Uvulitis (Galashundi) – Causes, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Galashundi / Kanthashundi is a disease caused by vitiated kapha and blood wherein there is a swelling resembling a water filled pot / leather bag / bladder at the root of the palate i.e. in the uvula.

Introduction

Gala / Kanta = throat, neck
Shundi – swelling resembling water filled pot / bladder / leather water bag or the shape of an elephant’s trunk.
Read – Sore Throat Causes, Ayurveda Remedies, Treatment, Therapies

Though the disease is categorized in talugata rogas i.e. diseases of the palate, its name i.e. galashundi / kanthashundi which indicates the involvement of neck / throat seems to be misleading. But it is not so. This is of course a disease of the palate, but the swelling seems to be extending into the throat / neck. This is substantiated by the mention of difficulty in breathing and cough as symptoms of this disease. These symptoms are caused only if the swelling blocks the trachea / pharynx or larynx located in the neck by extending backwards.
Read – Laryngitis (Swelling of voice box) – Causes, Ayurvedic Treatment

Category – Galashundi / Kantashundi can be grossly classified under Mukhagata Rogas (diseases of the oral cavity).

Galashundi / Kanthashundi disorders occurs in the palate. Therefore it is included under Talugata rogas (diseases / afflictions of the palate). To be more specific, this disease occurs in the uvula. Talugata rogas is the sub-category under Mukhagata Rogas.

Uvula – It is a conic projection from the posterior edge of the middle of the soft palate i.e. the portion that forms the smooth part of the roof of our mouth. It is composed of connective tissue containing many racemose glands and musculus uvulae i.e. muscular fibres of uvula. It also is made up of many serous glands that produce a lot of thin saliva.
Read – Tonsillitis Ayurvedic Treatment, Herbs, Home Remedies

Pathogenesis

Pathogenesis and symptoms of Galashundika –
Galashundika / Kantashundika are caused due to the vitiation of kapha and blood tissue. When the vitiated kapha and blood gets lodged in the palate, a swelling resembling a pot / leather bag / bladder filled with water is formed at the posterior part of the palate i.e. in the uvula being associated with thirst, difficulty in breathing, cough etc symptoms. This condition is called Galashundika / Kanthashundika.

Symptoms –

• Talumule deerghah shophah dhmaata vasti prakaashah – an elongated swelling of the shape of a water filled pot / bladder / leather bag at the root of the palate i.e. in the uvula
• Trushna – thirst
• Kasa – cough
• Shwasa – difficulty in breathing / dyspnea
  Read – Hoarse Voice Causes, Ayurvedic Treatment, Home Remedies

Shloka

Treatment

Treatment of Galashundi / Kanthashundi –
Kaphahara measures – Since Galashundi / Kanthashundi palate disorder is caused due to increased kapha, all kapha mitigating and expelling measures should be done in treating this condition.
Read – Activities And Diet For Kapha Balance

Kaphahara rasa gandusha dharana – Full mouth gargles using juices and decoctions capable of mitigating kapha should be given.
Read – How To Do Oil Pulling In Genuine Ayurvedic Way?

Kushtadi kalka pragharshana – the powders of the below mentioned herbs should be mixed in honey and made into paste. This paste should be used to rub against the swelling of galashundika in order to relieve the condition. The herbs are –

• Kushta – Saussurea lappa
• Black pepper
• Vacha – Acorus calamus
• Rock salt
• Long pepper
• Patha – Cissampelos pareira
• Cyperus rotundus

If the condition doesn’t respond to the medications, it shall be dealt by surgical intervention. Master Sushruta has explained the surgical process for Galashundi / Kantashundi.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

Surgery

Surgical procedure for Galashundi / Kanthashundi Oral Disorder

Purvakarma – Pre-operative measures

• Patient should be thoroughly examined and checked if he is eligible to undergo surgical intervention.
• All the essential equipments and ingredients needed to conduct surgery should be kept ready, including the forceps and round edged knife.
• All medicines needed for post-operative care should also be kept ready.
• The patient should be explained about the procedure and counselled.
• The pre-operative measures have not been highlighted by master Sushruta in the verses related to surgical intervention for galashundi, but I have highlighted a few points which need to be kept in mind before any surgery.
• Ayurveda too has emphasized the importance of pre-operative procedures. In some instances it has not been explained due to fear of elaboration and also taking for granted that the student of surgery will have essential knowledge of the same beforehand).
  Read – Procedure of surgical operation: Ashtanga Hrudaya Sutrasthana 29

