Swallowing is reflex that is largely involuntary. Only the first stage of swallowing, known as oral swallowing is under voluntary control, where the tongue pushes the chewed food to the back of the throat. The swallowing process then continues with pharyngeal and esophageal swallowing.

Normally, swallowing should be neither difficult nor painful. Swallowing hard and partially chewed foods could cause some difficulty swallowing (dysphagia) and even painful swallowing (odynophagia). However, pain when swallowing thoroughly chewed foods and drinks is almost always a sign of pathology within the mouth, throat or esophagus (gullet). This may be acute, as is often seen with infections, or chronic (persistent, long term).

Throat pain when swallowing may also be accompanied by other symptoms :

  • difficulty swallowing
  • coughing
  • regurgitation
  • gagging
  • mouth pain
  • chest pain
  • hoarse voice

Some of these symptoms may be unrelated to the act of swallowing but rather a consequence of the causative condition. Bleeding after swallowing is a serious sign and warrants immediate medical attention. Refer to blood in the mouth.

Causes of Throat Pain When Swallowing

Throat pain when swallowing indicates pathology in the throat (pharynx) and may include the distal part of the mouth and proximal part of the esophagus. Most cases of throat pain when swallowing is a result of pharyngitis – inflammation of the throat that typically presents as a sore throat. The causes of these conditions are discussed further under :

Infections

Most cases are due to bacterial (refer to strep throat) or viral infections. Fungal infections are less common and are more likely to be seen in immunocompromised patients, like with poorly managed diabetes mellitus and HIV infection.

Trauma

Trauma to the mouth, throat and upper esophagus due to the causes below may cause throat pain when swallowing.

  • Mechanical
  • Snoring
  • Post-operative (throat surgery like a tonsillectomy)
  • After diagnostic procedures like a laryngoscopy/endoscopy
  • Tonsil stones
  • Foreign bodies
  • Mouth breathing
  • Voice strain
  • Radiation
  • Chemical
  • Acid reflux
  • Air pollution
  • Alcohol abuse
  • Corrosive substances
  • Smoking – tobacco (cigarettes, cigars), narcotics
  • Chewing tobacco, areca nut/betel leaf
  • Repeated vomiting (gastric acid) – pregnancy, eating disorders and other usually chronic gastrointestinal diseases

Mouth Conditions

  • Mouth sores and ulcers – aphthous stomatitis
  • Skin conditions – lichen planus, pemphigus vulgaris, erythema multiforme
  • Nutritional deficiencies – iron, folate, vitamin B12
  • Dental conditions – tooth cavity, abscess, gingivitis, periodontitis
  • Sjogren’s syndrome

Esophagus Conditions

  • Achalasia
  • Esophageal spasms – diffuse or nutcracker syndrome
  • Esophageal tears/perforation
  • Esophageal ulcers
  • Esophageal webs
  • GERD
  • Zenker’s diverticulum

Cancer

  • Throat cancer
  • Mouth (oral cavity) cancer
  • Nose (nasal cavity) cancer
  • Esophageal cancer

Other Diseases

  • Bechet’s syndrome
  • Celiac disease
  • Inflammatory bowel disease – Crohn’s disease, ulcerative colitis
  • Leukopenia
  • Reactive arthritis (previously Reiter’s syndrome)

Article reviewed by Dr. Greg. Last updated on February 4, 2011