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Idiopathic uvulitis is the most common cause of uvulitis, followed by infections and angioedema. Most patients complain of a sore throat, a gagging sensation, or a foreign-body sensation in the back of the mouth.
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The infectious etiologies of uvulitis include bacterial, including H influenzae and streptococci; fungal, such as C albicans; and viral. Uvular infections are typically extensions from adjacent infections, such as epiglottitis, tonsillitis, PTAs, and pharyngitis. Patients note fever, odynophagia, trismus, facial pain, hoarseness, neck pain, and headache. On examination, the uvula is red, firm, swollen, and very tender to palpation.
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Angioedema of the uvula, known as the Quincke disease, can be hereditary, acquired, or idiopathic. Medications, allergens, thermal stimuli, pressure, and iatrogenic or accidental trauma can initiate angioedema. In addition to the swollen uvula, patients may note pruritus, urticaria, and wheezing. With uvular edema, the angioedema may also involve the face, tongue, and oropharynx. Airway compromise is more common in angioedema of the uvula, which appears pale, boggy, and edematous, resembling a large white grape (uvular hydrops).
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Management and Disposition
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Most cases of uvulitis are benign and self-limited. Angioedematous uvulitis is treated with steroids, antihistamines, and epinephrine in severe cases, either subcutaneously or nebulized. For infectious uvulitis, antibiotic coverage is dictated by the primary source of infection. Admission is based on severity of airway compromise and accompanying infections.
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Any airway symptom prompts an evaluation of the hypopharynx, by either radiographic imaging, fiberoptic nasopharyngoscopy, or direct laryngoscopy.
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