What is the treatment for a swollen uvula?

Treatment of Swollen Uvula

For isolated uvular swelling without signs of anaphylaxis or airway compromise, symptomatic treatment with antihistamines, corticosteroids, and observation is appropriate, while patients with respiratory symptoms, fever, or signs of epiglottitis require immediate airway assessment and parenteral antibiotics. 1, 2, 3

Immediate Assessment

First, determine if this is an emergency requiring airway intervention:

• Assess for anaphylaxis: Look for accompanying respiratory compromise (stridor, dyspnea, wheezing), skin manifestations (urticaria, angioedema elsewhere), hypotension, or gastrointestinal symptoms (nausea, vomiting, abdominal pain). 4, 1
• Examine for epiglottitis: Check for fever, severe dysphagia, drooling, muffled voice, and respiratory distress. The uvula may appear "beefy red and swollen" in inflammatory conditions. 4, 3
• Rule out infectious causes: Fever and severe pain suggest bacterial uvulitis, particularly Haemophilus influenzae type b or group A streptococcus. 5

If any signs of airway compromise exist, this is a medical emergency requiring immediate intervention. 6

Treatment Based on Clinical Presentation

For Anaphylaxis with Uvular Swelling

• Administer epinephrine immediately (0.3-0.5 mg intramuscularly in the anterolateral thigh for adults). This is the first-line treatment and should not be delayed. 1
• Provide supplemental oxygen and establish IV access. 4
• Administer antihistamines (H1 and H2 blockers) and corticosteroids as adjunctive therapy, though these do not replace epinephrine. 4
• Observe for at least 4-6 hours as biphasic reactions can occur. 4
• Prescribe an epinephrine auto-injector at discharge and provide education on its use. 1

For Suspected Bacterial Uvulitis (Fever, Severe Pain)

• Obtain a lateral neck radiograph to evaluate for epiglottitis, which can coexist with uvulitis. 5, 3
• Initiate parenteral antibiotics covering H. influenzae type b and group A streptococcus (e.g., ceftriaxone or ampicillin-sulbactam). 5, 3
• Administer intravenous corticosteroids (e.g., dexamethasone 10 mg) to reduce inflammation. 3
• Admit for observation if epiglottitis is present or airway compromise is a concern. 3

For Isolated Uvulitis (No Fever, No Respiratory Distress)

The majority of isolated uvulitis cases follow a benign course and resolve with symptomatic treatment. 2

• Oral antihistamines (e.g., diphenhydramine 25-50 mg every 6 hours or cetirizine 10 mg daily) to reduce edema. 2
• Oral corticosteroids (e.g., prednisone 40-60 mg daily for 3-5 days) to decrease inflammation, though definitive evidence for efficacy is limited. 4, 2
• Sympathomimetic agents such as nebulized racemic epinephrine or albuterol may provide rapid relief in cases with upper airway symptoms. 7
• Analgesics for pain control (NSAIDs or acetaminophen). 4
• Cold compresses and oral hydration for comfort. 4

Antibiotics are not indicated unless there is evidence of bacterial infection (fever, purulent exudate, positive cultures). 4, 2

Common Pitfalls

• Do not assume isolated uvular swelling is benign without examining the epiglottis. Up to 13% of adult uvulitis cases may have coexistent epiglottitis. 3
• Do not delay epinephrine in anaphylaxis. Antihistamines and corticosteroids are adjuncts only and do not prevent airway compromise or cardiovascular collapse. 4, 1
• Do not prescribe antibiotics empirically for non-infectious uvulitis. Most cases are due to angioedema, trauma (snoring, intubation), or allergic reactions and do not require antimicrobials. 4, 2

Follow-Up and Prevention

• Discharge patients with isolated uvulitis after symptom improvement, typically within 30 minutes to a few hours of treatment. 7, 2
• In a series of 15 patients with uvulitis, 93% required no further care after discharge, and 50% needed only symptomatic treatment. 2
• Refer patients with recurrent episodes for allergy testing and possible immunotherapy if an allergic etiology is suspected. 1
• Consider intranasal corticosteroids for patients with associated allergic rhinitis contributing to upper airway inflammation. 1