Painful Swallowing: Causes, Diagnosis, and Home Remedies

By Frank DiVincenzo, MD
Medically reviewed checkmarkMedically reviewed
July 22, 2022

Pain when swallowing is a symptom with which many people are familiar.

The upper part of the throat or deep in the chest is where the pain can be felt.

A sore throat can signify an oncoming illness like the common cold, an infection of the ears or throat, heartburn, or something more serious like esophageal cancer. 

Read on to learn more about what causes painful swallowing and what treatments are available.

Lastly, learn when to contact your medical professional about your painful swallowing. 

Causes

There are a few structures that make up the back of your throat including your tonsils, connections to your sinus cavities, your esophagus, and your epiglottis.

The most common cause of painful swallowing is the common cold; however, inflammation of any of the other structures can cause painful swallowing as well. 

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Common cold

There are more than 200 viruses that can cause the common cold.

Colds spread through the air from person to person or close contact with an infected person.

Symptoms include:

Cold symptoms can last between 10-14 days. 

Strep throat

Strep throat is an infection of the throat and tonsils caused by bacteria called group A Streptococcus (or group A strep).

The bacteria spread easily from person to person when an infected person talks, coughs, or sneezes.

Symptoms include:

  • Fever
  • Pain when swallowing
  • Sore throat
  • Swollen lymph nodes
  • Red and swollen tonsils (sometimes with white patches)

Tonsillitis

Your tonsils are the two lumps in the back of your throat, one on each side.

They are part of your lymphatic system, which helps fight infection and keep your body fluids balanced.

Tonsillitis is when your tonsils are inflamed from an infection caused by a virus or bacteria.

Children over the age of two most commonly get tonsillitis.

The underlying bacterial or viral infection that causes tonsillitis is contagious.

Frequent hand washing helps stop the spread.

Symptoms include:

  • Sore throat
  • Red and swollen tonsils
  • Trouble swallowing
  • Swollen lymph nodes
  • Fever
  • Bad breath 

Thrush

Thrush is an infection caused by a yeast called Candida.

Candida naturally lives on your skin along with many other bacteria as part of your normal flora.

However, certain things change the environment of your mouth’s flora and allow Candida to grow out of control. 

Thrush is not typical for healthy adults but is seen in babies or people with other medical conditions that suppress their immune systems.

Symptoms include:

  • White patches in the mouth
  • Loss of taste
  • Pain with eating and swallowing
  • Mouth feels cotton-like
  • Cracking or redness in the corners of the mouth

Epiglottitis

Your epiglottitis is cartilage at the back of your tongue that covers your windpipe (trachea) when you swallow to prevent the food from entering your lungs. 

Epiglottitis is when the epiglottis is infected with a bacteria or virus.

Epiglottitis is a dangerous infection that requires immediate medical attention by a healthcare professional. 

Symptoms include:

  • A high-pitched, abnormal breathing sound
  • Blue skin
  • Fever
  • Difficulty breathing
  • Difficulty swallowing
  • Hoarse voice

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD), also known as heartburn, is when stomach acid travels from the stomach up into the esophagus.

As a result, you may feel burning in your chest or throat and sometimes taste stomach acid.

If not treated, GERD can lead to more serious problems. 

Injury

While not as common as the other causes, any type of injury to the throat can also make swallowing painful.

For example, eating or drinking something that is too hot may burn the back of your throat and cause painful swallowing for a few days.

Sometimes a sharp food like a chip can scratch the back of your throat.

These injuries can make swallowing hurt for a few days. 

Ear infection

Infections of the ear can be caused by bacteria or viruses.

Fluid buildup from the infection can drain from a tube in the middle ear down the back of your throat and cause irritation.

Other symptoms include:

To learn more about ear infections, click here. 

Esophageal cancer

Your esophagus is the tube that connects the back of your mouth to your stomach.

Esophageal cancer is when cancer cells form in the tissues of the esophagus.

Smoking and heavily drinking alcohol put you at a higher risk for esophageal cancer. 

Symptoms include difficult and painful swallowing and weight loss.

Diagnosis

To diagnose what is going on, your medical professional will review your health history and current medications.

They will also ask you questions about when your pain started and if you’ve experienced any other symptoms. 

They will perform a physical exam, look in your ears, nose, and throat and gently press on the sides of your neck to feel your lymph nodes. 

If your provider feels it is necessary, they may order some other tests.

Throat culture

A throat culture can help determine what may be causing an infection in the throat.

The results determine what medication will be most helpful. 

To perform the test, a medical professional rubs a sterile cotton swab on the back of your throat and sends the swab to the lab.

The test is not painful, but it may cause you to gag for a few seconds. 

Blood tests

A blood test called a complete blood count can provide information related to your sore throat. 

