The 7 Dangers of Uvulitis (swollen uvula)

There are many common misconceptions about uvulitis that often get in the way of treating it properly. Since the symptoms typically mimic a common throat infection, most people tend to ignore the problem hoping it will go away on its own or even worse, try treatments that actually make it worse (for example gargling with hot water can further irritate the uvula if the real underlying problem is an ulceration).

We now know that uvulitis is a lot more dangerous than we once thought and that even small amounts of uvula inflammation or enlargement can have lasting effects on your overall health.

Here are 7 important reasons why you should always take your uvula symptoms seriously:

1. The uvula is very easily damaged and this damage can last a lifetime - Though anatomically the uvula is situated close to the throat, physiologically it is a distinct piece of tissue. On the outside it is covered with a delicate mucous membrane similar to the inside of our eyelids and on the inside it is made up of soft connective tissue, some glands and a small number of muscle fibers.

In essence the uvula is much softer and much more sensitive than its neighboring tissues because it lacks tough protective features to physically guard it from damage. This means that even mild episodes of inflammation can lead to uvula tissue injury or even worse - scarring. Remember, once your uvula forms scar fibers it never fully recovers and part of its function is permanently lost.

It is this vulnerability that makes our uvula extremely prone to inflammatory injury.

How dramatic really is the effect of inflammation on our uvula?

Consider this…

By the time you feel the symptoms of uvulitis, it isn't uncommon for the uvula to swell up to five times its normal size. This may seem like a miniscule change and since the uvula is small to begin with it is easy to overlook the sheer magnitude of this growth. To put things in perspective, that's the equivalent of your heart swelling up to the size of a bowling ball. That kind of inflammation would be catastrophic for any organ, let alone a small, sensitive piece of tissue like the uvula.

In addition, our uvula has canals that allow it to secrete large amounts of fluids (such as saliva and mucus) when necessary. During uvulitis these canals can become doorways for viruses, bacteria and fungi to get deep inside the uvula and can cause much greater damage.

It is important to realize that even if your pain is mild and your symptoms short lived, it doesn't take much to permanently damage your uvula. That's because there is very little of it to begin with and what little we have is very vulnerable to injury.

And what would happen in the event that your uvula is indeed damaged? As you are about to see, a damaged uvula can lead to several lasting health issues, some of them even life threatening…

2. The problem can grow worse and spread to the surrounding tissues - Studies have shown that problems of the uvula almost never stay confined just to the uvula itself. Since the uvula tissue forms a continuum with many nearby structures such as the tonsils, the larynx, the pharynx and the epiglottis, the spread of the inflammation to any of these regions can make things much worse.

Take for instance what happens when the inflammation spreads from our uvula to our tonsils or the epiglottis:

Tonsillitis - Located on either side of the uvula are two soft tissue masses called the tonsils. Our tonsils share an intimate relationship with the uvula since both structures protect us from harmful pathogens entering our digestive tract and breathing passages. This intimate partnership also means that an infection of the uvula can easily spread to the tonsils causing a condition known as tonsillitis (inflammation of the tonsils). Besides being painful, the biggest danger of tonsillitis is that the infection can lead to an abscess in the tissues surrounding it which often requires aggressive treatments including surgery.

Epiglottitis - The epiglottis is a tiny leaf shaped flap of tissue in our throat that has a simple yet extremely important function - it temporarily covers our windpipe when we swallow food, preventing us from choking on it. One of the biggest concerns during uvulitis is the spread of the inflammation to the epiglottis causing a condition known as epiglottitis during which this small flap structure can swell up and block the flow of air into our lungs, creating a life threatening situation.

As you can see, depending on where the inflammation spreads further, a seemingly "harmless" uvula problem can quickly turn into a much more serious condition requiring emergency treatment.

3. Uvula damage can permanently affect your speech - One of the important functions of the uvula is its role in our ability to speak. The uvula especially comes into play with sounds that are articulated with the back of our tongue. There are also sounds, known as oral pressure consonants, that require the closure of the uvula against the back of our throat creating something known as the velopharyngeal closure.

Damage to the uvula can prevent this closure, leading to a condition known as velopharyngeal insufficiency where the uvula becomes unable to create a proper seal against the back of our throat. This causes extra air to escape into the nasal cavity when we speak, making the sufferer's speech sound nasally and unable to properly articulate certain sounds.

4. It can lead to a condition known as nasal regurgitation - The proper routing of food into the foodpipe (esophagus) requires the perfect coordination of many oral structures. As our tongue pushes chewed food towards the back of our mouth, our throat moves upwards and forwards to help properly direct food into the foodpipe. As this happens, a small flap structure, called the epiglottis, temporarily covers our windpipe, ensuring that our food stays clear of our breathing passages.

