Why does my throat hurt when I swallow?
Everyone experiences pain when swallowing at some point in life.
It is a very common symptom, especially in children.
In medical terms, such a condition is called odynophagia.
Odynophagia usually comes with dysphagia, another closely-related swallowing problem describing the difficulty in swallowing.
On the other hand, a sore throat means one has throat pain even without swallowing.
In odynophagia, the pain can be anywhere from the middle part of your throat, just beyond your mouth (pharynx), to the esophagus (food pipe).
Any inflammation of the structures in that area can trigger pain in swallowing. These structures include the base of the tongue, tonsils, soft palate, and throat walls.
Why does my throat hurt when I swallow?
Pain is a manifestation of an ongoing inflammation process. An inflamed mucosa lining in the mouth and throat will be irritated by food in contact with them; that’s why your throat hurts when swallowing.
While there are many causes of pain when swallowing, we can broadly classify them into two groups: infectious and non-infectious.
Infectious causes of a sore throat when swallowing
The most common etiology of pharyngitis is viruses, including influenza (flu-type virus or common cold), cytomegalovirus (CMV), mononucleosis by Epstein-Barr virus (EBV), human simplex virus (HSV), human immunodeficiency virus (HIV) and coronavirus (SARS-CoV-2 or COVID-19).
Viral-induced pharyngitis usually carries milder signs and symptoms in contrast to bacteria-induced pharyngitis.
Group A streptococcus is the most common bacteria that cause pharyngitis, a condition called strep throat. It is prevalent in children, and 1 in 3 children suffers from at least one episode of strep throat every year, according to an extensive review conducted this year.
Other bacteria that can infect the pharynx are non-group A streptococci bacteria, Corynebacterium diphtheriae, and Mycoplasma pneumoniae.
CMV and HSV are prone to infect the esophagus (food pipe). They are both opportunistic throat infection that usually occurs in people with a compromised immune system.
Post-organ transplantation, human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and long-term steroid intake are some examples.
Besides being hard to swallow with a sore throat, people with CMV or HSV esophagitis may experience fever, nausea, vomiting, stomach pain, swallow pain, weight loss, and chest pain behind the breastbone.
3. Candidiasis (thrush)
Candidiasis (thrush) is a yeast infection caused by Candida albicans, a dormant fungus that lives quietly on our skin, mouth, gut, and vagina.
When the host’s (us) immune system weakens, the fungus grows uncontrollably, causing pain and inflammation. Candidiasis is commonly seen in people with high HIV viral load due to their vulnerable immune systems.
4. Aphthous ulcers (canker sores)
Aphthous ulcers (canker sores) are recurrent, round, small, and painful. They are located in the oropharynx (back of the throat, including the tongue base and tonsils) and usually disappear naturally in less than two weeks.
To date, scientists are unsure why canker sores happen. Still, they managed to identify specific risk factors that can trigger the development of these ulcers, including stress, injury to the inner mucosa lining of your mouth, acidic foods, nonsteroidal anti-inflammatory drugs (NSAIDs), dental appliances, such as braces or dentures.
People with immune system defects and nutritional deficiency are also linked to a higher chance of getting this condition.
Non-infectious causes of a sore throat when swallowing
Foreign bodies in the esophagus
Foreign bodies like sharp objects, batteries, and magnets can cause direct trauma to the mouth and esophagus lining.
Other than pain when swallowing, you may feel constant or recurrent chest pain behind the breastbone, swallowing difficulties, dysphagia, feeling of something in your throat (globus sensation), overproduction of saliva, stridor, wheezing, or choking.
When these foreign objects are stuck in the throat for an extended period, they erode the esophagus, leading to esophageal perforation, fever, air in the mediastinum (pneumomediastinum), crepitus, and digestive tract bleeding.
2. Local trauma to the esophagus
These are man-made causes of pain when swallowing. Classic examples include esophageal injury when inserting an endoscopy tube, consuming hot drinks or foods, ingesting corrosive substances, or localized radiation in cancer treatment.
People often have difficulties swallowing (dysphagia) when fibrosis occurs as a long-term complication of mucosal irritation.
Allergies can irritate and trigger inflammation of the throat lining. Common allergens include pet furs, molds, dust, and pollens.
Air pollution, such as second-hand smoke or chemicals, can cause a chronic sore throat. In addition, smoking, drinking alcohol, and frequently eating over-spicy foods also can irritate your throat.
5. Muscle strain
A sore throat can be caused by overuse of throat muscles, such as yelling, talking loudly, or talking non-stop for an extended period. Examples of people vulnerable to having throat muscle strain are teachers, singers, and military officers.
6. Gastroesophageal reflux disease (GERD)
GERD, simply called reflux, describes the backflow of stomach acid upwards into the esophagus (food pipe), causing a burning sensation in the chest. This acid causes irritation to the esophageal lining (acid reflux esophagitis).
Malignant tumors of the throat, tongue, or voice box (larynx) can block the passage of food, therefore, causing swallowing problems.
Other warning signs of throat cancers include voice hoarseness, noisy breathing, a lump below the jaw or in the neck, and blood in saliva.
Should I be worried if it hurts to swallow?
Sore throats are extremely common. Usually, there is nothing sinister if your throat hurts when swallowing.
Most are caused by minor ailments such as common colds or flu, and you can just take medications at home.
How long a sore throat will last depends on your health condition, but generally, the condition usually goes away within a week.
If your condition worsens drastically despite complying with all medications, or if you have any warning signs (we will see later), you should go to the emergency room immediately.
Possible accompanying symptoms
Symptoms related to pain when swallowing vary depending on the cause. They can be classified into local and systemic symptoms:
Local symptoms include:
- Pain or scratchy sensation in the throat
- Pain that worsens with talking
- Difficulties in swallowing
- Tender and swollen glands below the jaw or in the neck
- Swollen and red tonsils, associated with white patches or pus discharges
- Hoarseness (dysphonia) or muffled voice
- Profuse saliva secretion
- Locked jaw (trismus)
Throat infection is usually held accountable for systemic symptoms, which include:
- Runny nose
- Body aches
- Nausea or vomiting
- Loss of appetite
Are there any complications?
The throat infection can extend to nearby structures, causing more severe complications such as epiglottis, peritonsillar abscesses, retropharyngeal abscesses, deep tissue infections, gastrointestinal bleeding, and the development of an abnormal connection between the windpipe and food pipe (tracheoesophageal fistula).
People suffering from these conditions are usually very ill and need immediate medical attention.
Should you see a doctor?
See a doctor as soon as possible if you have below conditions:
- Severe sore throat that lasts longer than ten days
- Difficulty breathing
- Difficulty swallowing
- Swelling of the face or neck
- Difficulty opening the mouth
- Joint pain
- Ear pain
- Skin rash
- High-grade fever (over 101°F or 38.3 °C)
- Blood in saliva or phlegm
- Frequently recurring sore throat
- Lump in neck
- Hoarseness lasts more than two weeks
Although sore throat and pain when swallowing are common, they can indicate some severe conditions.
To find out why it hurts to swallow, you should visit your doctor and mention every single sign and symptom you’re experiencing. This helps your doctor determine the cause of your pain.
After careful history taking, your doctor will do some physical examinations, including checking your mouth to observe the condition directly. Your doctor may order specific tests to investigate the reasons behind your pain. These tests are:
A complete blood count test
This measures the amount of different blood cells in your body. A high level of white blood cells suggests an ongoing infection and inflammation.
Subtypes of white blood cells can also be used to determine the etiology of the infection, whether it is a virus or bacteria cause.
MRI and CT scans
These scans can produce detailed images of your throat, which cannot be observed using the naked eye. Your doctor will read the images and check for any abnormalities. A tumor can also be detected via these imagings.
A throat swab culture
This involves taking a mucus sample from the back of your throat. This sample will then be transported to the lab for further analysis.
The result usually takes several days, but it gives the highest accuracy in detecting the causative organism.
A sputum culture
This is similar to a throat swab culture, just that sputum or phlegm is used instead of a throat swab. It is relatively simple, non-invasive, and painless.
A barium swallow test
This uses X-rays to capture a series of images of your esophagus. Before the procedure, you will be asked to drink a special liquid called barium. Then, you will go for the X-rays as usual.
Barium highlights your esophagus, allowing your doctor to check if there is anyway blocked pathway for the food to travel down from the mouth to the stomach.
Treatments for pain when swallowing are based on its underlying cause. In most cases, infection is the culprit.
In that case, you most likely will receive prescription antibiotics to treat your pharyngitis, laryngitis, tonsilitis, or esophagitis.
Your doctor may give you a gargle or mouthwash that can numb your throat when you swallow the oral medications.
The other alternative anesthesia is a throat spray, usually reserved for severe pain. Your doctor may also prescribe anti-inflammatory medications to reduce inflammation and minimize pain.
People with recurrent tonsillitis often experience pain when swallowing. This is debilitating and severely impacts their quality of life.
Your doctor may recommend tonsillectomies (surgery to remove the tonsils) if you have such a condition. Discuss with your doctor the risks of having the surgery and whether the surgery suits you.
Tips for sore throat relief
If your symptoms are mild, you can try some health tips and wait for it to recover on its own. These tips for sore throat relief include:
- Gargle with warm, salty water (mix one teaspoon of salt in eight ounces of water)
- Drink plenty of water, at least eight glasses per day
- Sip warm liquids, such as warm water or tea mixed with honey
- Eat cool or soft foods
- Avoid smoking or places full of second-hand smoke
- Suck ice cube, ice lolly, or hard candy
- Try herbal lozenges such as sage, licorice root, and honeysuckle flower
- Breath in moist air by using a room humidifier or taking a hot bath
- Take over-the-counter pain medications and antacids if the pain is caused by GERD
- Rest well
Sore throat and pain when swallowing are very common. Although they usually come and go without causing significant impairment of our daily functions, we should not ignore the symptoms.
As the saying goes, better be safe than sorry. Seek medical attention if you notice any warning signs or if the symptoms bother you too much.