Pradhana Shastra Karma – Operation – the main surgical procedure for Galashundi

• The swelling of galashundi which lay on the tongue should be held carefully with the help of thumb, finger and sandamsha yantra i.e. forceps and gradually pulled outwards, towards the mouth.
• After gripping the swelling firmly and pulling it towards the mouth. The swelling should be excised using a mandalagra shastra i.e. knife with round edge.
• Half or one third of the swelling should be excised, not in totality.
• Physician should take caution so as to not excise the swelling excessively or lesser than required.
• Excessive or deficit excision of galashundi is harmful to the patient. When it is excised excessively, severe bleeding may occur which may cause the death of the patient also.
• If deficit excision is done, the patient will suffer from swelling of the palate, excessive salivation, excessive sleep and giddiness. Therefore this surgery should be delicately handled by an experienced and wise surgeon.
  Read – Tested Remedies For Eye, Ear, Nose, Throat Problems: Ramdas Pai

Paschat Karma – Post operative care
The post-operative care of the patient is equally important for comprehensive results of the surgical process.

Marichadi Kalka Pratisarana – After proper excision of the swelling, the paste of the below mentioned ingredients should be gently applied over the lesion –

• Black pepper
• Ativisha – Aconitum heterophyllum
• Patha – Cissampelos pareira
• Vacha – Acorus calamus
• Kushta – Saussurea lappa
• Kutannata – Oroxylum indicum

Vachadi Kwatha Kavala Dharana – Decoction of the below mentioned ingredients shall be used for half mouth / partial gargle.

• Vacha – Acorus calamus
• Ativisha – Aconitum heterophyllum
• Patha – Cissampelos pareira
• Rasna – Pluchea lanceolata
• Katuki – Picrorhiza kurroa
• Neem
  Read – Vacha – Acorus calamus Uses, Research, Side Effects, Remedy

Ingudyadi Panchagi Vartika Dhumapana – Medicated smoking should be given to the patient with the wick prepared from the paste of the below mentioned ingredients –

• Ingudi – Balanites egyptiaca
• Katabhi / Kinihi  – Albizia lebbeck
• Danti – Baliospermum montanum (read here)
• Sarala – Pinus longifolia / Chir Pine
• Devadaru – Cedrus deodara

Kshara sidda mudga yusha – Soup prepared from green gram processed with alkali should be served along with the food, as a part of disease specific diet.

Surgical procedure for Tundikeri and other palate disorders
Master Sushruta has mentioned that the same surgical procedure which has been explained for the treatment of Galashundi palate disorder should also be adopted in effective treatment of other palate disorders which are mentioned below. They are –

• Tundikeri – Tonsilitis / Enlarged tonsil
• Adhrusha – Palatitis
• Kachchapa / Kurma – Adenoma of the palate
• Mamsa Sanghata – Fibroma
• Talu pupputa / Lala Pupputa – Epulis

Modern correlation – On the basis of the predominant symptom i.e. elongated swelling at the root of the palate, i.e. uvula, Galashundi / Kanthashundi oral disorder can be closely compared to ‘uvulitis’ or ‘elongated uvula’. (read more)

Uvulitis

Uvulitis – Causes, Symptoms, Remedies and Treatment of swollen uvula

Uvulitis is inflammation of uvula. It is also called as swollen uvula.

The roof of the mouth is composed of two parts, hard palate in the front and the soft palate at the back. Uvula is a part of soft palat. It is the fleshy piece of tissue. It is made up of mucus membranes, connective and muscle tissues and small channels which secrete saliva into the mouth. It can be seen at the back of the throat, hanging from the middle of the soft part of the palate.
Read – Mouth Ulcers Ayurvedic Treatment, Medicines, Remedies, Tips

When we swallow food, the soft palate closes the nasal passages such that the food wouldn’t enter the respiratory passage. On the other hand, the uvula, which is a part of soft palate, helps to push the food towards your throat.

Uvulitis, as said, is inflammation as well as swelling of uvula. Most times it may not be severe and it may go away by itself. If the swelling and inflammation is sever and of not a temporary nature, it may bother you and may also intervene with your ability to swallow food and liquids. In most severe cases, a swollen and inflamed uvula can also restrict your breathing, though it is very uncommon to see such severe cases.
Read – Types Of Swelling – Ayurveda Diagnosis Charak Samhita Sutrasthan-18

Uvulitis can occur at any age. It is anyhow less common in adults in comparison to the children.

