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Throat MediBilbao Salud

Bumps on the Back of the Tongue: What Is Normal, What Causes Them and When to Worry

Many people notice bumps on the back of their tongue for the first time when they look in the mirror with a sore throat. In most cases these bumps are normal structures: large taste papillae and the lingual tonsil, a patch of lymphoid tissue at the base of the tongue. They can swell or become sore with infections, irritation or reflux, and only rarely point to something serious. This guide explains, from an ear, nose and throat (ENT) point of view, how to tell them apart.

Topic
ENT
Updated
Reading time
7 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 484809757

The normal bumps at the back of your tongue

The surface of the tongue is covered in small projections called papillae. Most are tiny, but at the back there are larger ones that are easy to mistake for a problem:

  • Circumvallate papillae: 8 to 12 large, round, flat-topped bumps arranged in a V shape, pointing towards the throat. Everyone has them and they contain many taste buds.
  • Foliate papillae: small vertical ridges or folds on both sides of the tongue near the back. They can look red and bumpy, especially when irritated.
  • Lingual tonsil: a cobblestone-like area of lymphoid tissue on the base of the tongue, behind the circumvallate papillae. It belongs to the same immune ring as the palatine tonsils and adenoids, and it can enlarge with infections or irritation.
  • Glands and blood vessels: small salivary glands and veins can also be seen under the surface.

If the bumps are symmetrical, painless, the same colour as the rest of the tongue and have always been there, they are almost certainly normal anatomy. Comparing both sides of the tongue is a useful first check.

Common causes of swollen or sore bumps

  • Inflamed papillae (transient lingual papillitis, «lie bumps»): one or a few papillae become red or white and painful for one to a few days, often after hot food, acidic or spicy food, minor injury or stress.
  • Viral infections: colds, sore throats and other viral illnesses can make the lingual tonsil and papillae swell. In children, hand, foot and mouth disease can cause sores in the mouth.
  • Irritation: very hot drinks, smoking, vaping, alcohol, strong mouthwashes or rubbing against a sharp tooth or dental appliance.
  • Mouth ulcers: canker sores are painful round ulcers with a white or yellow centre; they usually heal within one to two weeks.
  • Oral thrush: a yeast infection that causes creamy white patches, a sore tongue and altered taste, more common after antibiotics, with inhaled steroids, dentures or diabetes.
  • Acid reflux and postnasal drip: both can irritate the base of the tongue and enlarge the lingual tonsil (see the next section).
  • Squamous papilloma: a small, harmless, cauliflower-like growth linked to some types of human papillomavirus (HPV). It is usually removed to confirm the diagnosis.
  • Less often: allergic reactions, cysts of the small salivary glands and, rarely, cancer of the tongue base or oropharynx.

Bumps on the side of the tongue

Bumps on the side of the tongue, near the back, are often the foliate papillae. They can look prominent when irritated by sharp teeth, a broken filling or habitual tongue biting. Painful sores on the sides are frequently mouth ulcers or the result of accidental bites. A white patch that cannot be wiped off, a red patch, or an ulcer on the side of the tongue that does not heal within three weeks should be examined, because the sides of the tongue are a common site for early mouth cancer, especially in people who smoke or drink heavily. Most side-of-tongue bumps, however, are caused by friction and settle once the cause is removed.

The ENT view: lingual tonsil, reflux and throat symptoms

Because the lingual tonsil sits at the junction between the mouth and the throat, its enlargement often comes with throat symptoms rather than tongue symptoms. People may describe a feeling of something stuck in the throat, frequent throat clearing, a mild ache when swallowing or a muffled change in the voice. Common drivers are laryngopharyngeal reflux, where stomach contents reach the throat without classic heartburn, chronic postnasal drip from rhinitis or sinusitis, repeated throat infections and smoking.

Treating the cause usually helps the tissue settle: managing reflux with meal timing and, if prescribed, medication; treating nasal inflammation; and stopping smoking. Read more about acid reflux and sore throat, postnasal drip and sore throat and the feeling of a lump in the throat. Very large lingual tonsils can occasionally contribute to snoring or sleep apnoea, which an ENT specialist can assess.

