What is Odynophagia?
Odynophagia is painful swallowing, typically caused by inflammatory processes affecting the esophagus or pharynx, and must be distinguished from dysphagia (difficulty swallowing without pain). 1
Definition and Clinical Distinction
Odynophagia refers specifically to pain experienced during the act of swallowing, whereas dysphagia describes difficulty or abnormal swallowing mechanics without necessarily involving pain. 2, 1 This distinction is clinically critical because:
- Odynophagia usually indicates an inflammatory or ulcerative process affecting the esophageal or pharyngeal mucosa 1
- Dysphagia typically suggests mechanical obstruction, motility disorders, or neuromuscular dysfunction 3
- When pain accompanies difficulty swallowing, the term odynophagia takes precedence in describing the symptom 3
Key Diagnostic Consideration
Globus pharyngeus must be differentiated from odynophagia, as globus presents as a non-painful sensation of a lump in the throat and occurs in the absence of odynophagia. 2 This is an important distinction because globus is a functional disorder, while odynophagia typically indicates organic pathology requiring different management.
Common Causes in Clinical Practice
Infectious/Inflammatory Etiologies
- Esophageal candidiasis is the most frequent cause in immunocompromised patients, particularly those with AIDS 4
- Herpes simplex virus and cytomegalovirus esophagitis present with odynophagia and require antiviral therapy 4
- Acute infectious/inflammatory conditions in the ENT context, including pharyngitis and tonsillitis 5
Traumatic and Mechanical Causes
- Foreign body impaction commonly presents with acute odynophagia, neck tenderness, and retrosternal pain 5
- Esophageal perforation presents with odynophagia accompanied by fever, cervical subcutaneous emphysema, or cervical pain—requiring immediate surgical consultation 6, 5
Oncologic Causes
- Leukemic infiltration of the esophagus and mucosal necrosis following chemotherapy should be considered in patients with malignancies 7
- Oropharyngeal and hypopharyngeal malignancies may present with progressive odynophagia, particularly in older patients with tobacco/alcohol use or HPV infection 5
Clinical Pitfalls to Avoid
Never dismiss odynophagia as a functional complaint—it almost always indicates organic pathology requiring investigation. 1 Unlike dysphagia, which can occasionally be functional, odynophagia warrants thorough evaluation for inflammatory, infectious, or neoplastic processes.
In patients with neck pain and odynophagia, consider serious conditions beyond simple musculoskeletal causes, including longus colli tendinitis, retropharyngeal abscess, esophageal perforation, and aortic dissection. 8 These require urgent referral rather than physiotherapy interventions.
Red Flags Requiring Urgent Evaluation
- Complete inability to swallow saliva requires emergency endoscopy within 2-6 hours 6, 5
- Fever, cervical subcutaneous emphysema, or cervical pain suggest perforation and mandate immediate surgical consultation 6, 5
- Progressive odynophagia with weight loss or anemia suggests esophageal malignancy requiring rapid diagnostic evaluation 6, 5