What really causes uvulitis

The only thing more important than identifying your uvulitis symptoms is identifying the underlying cause of those symptoms. That's because uvulitis can be triggered by many different things and the proper treatment for each cause is different as well. Unless you directly target the precise cause of your uvulitis and employ an appropriate treatment approach, the problem will persist and your uvula will continue to experience prolonged damage.

Even in the event that your body does somehow overcome the threat on its own (for example a viral infection), precious time will have been lost during which you could have interjected to shorten the inflammatory phase and prevented irreversible uvula injury (permanent enlargement, scarring, etc.)

On the other hand, uvulitis is one of the few conditions where treating the wrong cause is almost as bad as not treating the problem at all. For example, treating fungal uvulitis with antibiotics can actually make the infection much worse or having a cough drop (for ex. menthol lozenge) when the underlying cause is acid erosion can further irritate the lining of your uvula.

In essence, by being aware of the different causes of uvulitis, you can quickly neutralize the problem at its source and ensure that your uvula makes it out unharmed.

Here are the 7 most common causes of uvulitis…

(while this section discusses what the main causes of uvulitis are in the next sections we discuss how you can overcome these causes)

1. Harmful microbes - Our uvula's location at the back of our throat puts it at the common entrance of our digestive and respiratory system. This places our uvula in the direct path of everything we eat, drink and breathe, including harmful microbes in our food, water and air. However, this critical location of our uvula in such a high-exposure, high-risk region is no coincidence. That's because our uvula also plays an immuno-defensive role in our body. Just like our tonsils, the uvula acts as sort of a pathogen detector to alert the rest of our body to an incoming microbial threat.

These microbial threats can come from three different types of pathogens:

Viruses - This is one of the most common pathogens our uvula usually comes across. Statistically the average person contracts a viral infection about 3-4 times a year in the uvula/throat region.

Bacteria - These infections tend to be lingering and cause the biggest risk of tissue scarring from prolonged inflammation. Bacterial infections can also easily spread to nearby tissues such as the tonsils, adenoids or even the epiglottis, which can require emergency medical care.

Fungus - Just the way our body maintains a delicate bacterial balance in our gut, it also maintains a similar fungal balance in our mouths. Sometimes this balance is disturbed by medications, stress or poor immunity, causing harmful fungi (such as candida) to suddenly become dominant and cause an infection. What's worse is that just like bacterial infections, fungal infections can be long lasting and cause extensive damage to our uvula.

Remember, though all three types of microbial infections typically exhibit identical symptoms, the treatment for each type of pathogen is completely different. Choosing the wrong treatment can allow the infection to continue or even make your infection worse.

2. Acid erosion - Not all threats to our uvula come from the outside world. In fact, one in particular comes from the inside - stomach acid. Our uvula hangs directly above the esophagus which in turn leads directly into our stomach where you'll find gastric fluids so acidic (pH 2) that they are similar in strength to battery acid. While the inner lining of our stomach constantly produces an alkaline fluid which protects it from this acid, there is no such defensive mechanism for our uvula located a mere 10 inches upstream.

The only thing preventing the acid from entering our foodpipe and severely damaging its tissue is a small ring of muscles known as the lower esophageal sphincter (LES). The LES usually remains tightly closed, creating a seal that prevents the backflow of stomach acids towards our throat. Any failure of this sphincter can cause gastric acid to go up into the foodpipe and eat away at sensitive lining of the esophagus and the uvula.

Shockingly the lower esophageal sphincter inherently has a very high failure rate. Over 40% of the adult population suffers from regular bouts of heartburn which is the hallmark of a malfunctioning lower esophageal sphincter. This means almost half the adult population frequently experiences the damaging effects of corrosive acid escaping the stomach and making its way towards the uvula - potentially causing a condition known as erosive uvulitis.

What's worse is that most people confuse the symptoms of erosive uvulitis with a typical sore throat. This creates a dangerous situation where the sufferer either waits for the problem to clear on its own or treats it for the wrong cause, all the while the acid continues to literally digest away the sensitive lining of the uvula.

3. Physical injury - Consider the makeup of any tissue in our body that comes into contact with the outside world. What you'll find is that it typically has protective features that shield it from physical damage. For example, the outer layer of our skin is guarded by tough keratin fibers and our eyes have tough collagen fibers embedded into the outer layers (in addition to our eyelids) to protect them from injury.

