The phrase “swallowing your tongue” is a common misunderstanding. It is not physically possible to literally swallow the tongue, as it is firmly attached to the floor of the mouth by a band of tissue called the lingual frenulum. This anatomical connection prevents the tongue from being swallowed. While the term is often used in situations of unconsciousness, it refers to a different, serious physiological event.
The Real Mechanism: How the Tongue Can Obstruct the Airway
During states of unconsciousness, such as fainting, seizures, or deep sedation, muscles throughout the body relax, including those supporting the tongue. When these muscles lose tone, the tongue can fall backward towards the posterior wall of the pharynx, the part of the throat behind the mouth and nasal cavity. This backward movement obstructs the upper airway, blocking the passage of air to the lungs.
The tongue acts as a physical barrier, pressing against the back of the throat. Other soft tissues in the airway may also relax and contribute to this blockage. This is a mechanical obstruction caused by the tongue’s relaxed position in a supine (lying on the back) individual. This can also occur in individuals with obstructive sleep apnea, where the tongue partially blocks the airway during sleep.
Recognizing and Responding to Airway Obstruction
Recognizing an obstructed airway is important, as oxygen deprivation to the brain can lead to unconsciousness in seconds and death in minutes. Signs include difficulty breathing or no breathing, gasping for air, and noisy breathing like high-pitched sounds or gurgling. The person may also show signs of agitation, confusion, or a bluish discoloration of the lips or face, known as cyanosis.
Immediate action is necessary to open the airway. For an unconscious adult or child without a suspected spinal injury, the head-tilt/chin-lift maneuver is recommended. This involves placing one hand on the forehead and gently tilting the head back while using two fingers of the other hand to lift the chin upward, which helps move the tongue away from the back of the throat. If a spinal injury is suspected, a jaw-thrust maneuver should be used instead to avoid further neck movement.
Another effective first aid step for an unconscious but breathing person is to place them in the recovery position. This involves rolling the person onto their side, allowing the tongue to fall forward by gravity and helping drain fluids like vomit or saliva from the mouth, preventing aspiration. After performing these maneuvers, continuously monitor their breathing and immediately call for emergency medical help.