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Raised, sensitive, hard patch on tongue. Redness, discoloration. What is it?

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ENT Specialist
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Hi, I have an unusual raised, sensitive, slightly hard patch on my tongue. It's about midway down the tongue just beyond where my lips XXXXXXX my tongue if I stick it out as far as I can (i.e. still inside the mouth), right in the center. It's a bit closer to my teeth than the circumvallate papillae. The area is ever so slightly red but there's very little discolouration. I have a few raised bumps in the area which look like taste buds too. Do you have any idea what it could be?
Posted Thu, 6 Sep 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 9 hours later
Hi,

Thank you for your query.

1. The patch in the image seems to be Median Rhomboid Glossitis.

2. If it is sensitive, you may use medical grade liquid glycerine and a topical anti-fungal oral paint for super-added fungal or yeast infection.

3. Multi-vitamins and anti-oxidants will help. Any acid reflux, if present must be controlled. Any cause for immuno-supression must be ruled out.

4. A differential will include mostly benign conditions such as Geographic Tongue (Benign migratory Glossitis), Oral Lichen Planus, Thyroglossal remnant, Lingual Thyroid, infections such as Tuberculosis, Gumma, Granular Cell tumor and so on. A Tongue Doppler Study and Neck Ultrasound will help. Scanning and biopsy will only be required if this condition spreads or increases in size.

5. The simplest course of action will be to get n oral examination and a dental opinion. If these are normal, only regular follow-up is required.

6. I must emphasize that the cause is unknown. It is not contagious.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Raised, sensitive, hard patch on tongue. Redness, discoloration. What is it? 8 hours later
Dear Dr. Bhatti,

Thank you for your time and insightful answers. I have looked up the condition median rhomboid glossitis on Google and to me it seems to have somewhat differing symptoms from those I express - the area does not feel velvety to the touch and is only very slightly discoloured when I examine it in front of a mirror, and does not seem to have a border.

Pressing on and around the area with my finger it feels like there is a harder patch of muscle or something under the sensitive patch. The sensitivity feels like it is from raised taste buds or bumps, possibly being pushed up by the harder slightly raised bump in or under the tongue. Squeezing the tongue does not seem to result in my feeling a hard or thick solid lump in the tongue, so if there is anything it feels like it's just below the surface.

Do you still think it's likely to be glossitis or does one of the other possible diagnoses you listed seem more probable? I will be seeing a doctor on Tuesday who should be able to advise (and I can keep you informed if you would like).

Many thanks!
-XXXXXX
 
 
Answered by Dr. Sumit Bhatti 16 hours later
Hi,

Thank you for writing back.

1. Glossitis will be the first condition which will have to be excluded by direct examination. Though rare, it is the commonest cause.

2. Spasm of the tongue musculature underneath this patch of inflammation give rise to the hard feeling.

3. Your doctor will have to inspect and palpate the area and then advise further investigations as required. Imaging and an FNAC (Fine Needle Aspiration Cytology) or Biopsy will settle the issue in case of doubt.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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