Barium swallow

A barium swallow test helps determine medical conditions of the throat, esophagus, and stomach.

This test is usually performed by a radiologist or radiology technician.

The barium swallow test uses fluoroscopy, a specialized x-ray, to see your throat, esophagus, and related structures moving in real-time. 

To perform the test, you may be asked to wear a hospital gown.

You will be given a chalky-tasting liquid that contains barium (which shows up on x-rays). 

The staff will have you sit on an x-ray table and take pictures while you drink the liquid.

Doing this helps the radiologist see what is going on inside your body when you swallow. 

If there is the possibility you can be pregnant, let them know, as radiation exposure could be harmful to a fetus. 

CT scan

A computed tomography (CT) scan uses x-ray and computer technology to take images of the inside of your body. 

To perform the test, you may be asked to wear a hospital gown and then lay down on a narrow table that moves inside the scanner.

The scanner then takes specialized x-ray images of your body. 

The scan is not painful and only takes a couple of minutes.

During the scan, you must lay very still so the images are not blurry. 

Medical Treatment

For bacterial infections, your doctor will order an antibiotic medication like penicillin or amoxicillin.

Take the medication as ordered.

Not completing the treatment can result in the infection returning. 

Viral infections are not treated with antibiotics and taking antibiotics for viral infections could result in more problems.

For viral infections, rest and over-the-counter (OTC) medications can be taken for comfort. 

In some cases, like recurrent tonsillitis or esophageal cancer, surgery may be required to remove the tissues causing the problem.

Home Remedies

At home, make sure you get plenty of rest and try to eat healthy foods that are easy to swallow.

Here are some more ideas to help you feel more comfortable.

OTC pain medications

To help relieve your sore throat, take OTC medications like acetaminophen (Tylenol) or ibuprofen (Advil or Motrin).

There are also OTC cough medications that can relieve coughing and congestion.

Throat sprays are available to help numb your sore throat; these can help when you are trying to eat. 

If your child has a sore throat, speak with their medical provider about what OTC medications would be best for them and what the correct dosage for that medication is.

Note: Do not give aspirin to children.

Sore throat lozenges

To help prevent your throat from drying out and being more painful, try sucking on throat lozenges to stimulate more saliva production. 

Saltwater gargle

One teaspoon of salt mixed in eight ounces of warm water and then gargled can help bring some relief. This can be done three times a day. 

Warm drinks

Warm drinks such as teas and broths can help keep the throat moistened and don’t hurt as bad when swallowed.

Getting plenty of liquids is important for healing.

Steam shower

Sitting in a steam shower a few times a day can help break up sinus congestion, which can bring sore throat relief. 

Humidifier

Putting a humidifier in your room helps prevent your throat from drying out and hurting more.

Keeping your throat moist helps relieve pain.

Humidifiers are especially helpful at night while you sleep.

Honey

Honey mixed with tea a few times a day can bring relief to a sore throat.

Never give honey to infants under one year old. 

For more at-home tips for treating your sore throat, click here. 

Prevention

To prevent getting sick, stay away from sick people.

If you need to have contact with anyone sick, wash your hands with soap and water after touching them or their items. 

If you are sick, cover your mouth with a tissue, your sleeve, or elbow (not your hands) when you cough.

Place used tissues directly into the wastebasket.

Wash your hands frequently and minimize contact with other household members. 

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When To See a Medical Professional

If your sore throat is not going away after a few days, call and let your medical provider know. 

Seek emergency care if you experience:

  • Difficulty breathing
  • Blood in your saliva or mucus
  • Difficulty swallowing
  • Excessive drooling (in children)
  • Joint swelling and pain
  • A rash

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What should I do if it hurts to swallow?
If your throat is hurting, it could mean you are getting sick with a viral or bacterial infection. You can try home remedies like gargling with saltwater and drinking warm fluids with honey. If your sore throat persists past a few days or if you get other symptoms like a fever, let your medical provider know, as they may need to order a prescription medication for you.
What can cause painful swallowing?
Several things can cause your swallowing to be painful such as the common cold, tonsillitis, acid reflux, thrush, or an ear infection. Most of these conditions can be treated by OTC or prescription medications to help you get better.
When should I be concerned about swallowing pain?
If your sore throat persists for more than two days or if you start experiencing other symptoms like fever or feeling very sick, you should let your medical professional know. Seek immediate care if you have trouble breathing, start drooling, or have a hard time swallowing.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Frank DiVincenzo, MD

Dr. Frank DiVincenzo has been a physician with K Health since 2020. He grew up near Chicago, Illinois, but left the big city to go to college and then attend graduate school in Missouri. He received a Bachelor of Science in Mathematics and a Master of Science in Microbiology before graduating from the University of Missouri–Columbia School of Medicine.

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