What is the treatment for a swollen uvula (uvular swelling)?

Treatment of Swollen Uvula

Immediately assess for anaphylaxis or epiglottitis, as these are life-threatening emergencies requiring urgent intervention—administer intramuscular epinephrine 0.01 mg/kg (max 0.5 mg adult, 0.3 mg child) to the anterolateral thigh without delay if anaphylaxis is suspected. 1, 2, 3

Immediate Life-Threatening Assessment

The first priority is ruling out conditions that can rapidly progress to complete airway obstruction and death. 3

Anaphylaxis Evaluation

Anaphylaxis is highly likely if the swollen uvula occurs with:

• Acute onset (minutes to hours) with skin/mucosal involvement (swollen lips/tongue/uvula, urticaria, flushing) PLUS respiratory compromise (dyspnea, wheeze, stridor) OR hypotension/syncope 1, 3
• Two or more systems involved after allergen exposure: skin/mucosal changes, respiratory symptoms, hypotension, or persistent gastrointestinal symptoms (crampy pain, vomiting) 1, 3

If anaphylaxis criteria are met:

• Administer intramuscular epinephrine immediately to the vastus lateralis (mid-outer thigh)—this achieves peak plasma concentrations in 8 minutes versus 34 minutes for subcutaneous deltoid injection 1
• Provide supplemental oxygen and establish IV access 2, 3
• Administer 1-2 liters normal saline rapidly 3
• Give antihistamines (diphenhydramine) and corticosteroids (methylprednisolone) as adjunctive therapy only—these do NOT prevent airway compromise or cardiovascular collapse 1, 2, 3, 4
• Observe for at least 4-6 hours as biphasic reactions can occur up to 72 hours later 2, 3
• Prescribe epinephrine auto-injector and provide education on its use 2

Epiglottitis Evaluation

Examine for fever, severe dysphagia, drooling, muffled voice, and respiratory distress. 2, 3 If epiglottitis is suspected, prepare for emergent airway management without manipulating the airway. 3

Non-Emergency Uvular Swelling

If anaphylaxis and epiglottitis are excluded, proceed with differential diagnosis.

Infectious Causes (Streptococcal Pharyngitis)

Look for: Tonsillopharyngeal erythema with "beefy red" appearance, tonsillar exudates (though not required), tender anterior cervical lymphadenopathy, fever, and absence of cough. 1, 5, 3

Critical caveat: The presence of cough, rhinorrhea, hoarseness, or conjunctivitis strongly argues against Group A Streptococcal pharyngitis—do not test or treat for bacterial infection in these cases. 5, 3

If bacterial pharyngitis is suspected:

• Obtain throat culture or rapid antigen detection test for microbiological confirmation—clinical findings alone are only 80% accurate 5, 3
• Treat confirmed Group A Streptococcal pharyngitis with penicillin or amoxicillin for 10 days to prevent rheumatic fever and post-streptococcal glomerulonephritis 3

Isolated Uvulitis (Non-Infectious)

For isolated uvular swelling without systemic features:

• Administer oral antihistamines (diphenhydramine or cetirizine) to reduce edema 2, 3
• Provide analgesics (NSAIDs or acetaminophen) for pain control 2
• Use cold compresses and encourage oral hydration for comfort 2
• Monitor for progression over 4-6 hours 3

Do not prescribe antibiotics empirically—most cases are due to angioedema, trauma, or allergic reactions and do not require antimicrobials. 2, 3

Traumatic or Drug-Induced Uvulitis

Consider recent trauma (intubation, snoring, cannabis use), ACE inhibitors, NSAIDs, or angiotensin II receptor antagonists as potential causes. 6 Treatment is supportive with antihistamines and observation. 2

Hymenoptera Sting to Uvula

If a stinger is visible, remove it immediately with tweezers. 7 Administer IV corticosteroid and antihistamine, but if significant upper airway edema persists, administer epinephrine—sympathomimetic drugs by injection and inhalation can achieve complete resolution within 30 minutes. 8, 7

Critical Pitfalls to Avoid

• Never delay epinephrine in suspected anaphylaxis while waiting for antihistamines or corticosteroids to work—delayed epinephrine is associated with hypoxic-ischemic encephalopathy and death 1, 2, 3
• Do not test for streptococcal pharyngitis when viral features (especially cough) are present—this leads to unnecessary antibiotic use 3
• Do not assume tonsillar exudates equal bacterial infection—viral infections frequently produce exudates 5
• Always examine the uvula in patients with airway-related complaints, as it is a potential cause of upper airway obstruction 8