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Acute painful swelling of the uvula

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Acute painful swelling of uvula is an uncommon infectious condition. Uvular enlargement frequently accompanies pharyngitis or epiglottitis (1,2,3,4)

Uvular inflammation may be secondary to infection, irritation, malignancy, trauma or allergy

Quincke's Disease is primary angioedema of the uvula

  • Quincke's disease is induced by several factors, including foods, drugs, and inhalants
    • most commonly attributed to a type 1 hypersensitivity reaction, but may also be due other causes such as medication reactions, inhalation reactions, and hereditary angioedema
    • should be differentiated from uvulitis, which is primarily considered to be an infectious process


  • uvulitis and pharyngitis share similar bacterial causes e.g. organisms such as Streptococcus Pyogenes, Haemophilus Influenzae, Streptococcus Pneumoniae, Fusobacterium
  • causes of viral pharyngitis may present as viral uvulitis
  • angioedema (Quincke's Disease)
  • trauma
  • iatrogenic (endotracheal Intubation, upper endoscopy, suctioning, anesthetic gas)
  • foreign body ingestion
  • tobacco or marijuana smoke exposure

Clinical Features:

  • possible symptoms
    • foreign body sensation in throat (worse when supine)
    • fever
    • pharyngitis V
  • possible signs
    • uvula swollen and red in midline (may approach grape size)
    • pharyngeal erythema
    • hoarse voice may be present
    • Additional findings in severe cases
      • odynophagia
      • drooling
      • airway compromise and respiratory distress


  • management is based on suspected aetiology
  • mild to moderate infectious cases
    • consider similar antibiotics to those used in streptococcal pharyngitis e.g. co-amoxiclav (4) if not penicillin allergic
  • severe infectious cases
    • may require intravenous antibiotics e.g. ceftriaxone
  • non-infectious management
    • angioedema management if Quincke's Disease is suspected
    • eliminate traumatic causes


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