Causes of Uvulitis

Uvulitis can occur following a local or systemic inflammation elsewhere in the body. The triggers for inflammation are as follows –

Environmental and lifestyle factors
The environmental and lifestyle factors enlisted below may lead to some inflammatory reactions in the body which may cause many disturbances and disorders including swelling of uvula. The important ones are –

Allergens – Exposure to allergens like dust, pollen, some incompatible foods, animal dander etc can cause severe allergic reactions, including inflammation and swelling of uvula. This leads to Uvulitis . Exposure to the mentioned allergens includes ingesting or inhaling them.
Dehydration – Less than required fluids in the body and water imbalance can cause uvulitis.
Alcohol consumption – People who consume more alcohol and have addiction to the same may develop uvulitis on long run.
Read – Effects Of Alcohol Consumption On Health
Medication – Swelling of uvula can occur due to the side effects of certain medicines.
Chemicals – Inhalation of certain substances having chemicals which trigger reactions in your body, of the likes of tobacco, cannabis etc can cause inflammation and swelling of uvula.
Snoring – In a person who is habituated to snore for long periods of time, the heavy vibrations that irritate the uvula will cause its inflammation and subsequent swelling. On the other hand, snoring can occur due to swollen and inflamed uvula. Thus, snoring can be both cause and effect of swollen uvula / uvulitis.
Read – Dry Mouth Causes, Ayurvedic Treatment, Remedies, Tips, Diet

Infections
Some infections can lead to irritation of uvula that causes inflammation and swelling of uvula.

Viral infections – The below mentioned conditions of viral infections can result in uvulitis –

• Common flu
• Common cold
• Croup
• Mononucleosis
  Read – Ayurvedic Remedy For Common Cold And Allergy

Bacterial infections – Throat infection with Streptococcus pyogenes bacteria is the most common bacterial infection of throat which also can cause uvulitis.
Infection of tonsils and tonsillitis – When your tonsils get infected leading to tonsillitis, the inflamed tonsils can push over your uvula. This will subsequently cause irritation, inflammation and swelling of uvula, leading to uvulitis.
Sexually transmitted diseases – In people having HIV and genital herpes, the immune systems would be compromised. These people are at greater risk of hiring oral thrush. These in turn leads to swollen uvula and potentially contribute towards the manifestation of uvulitis.
Read – Clinical Case Study: Herpes Zoster – By Dr Rangaprasad Bhat

Trauma
Trauma to uvula is the local cause of inflammation and swelling of uvula. It can be caused by a medical condition or surgical procedure.
The throat and uvula can become irritated and subsequently inflamed and swollen following –

• Frequent vomiting
• GERD (Gastroesophageal reflux disease) causing acid reflux
• Injury to uvula during intubation (during surgery)
• Injury to uvula during tonsillectomy
  Read – GERD, Heartburn: Causes, Symptoms, Ayurvedic Treatment, Tips, Remedies

Genetics
Hereditary angioedema – is an uncommon condition which can cause swelling of uvula and throat. It also causes swelling of hands, feet and face. It is a rare case and occurs 1 in 10,000 / 50,000 people as per US Hereditary Angioedema Association.

Elongated uvula – is a rare genetic condition. In this, the uvula is larger than normal. It is almost similar to Uvulitis but both conditions are different. Uvulitis doesn’t cause elongated uvula. Surgery is the only option in elongated uvula, but uvulitis may be treated with medications.

Other causes
Smoking and alcohol
General anaesthesia
Read – Ayurvedic Smokers Diet – Must Have Herbs In Your Diet

Symptoms of Uvulitis

• Swelling around the uvula and the surrounding areas
• Redness and soreness of uvula
• Feeling of something being stuck at the back of the throat
• Difficulty in swallowing and pain at swallowing
• Pain in the throat
• Fever
• Voice changes
• Difficulty in breathing
• Sore throat
• Excessive salivation
• Nasal regurgitation
• Swelling of tonsils
• Gagging
  Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know

Risk Factors

• Long standing allergies
• Addicted to tobacco and its products
• History of exposure to chemicals and other irritants
• A weakened immune system making you susceptible to frequent infections
  Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Diagnosis of Uvulitis

It is important to see your doctor as soon as you find that you have a swollen throat which is making you difficult to speak or swallow food and drinks. The more you delay, the more worse it gets. One should not waste time by trying home remedies and easy measures. On long term, these measures will harm.

