Sometimes, it is not only the visible part of the tongue that swells, but also the back of the tongue, the mouth, the gums, and occasionally the larynx or voice box, says Lorraine Smith, MD, of the Osborne Head and Neck Institute in Los Angeles.
The tongue is primarily a muscular structure covered by layers of cells called epithelium. Its surface is lined with taste buds, which allows us to differentiate tastes like bitter, sweet, and salty. Like the tongue, the taste buds on your tongue can swell.
Because a swollen tongue can interfere with your airways and cause serious problems with your breathing, it is usually a medical emergency that requires immediate treatment.
What Causes a Swollen Tongue?
Swelling is an important defense mechanism in our bodies. Swelling fights off harmful bacteria and parasites, and helps with injury and healing. However, inappropriate swelling or swelling that persists can be harmful.
There are multiple chemical pathways that turn swelling on and off, which are complicated and only partially understood, says Anna Feldweg, MD, a clinical instructor of medicine at Harvard Medical School and attending physician in allergy and immunology at Brigham and Women’s Hospital in Boston. A swollen tongue can happen when something – a medication, allergen (something that causes an allergic reaction), or medical problem – interferes with these pathways. Here’s a look at some common causes.
Medications. Many cases of a swollen tongue are the result of a reaction to a medication such as an ACE inhibitor, used to treat high blood pressure, or an NSAID, or non-steroidal anti-inflammatory drug, such as aspirin, ibuprofen [Advil, Motrin], or naproxen [Aleve, Naprosyn]. A swollen tongue due to a reaction to ACE inhibitors usually occurs during the first year of taking the medication, but can also happen after years of taking it, says Dr. Feldweg.
Allergens. In addition to allergic reactions to medications, allergic reactions to other substances – such as foods or bee stings – can cause swelling. In food allergies and bee sting allergies, the tongue can swell, but it is less common to have a swollen tongue than it is to have a swollen throat or lips.
Infection. Another possible cause of a swollen tongue is an infection deep inside the tongue or in the floor of the mouth. This usually develops over a day or two – more slowly than the allergic type of swelling.
Some people develop fungal infections in the mouth known as thrush. Fungal infections are caused by the fungus Candida and usually occur after a course of antibiotics. It’s the same fungus that can cause vaginal yeast infections. People with compromised immune systems, like those with HIV, also are susceptible to this yeast, also called simply candida thrush, that can cause the tongue to swell. Candida thrush can be treated with thrush medications that you swish and swallow, or swish and spit, Dr. Smith says. An oral medication often used to treat recurring thrush is fluconazole (Diflucan).
Herpes viruses also can cause infections that result in swelling of the tongue. “While there is no treatment for viral infections, recovery can sometimes be enhanced with the medicine acyclovir (Zovirax),” Smith says. Other similar drugs may also help. Herpes tongue lesions or ulcers are often extremely painful. They present as a red sore with a white overlying layer that can be wiped off with a cotton swab.
Medical illness. Very slow swelling of the tongue over weeks or months can occur in a condition called amyloid, a disease in which harmful amyloid proteins are deposited into tissues and organs. “With [amyloid], the tongue gets bigger and bigger over time,” says Feldweg.
Irritants and trauma. You may find that your tongue swells if you accidentally bite it or burn your tongue with hot liquids or hot foods. Dental appliances also can irritate your tongue and cause it to swell. Tobacco is yet another irritant that can cause tongue pain and swelling.
Tongue cancer. Tongue cancer is a common cancer of the head and neck – more than 10,000 new cases are diagnosed in men and women in the United States each year. Highly curable if caught early, tongue cancer usually starts as a lump, ulcer, or white spot or patch on the outer layer of the tongue or a surrounding area.
“Cancer of the tongue is often painful,” Smith says. An infection tends to be self-limiting and will go away, whereas tongue lesions associated with cancer often persist and increase in size with time. Suspicious lesions need to be biopsied and treated appropriately if found to be cancerous, Smith says. “Some tongue cancers may not involve pain but any mass that persists for more than two weeks needs to be biopsied.”
Other tongue cancer symptoms include pain when chewing or swallowing, ear pain, numbness in the mouth, bleeding in the mouth, and a persistent sore throat.
A red patch on the tongue is often painless, but has a higher chance of being associated with cancer than a white patch on the tongue. But both patches need to be biopsied to get a definite diagnosis, Smith says, and to be able to apply the appropriate treatment.
Both tongue disorders and cancers of the tongue may present with swollen lymph nodes – under the chin and in the mandible region. If you have an infection, the swollen lymph nodes or swollen taste buds near the tongue will eventually go away after the infection clears. But another tongue cancer sign is if the swelling continues to progress and doesn’t go away, Smith says.
In addition, a swollen tongue can be caused by:
Hormonal disorders such as acromegaly
Congenital disorders such as Beckwith Wiedemann syndrome
Genetic disorders such as Down syndrome and hereditary angioedema
Hypothyroidism, an underactive thyroid
Poor vitamin B12 absorption
Pituitary gland disorder
Treating a Swollen Tongue
Because a swollen tongue can lead to breathing problems, it should be looked at as an emergency situation. Medical personnel usually treat a dangerously swollen tongue with an injection of epinephrine, which may or may not work, depending on the cause. Once the person arrives at the hospital, “we usually give people steroids and antibiotics in the emergency room,” says Feldweg, adding that treatment for a swollen tongue ultimately depends on the cause.
If the swollen tongue is caused by a drug reaction, the person must stop taking the medication. In food allergies, foods that trigger the swelling must be avoided. Anyone who has a history of a swollen tongue due to an allergic reaction will probably be advised to carry an injectable dose of epinephrine with them, which may help control the swelling if the tongue begins to swell again. If the cause is infection or amyloid, those will be treated accordingly.
There are many different causes of a swollen tongue. Most are straightforward to treat and the swelling goes away. If your tongue swells and interferes with your breathing, you need to go to the ER for treatment. If it’s a persistent problem, see your doctor so he can determine the cause of your tongue swelling and find the most appropriate treatment.