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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
Causes by Organ System
| Cardiovascular
|
Aortic aneurysm, Double aortic arch, Enlarged left atrium, Mediastinitis, Mitral valve stenosis
|
| Chemical / poisoning
|
Botulism, Chemical burns
|
| Dermatologic
|
No underlying causes
|
| 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
|
| 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
|
| 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
|
| 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
|
| 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, 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. [1] [2]
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
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
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
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