While most people appreciate the importance of preventing food from entering our windpipe, many forget that there is one other place where swallowed food can mistakenly end up. Yes, right above the junction of the foodpipe & windpipe is yet a third potential exit - the opening of our nasal cavity. This cavity is where the nasal passages (nostrils) end at the back of your throat. And yes, as part of the careful routing of food into the foodpipe, our body also temporarily covers the opening of our nasal cavity just the way it temporarily covers our windpipe when we swallow.

The uvula plays a crucial role in this process of covering our nasal cavity. When we swallow food, small muscles pull the uvula and its surrounding tissue towards the upper part of our throat, creating a temporary seal that prevents food from entering our noses.

However, damage to our uvula can disrupt this mechanism. A damaged uvula can become unable to create a perfect closure against the throat, leading to a condition known as nasal regurgitation where swallowed food constantly gets pushed into the nasal cavity and is literally regurgitated out the nose.

5. The uvula's link to a sleep disorder that severely affects your heart, liver, lungs, brain and even lowers your life expectancy - Though it may be small, our uvula hangs inconspicuously over our windpipe. There, it is gently held up in place by a very small number of muscle fibers. Anything that affects these muscle fibers can create a dangerous situation where the soft tissue around your windpipe can collapse on top of it, interrupting your breathing.

That is exactly what happens to over 100 million people each day because of something known as obstructive sleep apnea (OSA) and many never realize that it is the uvula that is often at the center of this life altering condition.

Inflammation, weight gain and our natural aging process can easily weaken the muscle fibers surrounding your uvula. Though this may not cause any noticeable symptoms while you are awake, the situation quickly turns dangerous as soon as you fall asleep. That's because when we enter deep sleep, skeletal muscles of our body completely relax causing the soft tissue around the opening of our windpipe to droop. If your uvula already has a weakened tone from previous bouts of inflammation, further relaxation of its muscles during sleep can literally cause the soft tissue around your windpipe to wilt on top of it and completely block it.

In effect, the act of sleeping temporarily interrupts your breathing.

  • Inflammation causes the uvula tissue to scar and its muscles to weaken
  • Falling asleep causes the muscles around your uvula loosen further
  • The soft tissue on top of the windpipe collapses and blocks it
  • You breathing is interrupted and your oxygen levels begin to fall
  • Your brain is alerted by the high levels of carbon dioxide, forcing you to wake up and inhale
  • The cycle repeats itself over and over again, damaging your organs in the process

As the sufferer's breath remains paused for an extended period of time (up to several minutes), the oxygen starved brain is suddenly alerted to wake up and clear the obstruction over the windpipe by tightening the muscles around your uvula, allowing you to breathe again. Unfortunately, the brain nudges the sufferer just enough to do this without fully waking you up. This causes the suffer to quickly return to sleep unaware that they were choking just a few seconds ago or that they had even woken up to catch their breath. This process repeats itself over and over again throughout the night.

In fact a sleep apnea sufferer can stop breathing for up to 30 times an hour, every single night.

Indeed, the biggest irony of sleep apnea is that it attacks you when you are at your most vulnerable and least aware. What makes the entire situation worse is that the sufferer continues to remain unaware of the problem even after they wake up because they are only greeted with vague symptoms, such as tiredness during the day and a general decline in cognitive function (thinking abilities) - nothing that points to an obvious problem with the uvula.

However, these symptoms don't accurately reflect the true amount of damage the body experiences each night. Studies have revealed that sleep apnea takes a major toll on almost every major organ system in our body. Conclusive evidence has now linked sleep apnea to high blood pressure, heart disease, liver disease, type 2 diabetes, obesity, asthma, acid reflux, memory problems, mood swings, depression and even a shorter life expectancy.

It is almost astonishing to realize that all these problems can start when a small piece of tissue hanging at the back of our throat begins to experience damage that may even be imperceptible to us.

6. It can lead to a hypersensitive gag reflex - It is important to note that unlike throat infections where the irritated tissue usually returns to normal once the inflammation subsides, the uvula doesn't always heal completely from inflammatory injury. In fact, the uvula can become permanently enlarged or elongated after a single episode of inflammation. That's because inflammation doesn't just damage the soft tissue of the uvula, it also damages the muscle fibers (musculus uvulae), the connective tissue and the epithelial surface that give our uvula its shape and structure. Once these tissue layers are damaged severely enough, they can lose their tone and remain elongated. Besides causing the health issues mentioned above, permanent uvula enlargement can also lead to a condition known as a hypersensitive gag reflex.