What you can do at home

  • Avoid very hot, spicy, acidic or crunchy foods for a few days while the area is sore.
  • Rinse with warm salt water (half a teaspoon of salt in a glass of warm water) after meals.
  • Keep up gentle oral hygiene, including brushing the teeth twice a day and cleaning the tongue softly.
  • Drink plenty of water and avoid alcohol and smoking, which slow healing.
  • Use simple painkillers such as paracetamol (acetaminophen) or ibuprofen if suitable for you.
  • If you have reflux symptoms, avoid large late meals and lying down within three hours of eating.
  • Do not scrape, squeeze or try to cut the bumps; this causes bleeding and infection and does not remove normal papillae.

How an ENT specialist examines the back of the tongue

The base of the tongue is difficult to see in a mirror, and most of the lingual tonsil is hidden from view. An ENT doctor looks at the mouth with a light, feels the tongue and neck with a gloved hand, and often uses a small mirror or a thin flexible camera passed through the nose (nasendoscopy) to see the tongue base, throat and voice box. The test takes a few minutes, is done in the clinic with a local anaesthetic spray and is not painful for most people.

If a lesion looks unusual, a small sample (biopsy) can be taken. Swabs help if an infection such as thrush is suspected. The examination also looks for the causes of irritation, such as signs of reflux at the voice box or inflammation from postnasal drip.

When to see a doctor

  • A lump, ulcer or sore on the tongue that does not heal within three weeks.
  • A red or white patch that cannot be wiped off.
  • A bump that is growing, hard or bleeds easily.
  • Pain that spreads to one ear, with a normal-looking ear.
  • Difficulty or pain when swallowing that lasts more than three weeks.
  • A hoarse voice for more than three weeks.
  • A lump in the neck or unexplained weight loss.
  • Bumps with fever and difficulty opening the mouth or breathing, which need urgent care.

Risk factors for tongue-base and oropharyngeal cancer include smoking, heavy alcohol use and infection with high-risk HPV. These cancers are uncommon and most bumps are harmless, but persistent changes should always be checked rather than watched for months.

Three common situations

  • You noticed a V-shaped row of large bumps while looking at a sore throat: these are circumvallate papillae and are normal.
  • One bump is red, painful and appeared yesterday after hot pizza: probably an inflamed papilla; it usually settles in a few days.
  • The back of your tongue feels lumpy and you keep clearing your throat: an enlarged lingual tonsil from reflux or postnasal drip is common; an ENT assessment can confirm it.

Key points to remember

  • Large bumps at the back of the tongue are usually normal papillae or lingual tonsil.
  • Infections, irritation, reflux and postnasal drip can make them swollen and sore.
  • Most sore bumps settle within days to two weeks.
  • Any lump, patch or ulcer lasting more than three weeks needs examination.

Questions about bumps on the back of the tongue

These answers are general information and do not replace an examination or individual medical advice.

Is it normal to have big bumps at the back of the tongue?

Yes. Everyone has a V-shaped row of large circumvallate papillae and lymphoid tissue (the lingual tonsil) at the back of the tongue.

Can a sore throat cause bumps on the back of the tongue?

Yes. Viral and bacterial throat infections can make the lingual tonsil and papillae swell. They usually settle as the infection clears.

Can acid reflux cause bumps on the tongue?

Reflux that reaches the throat can irritate the base of the tongue and enlarge the lingual tonsil, often with throat clearing or a lump-in-the-throat feeling.

Are bumps on the back of the tongue a sign of HPV?

Most are not. HPV can cause small harmless papillomas and, rarely, cancer of the tongue base. A persistent or growing lump should be examined.

How long do inflamed tongue bumps last?

Inflamed papillae usually settle in a few days. Ulcers heal in one to two weeks. Anything lasting more than three weeks needs a check.

Who should I see about a bump on the back of my tongue?

A family doctor or dentist can look first. An ENT specialist can examine the tongue base and throat with a small camera if needed.

Sources

  1. NHS · Sore or white tongue
  2. NHS · Mouth ulcers
  3. NHS · Oral thrush (mouth thrush)
  4. NHS · Heartburn and acid reflux
  5. NHS · Mouth cancer
  6. NHS · Head and neck cancer

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.