In this chapter, the evaluation and management of conditions causing acute difficulty in swallowing, particularly odynophagia or painful swallowing, are considered. The detailed history that needs to be elicited in such patients is listed. The common causes of acute dysphagia are described and amply illustrated both with diagrams and clinical pictures. A list of common differential diagnoses is provided. Assessment of the patient with this symptom is described in detail. The importance of general and local examination is highlighted. The clinical features of common acute inflammatory conditions in the oropharynx causing acute odynophagia like Ludwig’s angina, peritonsillar abscess (quinsy), acute tonsillitis, and foreign body in the tonsil or tongue are described. The investigations required based on the presumptive clinical diagnosis are detailed. The radiological appearance of various conditions causing acute dysphagia is described with accompanying illustrations. Finally, the treatment of specific causes of acute dysphagia is described. Medical management of acute inflammatory conditions is described. The specific surgical procedures required including incision and drainage for abscess collections and flexible laryngoscopy or direct laryngoscopy for foreign body extraction are outlined. The chapter has two videos, one showing extraction of fish bone from the tonsil and another showing extraction of another impacted foreign body in the vallecula, both of which caused the patients to present with acute dysphagia.