Now take a closer look at the uvula and you'll find something quite unexpected…

For a tissue that constantly comes across all sorts of substances from the outside world (some even harmful), the outer surface of our uvula seems unusually bare. It lacks any tough protective histological features and its surface is made up of exposed epithelium that is quite sensitive. Even if you put aside how it stacks against other exposed tissues such as our skin or our eyes and compare it to other structures within the oral cavity, the uvula still seems pretty defenseless.

Let's see how our uvula matches up to its immediate neighbors…

The tough musculature of our tongue makes it quiet resistant to injury and our inner cheeks are incidentally protected from the simple fact that they are located on the outer perimeters of our mouth behind the guard of our teeth. Even our gums and the roof of our mouth are afforded substantial protection from the bone structure behind it. It isn't until you get to the uvula at the back of your mouth when the tissue suddenly becomes softer, more fragile and much more sensitive. Add to this the fact that our uvula extends further away from the roof of our mouth and is projected directly into the path of everything we eat, drink or breathe and you begin to grasp its true vulnerability.

Certainly it doesn't take much to irritate or even permanently damage your uvula. Swallow anything too big, too sharp, too hot or too cold and your uvula is likely to encounter the threat even before it gets to your throat. In fact, this is partly why the uvula is there in front of your throat in the first place. The uvula is extremely sensitive to touch sensations. This ensures that anything that poses a physical threat to our foodpipe or windpipe activates the gag reflex and forcibly pushes the threat back out. While this prevents the potential threat from entering our throat, it doesn't prevent injury to our uvula.

In many ways the uvula's protective role is almost a sacrificial one because it prevents bigger harm (injury to the throat or choking) at the cost of a "smaller" harm (uvula injury). The ultimate irony of this is that a damaged uvula can be equally devastating to your health and even your life in the long run.

4. Flow-over inflammation - Surprisingly, our uvula can even experience tissue damage when it isn't being directly threatened by an infection, acid erosion or injury. That's because the outer lining of the uvula forms a continuum with many other oral structures such as the throat, tonsils, gums and adenoids. Since these tissues share the same local blood vessel and lymphatic vessel supply, any kind of immune response to an injury or infection rarely remains confined to just the primarily affected tissue.

This also means that when any of these neighboring structures experiences inflammation, it can quickly flow-over into the uvula and cause secondary uvulitis. Oddly enough, since the uvula has very limited defensive capabilities, this flow-over inflammation can actually cause more damage to the uvula sitting on the sidelines than the very tissue where the inflammation first began.

This highlights the unique predicament our uvula is always in. Though each structure in our oral cavity faces its own particular set of threats, the uvula by default is forced share in with all these risks with them because of the flow-over effect. This is precisely why it is so important to protect your uvula even when it is your throat, gums, tonsils or adenoids that are inflamed or irritated simply because the problem can easily spread to the uvula. The main reason why your uvula needs the additional protection is because even if these other tissues come out of the infection unharmed, your uvula may not.

5. Allergic response - Our uvula's role as an immune-defense tissue is not always a helpful one. Sometimes our body misrecognizes harmless substances as a threat and launches an unnecessarily harsh immune attack on the very tissue that encounters this harmless substance. This is your typical allergic response. For some people the trigger for this allergic response can be something in the air they breathe (dust or pollen) and for others it could be something they ate or drank. However, our uvula's peculiar location at the junction of our foodpipe and windpipe means that regardless of how this potential allergen enters our oral cavity it will most likely encounter our uvula's surface.

Now consider this…

Our uvula's surface is comprised of a sensitive mucousal membrane that has highly active immune surveillance. When an allergen comes into contact with this membrane it initiates a domino effect that results in the release of inflammation-causing histamines. While this kind of inflammation doesn't usually cause any lasting damage in other parts of our body, that's not the case with our uvula.

Here's a perfect example of how the sensitive nature of our uvula tissue can turn a typically harmless irritation into something much more damaging. Even brief episodes of inflammation can significantly injure the uvula. The fact that exposure to certain allergens is almost unavoidable combined with the fact that the inflammation remains persistent as long as the allergen exposure does, means that your immune system can sustain a relentless attack on your uvula for days to weeks at a time - long enough to cause permanent tissue damage.

Finally, add to this the fact that most people consider allergies as nothing more a tolerable nuisance and rarely treat it aggressively also means that an allergic response is one of the common ways a lot of people unknowingly damage their uvula.

6. Uvula ulcers - A uvula ulcer is a deep erosion of its mucosal surface. Quite often this ulceration can eat into the outer lining of the uvula to the point of affecting its function. Unfortunately, uvula ulcers are often treated improperly because most over-the-counter treatments are nothing more than analgesics that simply numb the pain while allowing the lesion to remain exposed and the underlying problem to remain untreated.

