Odynophagia

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: painful swallowing

Overview

Odynophagia is defined as painful swallowing.

Causes

Common Causes

• Upper respiratory tract infections
• Achalasia cardia
• Scleroderma
• Zenkers diverticulum
• Esophageal cancer
• Myasthenia gravis
• Tonsillitis

Causes by Organ System

Cardiovascular	Aortic aneurysm, Double aortic arch, Enlarged left atrium, Mediastinitis, Mitral valve stenosis
Chemical / poisoning	Botulism, Chemical burns
Dermatologic	Scleroderma
Drug Side Effect	Stevens-Johnson Syndrome
Ear Nose Throat	Cricopharyngeal spasm, Epiglottitis, Esophagotracheal fistula, Glossitis, Goiter, Gum disease, Laryngitis, Oral submucous fibrosis, Oral ulcers, Palatoplegia, Stomatitis, Zenker's Diverticulum, Herpangina, Retropharyngeal abscess , Palate cancer, Supraglottic laryngeal cancer , Xerostomia
Endocrine	Diabetic neuropathy, Hyperthyroidism, Hypothyroidism, Riedel thyroiditis
Environmental	No underlying causes
Gastroenterologic	Achalasia, Barrett's oesophagus, Diverticulum, Esophageal achalasia, Esophageal atresia, Esophageal spasm, Esophageal stricture , Esophagitis , Fibrosis, Gastritis, Gastroesophageal reflux, Intramural pseudodiverticulosis, Intramural pseudodiverticulosis, Peptic stenosis, Schatzki ring, Myoneurogastrointestinal encephalopathy syndrome, Crohn's disease, Eosinophilic esophagitis
Genetic	Opitz-Frias syndrome
Hematologic	Agranulocytosis, Lymphadenopathy
Iatrogenic	Radiation esophagitis
Infectious Disease	Abscesses, Acute pharyngitis , Adenoiditis, Angina tonsillaris, Candidiasis, Chagas Disease, Cytomegalovirus , Diphtheria, Esophageal moniliasis, Flu, Herpangina, Herpes simplex virus (HSV), Herpes stomatitis , HIV/AIDS, Mononucleosis, Mumps, Oral candidiasis, Paracoccidioidomycosis, Pharyngitis, Poliomyelitis, Rabies, Reflux esophagitis, Respiratory tract infections , Retropharyngeal abscess , Scarlet Fever, Tetanus, Tonsillar abscess, Tooth infection, Typhoid fever
Musculoskeletal / Ortho	Elongated styloid process, Extreme spinal curvature, Global hystericus, Schatzki ring, Leiomyoma, Dermatomyositis, Myasthenia Gravis
Neurologic	Amyotrophic Lateral Sclerosis (ALS), Brainstem stroke, Bulbar palsy, Central hypoglossal nerve paralysis, Central vagal nucleus lesion, Cerebrovascular accident, Guillain-Barre syndrome, Huntington's chorea, Multiple Sclerosis, Myoneurogastrointestinal encephalopathy syndrome, Neuroferritinopathy, Peripheral neuropathy, Polyradiculitis, Syringobulbia, Vagal disorder, Diabetic neuropathy, Poliomyelitis
Nutritional / Metabolic	Gaucher's disease, Plummer-Vinson Syndrome
Obstetric/Gynecologic	No underlying causes
Oncologic	Bronchial carcinoma, Carcinoma of the vocal tract , Carotid body tumor, Esophageal cancer, Gastric tumors, Hypopharyngeal cancer , Laryngeal cancer, Leiomyoma, Oral cancer , Palate cancer, Paraneoplastic syndrome, Supraglottic laryngeal cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Anxiety disorders
Pulmonary	Bronchial carcinoma
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Allergic swelling, Amyloidosis, Behcet's Syndrome, CREST syndrome , Crohn's disease, Dermatomyositis, Eosinophilic esophagitis, Esophageal sarcoidosis, Graft versus host reaction, Inclusion body myositis, Myasthenia Gravis, Parkinson's Disease, Riedel thyroiditis, Rheumatoid Arthritis, Scleroderma, Systemic Lupus Erythematosus, Systemic sclerosis, Xerostomia
Sexual	No underlying causes
Trauma	Esophageal trauma
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcoholism, Aspiration of foreign body

