Enlarged Tongue

Finding an enlarged tongue may be related to a whole series of pathological conditions. Abnormally large tongue is professionally referred to as macroglossia.


Congenital condition

There are many genetic disorders and congenital syndromes that are associated with macroglossia. Down syndrome is a typical example. Tongue can be truly enlarged, for example because of accumulation of various substances in its tissue (by inherited metabolic disorders). The other option is a malformation of jaws and oral cavity that pushes the tongue up, which makes it looking bigger.

Allergic reaction

A sudden enlargement of the tongue is potentially dangerous form of allergic reaction. It is usually a manifestation of allergy to insect sting (particularly wasp or bee sting) or a food allergy. Macroglossia is in this case caused by swelling of the tongue.


This disease is associated with abnormal deposition of protein (amyloid) in various organs of the body. Macroglossia is obviously not the main problem; amyloidosis can actually damage heart, kidneys, lungs and other vital organs.


This is a hormonal disorder, in which pituitary gland of an adult person overproduces the growth hormone. The essence of acgromegaly is asymmetric enlargement of certain body parts like tongue, ears, limbs, penis, etc.

Tongue cancer

This is not a very common form of cancer. Smokers and alcoholics have higher risk; it is especially risky to smoke a pipe speaking about oral cancers. Tongue enlargement is caused by tumor tissue growth.

Underactive thyroid gland

Decreased production of thyroid hormones leads to swelling of some body tissues including the tongue. Significantly enlarged tongue is found in children with congenital hypothyroidism. Another symptom of such children is unfortunately a significant mental disability (professionally cretenism).

Tongue infection

Infectious inflammation of tongue is not so common, it may occur when bacteria penetrate through a local injury (like when someone accidentally bites his or her own tongue). The tissue is swollen, reddish and painful. This condition may be followed by abscess formation.

Leukemias and lymphomas

These “blood cancers” sometime infiltrate tongue with tumor cells and their proliferation causes macroglossia.


Enlarged tongue can cause troubles by swallowing and it can also interfere with speaking and sometimes it may cause hyponasal speech. Dramatic and rapid swelling of the tongue during an allergic reaction may narrow nasopharynx and cause acute suffocation.

Diagnostic approach

Congenital big tongue in a child falls within the competence of pediatricians, it is important to confirm or exclude congenital defects. Large tongue of an adult without a clear underlying cause may be a diagnostic challenge. Blood test can provide a lot of information (blood count, thyroid hormones levels, inflammation parameters like such as CRP, etc.). It is certainly appropriate to perform an examination by an otolaryngologist. When there is a suspicion of a local oral tongue tumor, it is possible to take a biopsy sample for histological examination.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources