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Painful Swallowing (Odynophagia)

Introduction

A feeling of burning or squeezing pain while swallowing. This sensation may be felt high in the neck or lower down, behind the breastbone (sternum).

Alternative name :

  • Odynophagia
  • Burning feeling while swallowing

Signs & symptoms

Swallowing is a complex act that involves the mouth, throat area, and esophagus (tube that transports food into the stomach).

Problems at any point, from the mouth to the esophagus, can result in burning or intense pain while swallowing.

Common causes :

  • Infection
    • Tooth infection or abscess
    • Gum infection
    • Pharyngitis (Viral / Bacterial)
    • Tonsilitis / Peritonsillar abscess
    • Thrush (a fungal infection caused by candida)
    • Herpes simplex, cytomegalovirus or Human immunodeficiency virus infection
  • Ulcers – arising from infection, medication or chemical ingestion.
  • Esophagitis (inflammation in the esophagus, often from gastro-esophageal reflux – bringing food back up).
  • Foreign body (such as fish or poultry bones)
  • Tumor

Infection in adults are commonly multifactorial, smoking and alcohol are predisposing factors leading recurrent infection or ulcers.


Peritonsillar abscess


Acute tonsillitis

Symptoms & signs

  • Most patient normally complain of general constitutional symptoms such as running nose, cough, fever.
  • Badbreath
  • Not being able to swallow all, drooling of saliva.
  • Difficulty in opening the mouth.
  • Pressure or pain in your chest.

Complications

Most of the complications are predisposing causes of painful swallowing / odynophagia :

  • Dental caries causing dental abscess.
  • Tonsillitis / Pharyngitis causing peritonsillar abscess, retropharyngeal abscess and parapharyngeal abscess.
  • Foreign body migration from esophagus into the chest penetrating vital structures.

Treatment (Treat the causes of odynophagia)

  • Tonsillitis / Pharyngitis – Bed rest, antibiotics, maintenance of fluid, analgesics (paracetamol) & mouth gurgle. Tonsillectomy (removal of tonsils) in cases of severe recurrent infection.
  • Peritonsillar abscess (collection of pus at tonsil bed) will require drainage of pus and tonsillectomy in recurrent cases.
  • Dental caries & gum infection require appropriate care with the dentist and oral hygiene.
  • Foreign body : removal of foreign body
  • Tumour : surgery, radiotheraphy or chemotheraphy

Prevention

  • Reduce or abolish of irritating agents (such as smoking, alcohol and spicy food).
  • Good oral hygiene to avoid gum infection and dental caries, regular dental check up.
  • Eating slowly and chewing of food well to avoid foreign bodies getting stuck.
Last reviewed : 26 April 2012
Writer : Dr. Dipaka/lBanarsi Dass
Reviewer : Dato’ Dr. Narizan Ariffin