Swelling inside the mouth, at the region of uvula along with fever should be a signal to take a consultation. Fever may indicate infection. These signs may also point towards some medical conditions in the body which is causing uvulitis and need to be diagnosed without delay.

One should give a detailed account of the problem to the consulting physician or surgeon so that they can take prompt action. One should let the doctor know about all the medications you take, your habits related to smoking and tobacco chewing if any, any new and incompatible foods that you have tried, exposure to any unusual substances including chemicals if any, and very importantly about the associated symptoms such as pain in the tummy, fever, dehydration, difficulty in swallowing food and liquids, cough etc. All these information will help the doctor to make correct diagnosis and treat your uvulitis promptly.
Read – Turmeric Curcuma longa Benefits, Usage, Dose, Side Effects

ENT specialists i.e. the physicians having expertise in treating ear, nose and throat conditions are the best physicians to deal these problems. The doctor may put you through a thorough physical examination and a set of tests to make a confirmed diagnosis, but the typical signs and symptoms of uvulitis are usually the telltales of the disease.

Throat swabs may be taken to test for a bacterial or fungal infection. Nose swabs to rule out influenza may also be taken. Blood tests to help identify or rule out some other infections and infectious agents in the body are also preferred.
Read – Sinusitis: Ayurvedic treatment, Remedies, Preventive tips

An opinion of allergist is also essential when the preliminary tests for diagnosis of a throat swelling fail. Blood and skin tests can help in identifying foods or other substances and any allergens which might have caused allergic or inflammatory reactions in the body leading to the manifestation of uvulitis.

When to see the doctor?
One should see the doctor when the below mentioned symptoms are seen in a patient with swollen throat and uvula –

• Severe difficulty in swallowing
• Difficulty in breathing
• Severe and uncontrolled pain
• Muffled voice
• Severe signs of dehydration
• Fever and pain abdomen
• Blood, pus or any other abnormal fluid drainage from the uvula
  Read – Shoola Types, Symptoms, Treatment, Medicines, Remedies

Home Remedies for swollen uvula

The below mentioned home remedies may not cure your uvulitis but may help in easing the symptoms. Getting a medical opinion from your doctor or surgeon is very important to get rid of the swollen uvula.

Warm salt water gargle – Gargling with warm water mixed with salt will comfort the throat, relieves dryness and itching in the throat.
Suck ice pieces – Sucking pieces / chips of ice cools your throat. Alternatively, ice cream or frozen juice bars may be used.
Throat lozenges – will help to reduce pain. Eucalyptus cough drops or throat sprays or any herbal lozenges need to be used to relieve irritation and pain in the throat.
Herbal tea – Basil leaf tea reduces throat irritation and swelling. Hot tea and honey can help.
Hydration – keeping oneself hydrated by drinking right amounts of water and regular consumption of water throughout the day is good for uvula. Good sleep – Good quality and quantity of sleep during night helps ward inflammation and is good when one has uvulitis. A small additional nap in the noon too will help.
Read – 20 Simple Ayurveda Tips For A Better Sleep

Prevention tips

Preventive measures for swollen uvula / uvulitis

• One should keep away the allergens especially if he or she is prone to catch up frequent cold or throat infections.
• One should keep hydrated regularly.
• Alcohol, tobacco, cannabis and smoking shall be avoided.
• If any medicines are causing problems related to throat, report it to the doctor.
• One should protect oneself from chemical exposure when working in chemical related jobs.
• Prompt treatment for snoring should be taken.
• Any infections should not be neglected and should be got rid of.
• Trauma to the throat and GERD should be attended to promptly with the help of doctor.
• One should keep away from spicy, hot and pungent foods or any irritable foods which cause irritation to the throat.
  Read – Pungent Taste – Qualities, Health Benefits, Side Effects

Treatment options for uvulitis

• Treatment of uvulitis or swollen uvula depends on the cause. Treating the underlying cause will resolve swollen uvula / uvulitis.
• Viral infections clear up without treatment most of the times. In case of presence of common cold or stubborn flu / influenza, they should be promptly treated. If uvulitis is caused due to these conditions, treating them will clear the uvulitis.
• When there are bacterial infections on the backdrop of uvulitis, antibiotics are prescribed. A contagious patient may be advised to stay at home until he is no longer at risk of spreading it to others.
• When allergies are diagnosed and possible allergens tracked down, the patients are treated with antihistamines or steroids.
• Hereditary angioedema will be treated using one or the other of the C1 esterase inhibitors, plasma kallikrein inhibitor, bradykinin receptor antagonist or androgens.

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype