triggers it.

Odynophagia is often confused with dysphagia because they commonly occur at the same time, although they are two different conditions. While odynophagia is only pain, dysphagia prevents normal deglutition; in other words, it makes swallowing difficult without necessarily causing discomfort.

Odynophagia can be of two types, taking into account the intensity of the pain:

  • Mild odynophagia: discomfort, burning sensation, and throat irritation.
  • Severe odynophagia: stabbing pain that usually extends to surrounding regions, such as the ear.

The prognosis of odynophagia is usually good since, in most cases, it resolves within a short time. Even so, this pain may be a symptom of a serious condition that requires a longer recovery period. To avoid complications, it is recommended to consult a specialist when the discomfort persists for several days or if it prevents normal breathing.

Symptoms

The main symptom of odynophagia is pain on both sides of the throat or on only one side (unilateral odynophagia), which may have different characteristics depending on the severity of the underlying disease:

  • Burning sensation.
  • Stabbing pain in the throat, esophagus, or chest when swallowing.
  • Constant pain, even at rest.

It is normal for these symptoms to worsen when hard, dry, or very hot foods are consumed.

Other signs associated with odynophagia include:

  • Sensation that food remains stuck.
  • Redness of the throat.
  • Inflammation of the tonsils.
  • Headaches .
  • Fever.
  • General malaise.
  • Swollen lymph nodes.

Causes

Pain when swallowing may have very diverse causes. Among the most notable are:

  • Viral or bacterial infections: these are the most common cause.
    • Pharyngitis: inflammation and irritation of the pharynx.
    • Tonsillitis: inflammation of the tonsils and formation of pus plaques.
    • Laryngitis: inflammation of the larynx.
    • Mononucleosis: inflammation of the pharynx, tonsils, and lymph nodes in the neck due to infection with the Epstein-Barr virus.
    • Peritonsillar abscess: accumulation of pus beneath the tissue surrounding the tonsils.
    • Covid-19: condition of the respiratory system caused by the SARS-CoV-2 virus.
    • Herpes simplex virus: discomfort or appearance of ulcers on the mucous membranes as a consequence of HSV.
    • Oral or esophageal candidiasis: infection caused by the fungus Candida.
    • HIV and AIDS: reduction of the body’s defences and immunosuppression caused by the human immunodeficiency virus.
  • Inflammation and non-infectious lesions:
    • Gastroesophageal reflux disease (GERD): abnormality of the digestive system in which stomach contents rise up through the esophagus.
    • Esophagitis: inflammation of the tissue lining the inside of the esophagus.
    • Eosinophilic esophagitis: the swelling occurs due to the accumulation of white blood cells in the lining of the esophagus, usually as a consequence of an allergic reaction.
    • Ingestion of foreign bodies or very hot foods.
    • Oral or esophageal ulcers.
  • Oncological disease: although less frequent, the pain may occur due to:

Risk factors

The risk of developing odynophagia increases when any of these factors are present:

Complications

When the underlying cause is not treated adequately, the following complications may occur:

  • Malnutrition and dehydration: intense pain makes eating difficult, as patients tend to avoid eating and drinking.
  • Weight loss.
  • Aspiration pneumonia: when deglutition is difficult, food may pass into the airways.
  • Chronic odynophagia: persistent pain that significantly worsens quality of life.
  • Spread of the infection to other parts of the body.

Which doctor treats odynophagia?

Odynophagia is treated in the specialties of Otorhinolaryngology, Gastroenterology, Family and community medicine, and Paediatrics. On some occasions, the intervention of Medical oncology or Radiation oncology is necessary.

Diagnosis

To diagnose the cause of odynophagia, the specialist takes a detailed medical history of the patient and performs a physical examination of the mouth and throat.

Depending on the additional symptoms, the following tests are carried out to determine the origin of the pain:

  • Pharyngeal swab: a sample is taken from the mucosa to observe it in the laboratory and detect the presence of bacteria, usually streptococcus.
  • Blood test: used to identify signs of infection or inflammation.
  • Upper gastrointestinal endoscopy: a flexible tube with a camera at the end is inserted through the mouth to visualise the esophagus, stomach, and duodenum. It is a useful procedure for detecting inflammation, ulcers, or tumours.
  • Imaging studies: X-ray or computed tomography (CT) are used to check for foreign bodies, structural abnormalities, or severe inflammation.

Treatment

Mild odynophagia can be relieved with home remedies, such as:

  • Drinking plenty of cold or room-temperature fluids.
  • Eating soft foods that are easy to swallow (yogurts, soups, purées).
  • Avoiding dry, very hot, acidic, or spicy foods, as they may irritate the throat.
  • Gargling with warm water and salt.

Treatment of severe odynophagia focuses on resolving the cause that triggers it:

  • Viral infections: these usually resolve on their own. To improve the patient’s quality of life during the process, rest and taking analgesics or anti-inflammatory drugs are recommended.
  • Bacterial infections: these are treated with antibiotics.
  • Fungal infections: antifungal medications are used.
  • Gastroesophageal reflux disease (GERD): it improves by following a balanced diet, maintaining an appropriate weight, and taking antacids and gastric protectors.
  • Esophagitis: depending on its origin, allergens are eliminated from the diet or corticosteroids are used.
  • Oral ulcers: mouthwashes, protective gels, or topical anti-inflammatory drugs are effective.
  • Esophageal ulcers: these respond well to proton pump inhibitors to reduce acid. In the most severe cases, surgery may be necessary to close the open tissue.
  • Cancer: each case is treated in a personalised manner. As a general rule, surgery is performed to remove the tumour and, subsequently, treatment with chemotherapy, radiotherapy, or immunological therapy is followed to destroy any cancer cells that may remain in the body.
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