From the Guidelines
A thick tongue that makes oropharyngeal examination difficult puts the patient at risk for several serious conditions, primarily aspiration pneumonia, malnutrition, and decreased quality of life. These conditions can arise due to oropharyngeal dysphagia, which is a common feature of many neurological disorders, including amyotrophic lateral sclerosis (ALS), Parkinson's disease, stroke, and multiple sclerosis (MS) 1. The risk of aspiration pneumonia is particularly high in patients with oropharyngeal dysphagia, as they are more likely to experience silent aspiration, which can lead to pneumonia and even death 1. Additionally, oropharyngeal dysphagia can result in malnutrition and dehydration, as patients may have difficulty consuming adequate nutrients and fluids 1. The management of oropharyngeal dysphagia should include a comprehensive evaluation, including a clinical swallow exam and/or instrumental dysphagia assessment, and may involve the use of texture-modified diets and/or thickened liquids to reduce the risk of aspiration 1. It is essential to investigate the underlying cause of the thick tongue, as it may be related to conditions such as hypothyroidism, amyloidosis, acromegaly, or angioedema, which require specific treatment. Patients with oropharyngeal dysphagia should be counseled about the risks of aspiration pneumonia, malnutrition, and decreased quality of life, and should be referred to specialists, such as speech-language pathologists, for further evaluation and management 1. Overall, the presence of a thick tongue that makes oropharyngeal examination difficult is a significant concern, and prompt evaluation and management are necessary to prevent serious complications and improve patient outcomes.
From the Research
Conditions Related to Thick Tongue and Oropharynx Exam Difficulty
- Upper airway obstruction: A thick tongue can cause upper airway obstruction, which can lead to serious conditions such as respiratory failure or cardiac arrest 2.
- Aspiration pneumonia: Patients with a thick tongue or difficulty with oropharynx exams are at risk for aspiration pneumonia, a type of pneumonia that occurs when food, liquids, or other materials are inhaled into the lungs 3, 4, 5.
- Aspiration pneumonitis: This is another condition that can occur when materials are inhaled into the lungs, causing inflammation and damage to the lung tissue 5.
- Dysphagia: Abnormal swallowing can lead to aspiration pneumonia and other complications, and a thick tongue or difficulty with oropharynx exams can contribute to dysphagia 4.
Risk Factors and Prevention
- Poor oral health, abnormal swallowing, and certain medical conditions such as Parkinson's disease or stroke can increase the risk of aspiration pneumonia 4.
- Prevention strategies include dietary modifications, assistance with feeding, use of postures that facilitate normal deglutition, rehabilitation, and medications to improve swallowing defects 4.
- Pharmacologic interventions such as angiotensin-converting enzyme inhibitors and capsaicin may be beneficial in preventing aspiration pneumonia, but more research is needed to guide an evidence-based approach 6.