Simply put, reflexes are our body's automatic responses to certain types of stimuli. They are designed to help us react almost instantaneously to things without involving conscious thought, often to save time during dangerous situations. One such reflex you might be familiar with is the withdrawal reflex where someone might suddenly pull back their hand after it touches a hot object. This speedy reaction helps limit the amount of heat damage to our body.

Another similar automatic response is the gag reflex. It helps prevent anything potentially damaging from entering our throat. It is activated when an unusually large object (for example unchewed food), or something too hot or too cold enters the back of our throat. Our body's instant reaction is to suddenly raise the uvula and squeeze the muscles at the back of our throat and force the threatening object back out in a gagging motion.

The uvula plays a central role in activating this reflex.

The nerves of the uvula are very sensitive to touch sensations. This is why simply touching the uvula with your finger can induce vomiting. An enlarged or permanently elongated uvula can constantly activate the gag reflex even in the absence of any threat. This is known as a hypersensitive gag reflex which can make swallowing food very difficult because it frequently triggers the nerves of the enlarged uvula to induce sensations of nausea and vomiting.

7. Carcinoma of the uvula - This is by far the biggest danger that uvulitis poses. Unfortunately, our uvula is located in a region of our body that is particularly prone to certain types of cancers. It only makes matters worse that it is also one of the more sensitive tissues in that region as well. Carcinoma of the uvula belongs in a subclass of cancers known as oral cancers. Here are some startling facts relating to oral cancers in particular:

  • Over 450,000 new cases of oral cancers occur worldwide each year (that's one new case every 70 seconds)
  • Almost 150,000 people die of oral cancer each year
  • Oral cancers account for over 85% of the total number of head and neck cancers
  • The survival rate of a typical newly diagnosed oral cancer case is less than 50%
  • The death rate for oral cancers is higher than cervical cancer, Hodgkin's lymphoma, laryngeal cancer, testicular cancer, thyroid cancer and even skin cancer

One of the main reasons the survivability of carcinoma of the uvula is so low is because it is often found too late. Uvula cancer usually does not produce any symptoms in the early stages and by the time the symptoms appear the cancer has already grown or metastasized to another location (typically the lymph nodes of the neck).

There are many reasons why the uvula in particular is vulnerable to oral cancer:

It is one of the most sensitive tissue structures in the entire oral cavity - Most oral cancers tend to develop towards the back of our throat, close to the soft palate. That's because the tissue here is a lot softer and more prone to injury. Compared to the other soft tissues in this region, the uvula is especially vulnerable because it lacks any tough protective features to physically shield it from damage.

It is constantly exposed to irritants - The fact that the uvula is suspended right above our foodpipe and windpipe constantly puts it in the path of harm from both the outside world and the inside of our body. From the outside it is constantly exposed to microbes (viruses, bacteria, fungi), allergens and to physical injury by the way of the food we eat and the air we breathe. From the inside, it is vulnerable to acid exposure from the stomach (one of the common causes of uvulitis) and flow-over inflammation from nearby structures such as the throat and tonsils.

It responds very poorly to inflammation - Our uvula's role in voice modulation, the gag reflex, closure of the nasal cavity and as a reservoir for saliva require it to be delicate and flexible. However, its soft structure also makes it very reactive to even small amounts of inflammation. This can be seen during uvulitis where it can swell up to almost five times its size. The uvula's soft tissue makeup also predisposes it to scarring. Once the uvula forms scar fibers, part of its function becomes permanently disabled. The most damaging aspect of inflammation is that it also leads to an increase in the number of DNA damaging free radicals that promote cancer cell development.

Uvula cancer is hard to catch in the early stages - Not only is uvula damage often subtle but its true effects may not become evident till decades later. It's not easy to test for uvula cancer and it tends to go unnoticed and untreated because the sufferer often remains unaware of the problem. Part of the reason is because uvula tumors can start from deep within the tissue without exhibiting any visible changes on the outer surface. Even when the lesions are present on the outer membrane, they are not always readily apparent because the uvula is located so far back in our mouth and the lesion can be on the throat facing side of the uvula.

The lesson here is - don't let your uvula's small size deceive you and never wait for the symptoms to get worse before you take action. When it comes to protecting yourself from uvula tissue damage or even uvula cancer, it is crucial to be proactive and at the very least provide your uvula with nourishing substances that support its function and protect its tissue.

SEEK MEDICAL CARE IF:

  • You have an oral temperature above 102° F (38.9° C).
  • You develop large, tender lumps in your the neck.
  • You develop a rash.
  • You cough up green, yellow-brown, or bloody substances.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop symptoms such as vomiting, earache, severe headache, stiff neck, chest pain, or trouble swallowing.
  • You have trouble breathing or your airway is blocked.
  • You develop more severe throat pain along with drooling or voice changes.
  • You have an ulceration or sore on the uvula that hasn't healed in 14 days