Ulcers of the uvula can form as a result of viral infections, acid reflux, physical injuries and even an allergic reaction. Did you notice the common thread here? Yes, every single one of the other uvulitis causes mentioned above can also trigger an ulceration of the uvula. Even worse, because uvula ulcers can be self sustaining, they can take a short term problem (infection, allergy, etc.) and turn it into a chronic, long term condition where damage to the uvula continues even after the original problem has resolved.

How long lasting and damaging can these ulcers be? Take for instance one of the most common types of oral ulcers, called apthous ulcers…

  • They affect about 1 out of 4 people
  • These ulcers can take over a month to heal
  • These ulcerations tend to recur at every 1-4 month intervals
  • A single ulcer can leave your uvula scarred with permanent tissue damage

This illustrates how even small, seemingly mild uvula irritations have the potential of spiraling out of control and become chronic problems that keep injuring the uvula on an ongoing basis.

7. Uvula tissue dehydration - Ever notice what happens to your skin when it dries up? It gets itchy, begins to crack up and if its moisture barrier gets depleted, it becomes vulnerable to irritation, inflammation and skin infections. The same thing happens to our uvula, except the end result is much worse.

While the top layer of our skin is composed of dead, flattened cells that physically shield its moisture loss, the surface of our uvula is made up of exposed epithelial tissue. What's worse is that since our uvula hangs right above our windpipe it also has to constantly contend with the evaporative effect of air repeatedly gushing past it.

In essence our uvula has two tough tasks…

  • Not only does its surface need a constant supply of moisture,
  • It also needs to prevent this moisture from constantly being wicked away by our breath

Remarkably, our uvula utilizes a simple yet ingenious method to accomplish both these tasks. It uses a combination of a watery fluid and a thick, gluey substance to maintain its moisture barrier:

  • The watery fluid constantly hydrates the uvula surface
  • While the gluey substance creates a waterproof coating on top to prevent this moisture from evaporating

And what are these two crucial uvula moisturizing fluids?

Saliva & Mucus

Both of which are produced by glands located on the uvula itself.

Yes, our uvula is a self hydrating structure!

The combination of saliva and mucus plays a vital role in protecting our uvula in many different ways:

Since saliva is 99.5% water, it is an ideal hydrating agent while the thick consistency of mucus makes it an ideal waterproofing agent that prevents our uvula from drying out

Both saliva and mucus also contain antibodies, antiseptic enzymes and proteins that help protect our uvula from viruses, bacteria and fungi

This thick fluid coating also has a shielding effect on the uvula because it acts as a cushioning lubricant that prevents micro-trauma

As sensitive as the outer lining of our uvula is, imagine how much more defenseless it would be if something were to disrupt this protective hydration system.

Unfortunately, that is exactly what happens during uvulitis.

Inflammation during uvulitis interferes with the proper functioning of the salivary and seromucous glands located on our uvula. This quickly results in the dehydration of the uvula tissue, leaving it extremely exposed without its moisture barrier.

In this state of extreme vulnerability, almost anything can set off a new round of uvula problems and further damage its tissue:

  • Bacteria and fungus that are normally present in our mouths can suddenly begin to grow out of control and infect the uvula
  • Even the simple act of swallowing can further irritate the lining of the uvula and worsen the inflammation
  • In this dehydrated state the outer epithelium of our uvula can begin to break down, causing an ulceration
  • Prolonged dehydration can also lead to scarring of our uvula and permanently disable part of its function

Once the uvula has lost its moisture barrier, it is stripped bare of its last defense mechanism and the only way to return it back to good health is to quickly reestablish this moisture barrier. Unfortunately, this kind of dehydration cannot be reversed by simply drinking more water.

Remember, our uvula is a self hydrating structure and its moisture has to come from within. Since this kind of dehydration arises when inflammation interrupts the salivary and seromucous glands from working properly, the problem can only be reversed when you treat the underlying cause of the inflammation.

And what if your uvula problems aren't caused by any of the 7 causes mentioned above?

The other most common cause of uvula problems…

8. Age-Related Uvula Dysfunction - So far all of the 7 causes mentioned above are known as pathological causes of uvulitis. In other words, they happen when the normal function of your uvula is interrupted by a harmful substance, organism or injury. However, uvula problems can also arise from physiological causes. In other words, these problems can result from our body's natural aging process. It is important to note that age-related uvula problems can be just as harmful as any of the 7 pathological causes of uvulitis mentioned above.

