Palatine uvula

The uvula (pronounced /ˈjuːvjələ/) is a small, mucosa-covered set of muscles, musculus uvulae, hanging down from the soft palate, near the back of the throat. The word is derived from the diminutive of uva, the Latin word for "grape", due to the uvula's grape-like shape.

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Function in voice

The uvula plays an important role in the articulation of the sound of the human voice to form the sounds of speech.^[1] It functions in tandem with the back of the throat, the palate, and air coming up from the lungs to create a number of guttural and other sounds. Consonants pronounced with the uvula are not found in English; however, languages such as Arabic, French, German, Hebrew, Ubykh, and Hmong use uvular consonants to varying degrees. Certain African languages use the uvula to produce click consonants as well. In English (as well as many other languages), it closes to prevent air escaping through the nose when making some sounds.

Pathology

Universal Emetic

Patients that suffer from bulimia nervosa, an eating disorder, tend to take the uvula to their advantage. Massaging the uvula causes the gag reflex to initate and expell stomach contents. Massaging the uvula is the universal alternative to ipecac, but should not be practiced as it can result in damage to the lining of the esophagus and other long term health problems such as rotting of the teeth and gums.

Velopharyngeal insufficiency

In a small number of people, the uvula does not close properly against the back of the throat, causing a condition known as velopharyngeal insufficiency or VPI. This causes "nasal" (or more properly "hyper-nasal") speech, where a lot of extra air comes down the nose, and the speaker is unable to say certain consonants, for example producing the sound /b/ like /m/.

Snoring and sleep apnea

The uvula can also contribute to snoring or heavy breathing during sleep; having an elongated uvula can cause vibrations which lead to the snoring. In some cases this can lead to sleep apnea, which may be treated by removal of the uvula or part of the uvula if necessary, an operation known as uvulopalatopharyngoplasty (commonly referred to as UPPP, or U3P). It should be noted, however, that this operation can also cause sleep apnea if scar tissue forms and the airspace in the velopharnyx is decreased. The success of UPPP as a treatment for sleep apnea is unknown, but some research has shown 40-60% effectiveness in reducing symptoms.^[2] Typically apnea subsides for the short term, but returns over the medium to long term, and sometimes is worse than it was before the UPPP.

Nasal regurgitation

During swallowing, the soft palate and the uvula move superiorly to close off the nasopharynx, preventing food from entering the nasal cavity. When this process fails, the result is called nasal regurgitation. It is common in people with VPI.

Swollen uvula - uvulitis

At times, the mucous membrane around the uvula may swell, causing the uvula to expand 3-5 times its normal size. When the uvula touches the throat or tongue, it can cause sensations like gagging or choking, even though there is no foreign matter present. This can cause problems breathing, talking, and eating.

There are many theories about what causes the uvula to swell, including: 1) dehydration (from arid weather); 2) excessive smoking or other inhaled irritants; 3) snoring; 4) allergic reaction; or 5) a viral or bacterial infection.

If the swelling is caused by dehydration, drink plenty of fluids. If the cause is a bacterial infection, gargling salt water may help. A swollen uvula is normally not life-threatening and subsides in a short time, typically within a day. However, it can also be a sign of other problems. Some patients with a history or recurring uvulitis have to carry an EpiPen containing Adrenaline (Epinephrine) to inject themselves whenever the uvulitis begins. If the swelling has not subsided within 8-12 hours, or if it is accompanied by other symptoms (such as fever or pain), it is best to see your health care provider.

Bifid uvula

Splitting of the uvula occurs infrequently but is the most common form of mouth and nose area cleavage among newborns (roughly 2% of infants have this bifid or split uvula). Newborns with cleft palate also have a split uvula. The bifid uvula results from failure of complete fusion of the medial nasal and maxillary processes.

A bifid uvula is a split or cleft uvula. This occurs in about 1% of caucasians and 10% of Native Americans. Bifid uvulas have less muscle in them than a normal uvula, this may cause recurring problems with middle ear infections. While swallowing, the soft palate is pushed backwards. This prevents food and drink from entering the nasal cavity; if the soft palate cannot touch the back of the throat while swallowing, food and drink can enter the nasal cavity.^[3]

Removal of part of uvula to prevent throat infections

In some parts of Africa, including Ethiopia and Eritrea, part of the uvula may be removed by a traditional healer to prevent throat infections. ^[4] In this case, the uvula may be noticeably shortened. It is not thought to contribute to VPI, except in cases where the tonsils have also been removed ^[5].

Uvula in fashion

Today, the uvula is one of many body parts that people pierce. However, uvula piercings are very dangerous compared to other forms of body piercing, as the risks involved include swelling, throat edema, choking, and uvular infection.

Uvula in popular culture

• (1947) In the cartoon I Taw a Putty Tat, the uvula is depicted as a punching bag

• (1961) In the episode of The Andy Griffith Show called "Barney and the Choir", Deputy Barney Fife has learned this word while getting treatment for a sore throat, and recites a brief reference to the old Spiritual All God's Chillun Got Wings: "I got a uvula, you got a uvula, all God's chillun got a uvula!" In keeping with the reference, Andy responds, "Hallelujah!"

• (1976) The uvula was featured in an early Saturday Night Live comedy skit starring Gilda Radner, Chevy Chase, and Laraine Newman. The skit was a mock public service announcement about uvula care, featuring the tagline, "It'll behoove ya to care for your uvula."^[6]

• (c. 1990) It also features in a "Far Side" cartoon by Gary Larson entitiled "final page of the medical exam" where a person is depicted holding a question paper that reads "bonus question (50 points): what is the name of the dangly thing that hangs down in the back of our throats?"

• (1994) Bifid uvulas were featured as a part of Nickelodeon's animated series Aaahh!!! Real Monsters.

• (1995) American pop punk band Green Day have a song entitled "Bab's Uvula Who?" on the album Insomniac, a reference to the aforementioned Saturday Night Live sketch.

• (1997) In Cartoon Network's series Cow and Chicken the uvula is used along with the spleen to represent an unknown human organ. While the spleen is obviously mistaken for the spine, the uvula is most likely used because of its strange name.

• (1997) "Weird Al" Yankovic used the word uvula frequently the Weird Al Show.

• (2001) In Takashi Miikes Happiness of the Katakuris, a small monster runs away with a woman's uvula.

• (2006) The uvula is mistaken for a vulva as a gag in Monster House.

Notable patients

Anita O'Day, a popular big band singer, lost her uvula by a 'slip of the knife' during a childhood surgery. This affected her voice by eliminating vibrato, she said, in an interview with Terry Gross of NPR's "Fresh Air" radio show.

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References