What is the treatment for a swollen uvula?

Treatment of Swollen Uvula

Treat isolated uvulitis with symptomatic care alone (analgesics, oral antihistamines, and observation), as most cases resolve without antibiotics or corticosteroids and have a benign course. 1

Initial Assessment and Airway Management

The first priority is determining whether the swollen uvula represents an isolated finding or part of a more serious condition:

• Examine for airway compromise immediately by assessing for respiratory distress, stridor, drooling, or inability to handle secretions 2, 3
• Visualize the epiglottis in any patient with uvulitis who has fever, severe odynophagia, or respiratory symptoms, as simultaneous epiglottitis can occur and requires different management 3
• Look for a visible stinger if there is history of insect exposure, as hymenoptera stings to the uvula require immediate manual removal 2
• Assess for anaphylaxis by checking for urticaria, hypotension, bronchospasm, or other systemic symptoms beyond isolated uvular swelling 4, 5

Treatment Based on Etiology

Isolated Uvulitis (Most Common)

The majority of uvulitis cases are benign and require only symptomatic treatment:

• Analgesics (NSAIDs, acetaminophen, or throat lozenges) for pain relief 6, 1
• Oral antihistamines (such as diphenhydramine) may provide symptomatic benefit 1
• Observation is appropriate as 93% of patients discharged with symptomatic treatment alone required no further care 1
• Antibiotics are NOT indicated for isolated uvulitis without evidence of bacterial infection, as the condition typically resolves spontaneously 1
• Corticosteroids have no proven benefit for isolated uvulitis and should not be routinely prescribed 1

Allergic/Anaphylactic Uvulitis

If systemic allergic symptoms are present beyond isolated uvular swelling:

• Epinephrine (intramuscular) is the first-line treatment for anaphylaxis presenting with significant upper airway edema 5, 2
• Antihistamines (diphenhydramine) should be administered as adjunctive therapy 5, 2
• Corticosteroids (methylprednisolone or equivalent) are indicated for anaphylaxis to prevent biphasic reactions 5, 2
• Inhaled beta-agonists may provide additional benefit for airway edema 7, 1

Infectious Uvulitis with Bacterial Pharyngitis

Only prescribe antibiotics if there is concurrent bacterial pharyngitis confirmed by clinical and microbiologic criteria:

• A "beefy red swollen uvula" is a recognized finding in group A streptococcal pharyngitis but is not specific for bacterial infection 4
• Obtain throat culture before initiating antibiotics if bacterial pharyngitis is suspected based on fever, tonsillopharyngeal exudates, tender cervical lymphadenopathy, and absence of viral symptoms (cough, coryza, conjunctivitis) 4
• Amoxicillin is first-line treatment if group A streptococcal pharyngitis is confirmed 8
• Do not prescribe antibiotics for isolated uvular swelling without documented bacterial infection 1

When to Admit or Escalate Care

• Admit patients with associated peritonsillar abscess, epiglottitis, or significant airway compromise 1, 3
• Consider admission for patients with persistent respiratory distress despite epinephrine administration 2
• Discharge is appropriate for isolated uvulitis with patent airway and ability to swallow secretions 1

Common Pitfalls to Avoid

• Do not assume all uvulitis requires antibiotics - the largest case series showed 50% of discharged patients received symptomatic treatment only with excellent outcomes 1
• Do not miss concurrent epiglottitis in febrile patients with severe odynophagia, as this requires antibiotics and close observation 3
• Do not delay epinephrine if there is significant upper airway edema from allergic causes, as antihistamines and corticosteroids alone may be insufficient 2
• Do not confuse viral pharyngitis with bacterial infection - the presence of cough, coryza, or conjunctivitis strongly suggests viral etiology that does not require antibiotics 4