Consider the effect that aging has on our uvula and you can see why it naturally begins to malfunction and becomes prone to problems…

Let's first look at the makeup of our uvula tissue. A young, healthy uvula is held tightly together by its connective tissue and muscle fibers on the inside and a well toned epithelial layer on the outside. Now let's see how aging affects this structural makeup:

As we age…

  • Our uvula's epithelial surface gets progressively weaker since its cells are not regenerated as quickly
  • The connective tissue underneath progressively loses its collagen and doesn't repair as efficiently
  • The musculus uvulae (our uvula's primary muscle) progressively weakens in tone and loosens

The combined effect of all these things is that

It becomes prone to injuries

Since the epithelial surface is not replenished as quickly, the outer lining of our uvula becomes more brittle.

Also, because of its weakening muscle tone and loss of collagen in its connective tissue, the elongated uvula gets projected further into the path of food, irritants, etc where they are more likely to irritate the already vulnerable uvula surface.

It becomes prone to infections and allergies

Since the exposed surface of our uvula acts as an early pathogen detector for substances entering our windpipe and foodpipe, any imbalance in our immune function can greatly affect the health of our uvula.

Unfortunately, as we age our immune function declines and is increasingly put off-balance.

An underactive immune system can make the uvula more vulnerable to microbial infections while an overactive immune system can increase the likelihood of allergic attacks. In either case, the aging process often makes our uvula more prone to immune driven inflammatory damage.

It becomes prone to dehydration

As we get older, the function of many of our glands declines. This is especially true of glands linked to hydration. For example, the declining function of the sweat and sebum glands on our skin leads to progressively dryness of our skin as we age.

Something similar happens to our uvula where the function of our salivary glands and seromucous glands begin to falter, leading to a progressive dehydration of its tissue.

However, unlike our skin, our uvula's epithelial surface is much more vulnerable to dehydration damage since the moisture barrier is one of its few defense mechanisms.

It also becomes prone to all 7 pathologic causes of uvilitis

Notice how the aging process increases the uvula's vulnerability to all 7 uvulitis causes mentioned above. A lower hanging uvula is more prone to physical injuries and erosion from acid reflux while a poor local immunity and poor gland function can increase the likelihood of microbial infections, allergic responses, flow-over inflammation, ulcerations and dehydration.

In essence, the normal function of our uvula declines as time goes by and problems that start from natural phyisologic causes can soon turn into disease-driven pathologic problems.

Keep in mind, though these problems are age related, you don't have to be old to experience them. In fact, these issues can start as early as your 20s depending on your genetic makeup, lifestyle and environmental factors.

Fortunately, while it may seem like there is nothing you can do to reverse this kind of physiologic age-related deterioration of the uvula tissue, the truth is there are many things that can reverse this process and protect your uvula long-term.

A note on uvula cancer

Though it is not a common cause of uvulitis, it's certainly one that poses the gravest threat. It is crucial to note that every single one of the 7 uvulitis causes mentioned above is risk factor for uvula cancer because they all have one thing in common - uvula inflammation. We now have overwhelming scientific evidence that links chronic tissue inflammation to cancer. The fact that our uvula is especially under-equipped to defend itself against inflammation only adds to this risk. In addition, uvula inflammation can also lead to tissue scarring and an upsurge in DNA-damaging free radicals, both of which increase your lifetime risk of developing uvula cancer.

Many of the uvulitis causes mentioned above also promote uvula cancer in other ways.
For example…

Microbes - Recent studies point to an increase in the number of oral cancers due to the prevalence of HPV in the general population. It is estimated that over 80% of the adult population is exposed to this virus at some point in their lives. What makes this statistic disturbing is that HPV is one of the first viruses that was discovered to be oncogenic (cancer-causing). This is why HPV is not only one of the leading causes of oropharyngeal cancers but also uvula cancer.

Acid erosion - Almost 60% of adults experience acid reflux in any given year and over half of these adults experience it on a daily basis. It is one of the leading causes of oral cancers and over 30% of esophageal cancers are related to acid reflux. Since our uvula is often also exposed to acid during acid reflux, it is just as serious a cancer threat to our uvula as it is to our esophagus.

Ulcers - This is the primary way most uvula cancers are caught. In fact, up to 30% of all ulcerating tumors develop in the head and neck region. If you have an uvula ulcer that hasn't healed in 3 weeks, it is important to go see a doctor to have it closely examined.

This highlights how even small uvula problems have the potential of turning into serious health issues. The key to countering the risk of uvula cancer is to always treat uvula problems in the earliest stages and provide your uvula with the additional support it needs to remain healthy for life.