Causes in Alphabetical Order

• Abscesses
• Achalasia
• Acute pharyngitis
• Adenoiditis
• Agranulocytosis
• Alcoholism
• Allergic swelling
• Amyloidosis
• Amyotrophic Lateral Sclerosis (ALS)
• Angina tonsillaris
• Anxiety disorders
• Aortic aneurysm
• Aspiration of foreign body
• Barrett's oesophagus
• Behcet's Syndrome
• Botulism
• Brainstem stroke
• Bronchial carcinoma
• Bulbar palsy
• Candidiasis
• Carcinoma of the vocal tract
• Carotid body tumor
• Central hypoglossal nerve paralysis
• Central vagal nucleus lesion
• Cerebrovascular accident
• Chagas Disease
• Chemical burns
• CREST syndrome
• Cricopharyngeal spasm
• Crohn's disease
• Cytomegalovirus
• Dermatomyositis
• Diabetic neuropathy
• Diphtheria
• Diverticulum
• Double aortic arch
• Elongated styloid process
• Enlarged left atrium
• Eosinophilic esophagitis
• Epiglottitis
• Esophageal achalasia
• Esophageal atresia
• Esophageal cancer
• Esophageal moniliasis
• Esophageal spasm
• Esophageal stricture
• Esophageal trauma
• Esophageal sarcoidosis
• Esophagitis
• Esophagotracheal fistula
• Extreme spinal curvature
• Fibrosis
• Flu
• Gastric tumors
• Gastritis
• Gastroesophageal reflux
• Gaucher's disease
• Global hystericus
• Glossitis
• Goiter
• Graft versus host reaction
• Guillain-Barre syndrome
• Gum disease
• Herpangina
• Herpes simplex virus (HSV)
• Herpes stomatitis
• HIV/AIDS
• Huntington's chorea
• Hyperthyroidism
• Hypopharyngeal cancer
• Hypothyroidism
• Inclusion body myositis
• Intramural pseudodiverticulosis
• Intramural pseudodiverticulosis
• Laryngeal cancer
• Laryngitis
• Leiomyoma
• Lymphadenopathy
• Mediastinitis
• Mitral valve stenosis
• Mononucleosis
• Multiple Sclerosis
• Mumps
• Myasthenia Gravis
• Myoneurogastrointestinal encephalopathy syndrome
• Neuroferritinopathy
• Opitz-Frias syndrome
• Oral cancer
• Oral submucous fibrosis
• Oral ulcers
• Oral candidiasis
• Palate cancer
• Palatoplegia
• Paracoccidioidomycosis
• Paraneoplastic syndrome
• Parkinson's Disease
• Peptic stenosis
• Peripheral neuropathy
• Pharyngitis
• Plummer-Vinson Syndrome
• Poliomyelitis
• Polyradiculitis
• Rabies
• Radiation esophagitis
• Reflux esophagitis
• Respiratory tract infections
• Retropharyngeal abscess
• Rheumatoid Arthritis
• Riedel thyroiditis
• Scarlet Fever
• Schatzki ring
• Scleroderma
• Stevens-Johnson Syndrome
• Stomatitis
• Supraglottic laryngeal cancer
• Syringobulbia
• Systemic Lupus Erythematosus
• Systemic sclerosis
• Tetanus
• Tonsillar abscess
• Tooth infection
• Typhoid fever
• Vagal disorder
• Xerostomia
• Zenker's Diverticulum

Symptoms to Differentiate Odynophagia From

• Dysphagia is defined as difficulty in swallowing

Diagnosis

History and Symptoms

A directed history should be performed to characterize the following:

• Onset
• Severity
• Duration
• Dysphagia with liquids versus solids
• Psychiatric history
• Prior episodes
• Substance exposure
• History of neck and head problems

Laboratory Findings

Electrolyte and Biomarker Studies

• Creatinine phosphokinase (CPK) can be used to rule out cardiac ischemia as a cause.

Electrocardiogram

Can be used to assess for left atrial enlargement.

Chest X Ray

Can used to rule out lung cancer and other mass lesions as well as left atrial enlargement.

MRI and CT

• MRI of brain can be used to exclude CVA and mass lesions of the head and neck.

Echocardiography or Ultrasound

Can be used to rule out an aneurysm or left atrial enlargement as a cause.

Other Diagnostic Studies

• Esophagogastroduodenoscopy (OGD)
• Biopsy
• Barium swallow
• Electromyogram (EMG)
• Nerve conduction tests
• Esophageal manometry

Treatment

• Endoscopy (acute and chronic mechanical obstructions)
• Speech therapy (ALS and stroke patients)

Pharmacotherapy

• Proton pump inhibitors or promotility agents, weight loss, avoidance of offending foods (gastroesophageal reflux disease)
• Anticholinergics (ALS, stroke, lower esophageal spasms)
• Muscarinic agents (myasthenia gravis)
• Glucocorticoids (myasthenia gravis and polymyositis)
• Antispasmodics, botulinum toxin injection (lower esophageal spasm)

Surgery and Device Based Therapy

• Thoracic surgery, possible balloon dilation (chronic mechanical obstruction)

References

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