Odynophagie (approche clinique)

Odynophagia denotes painful swallowing originating from lesions between the oropharynx and distal esophagus. Most primary-care presentations are viral; group A Streptococcus accounts for a subset of pharyngitis, whereas deep neck infections are uncommon yet carry substantial morbidity. Assessment focuses on risk factors (age, immunosuppression, tobacco/alcohol, exposures), symptom course (acute vs chronic), pain location, and airway “red flags” such as stridor, dyspnea, trismus, and muffled voice. Diagnostic tools include rapid antigen testing and culture for GAS, EBV/HIV assays, and pharyngeal NAAT for gonorrhea; flexible nasopharyngolaryngoscopy and contrast-enhanced cervical CT guide complicated cases. Management ranges from supportive care (analgesics, short steroid burst for severe pain) to targeted antibiotics for GAS and antifungals when indicated, up to IV broad-spectrum therapy and drainage for abscesses. Persistent symptoms warrant evaluation for head-and-neck or esophageal malignancy.