On Swallowing Your Tongue

And What Actually Killed Jimi Hendrix

As a child, I always wondered how my tongue was attached in my throat. No matter how widely I opened my mouth while looking in the mirror, or how high I lifted my tongue to peer at purple serpentine blood vessels and juicy flesh beneath it, I couldn’t quite figure it out. I also heard stories about people swallowing their tongues with deadly results, and that confused me even more. So what’s the deal?

First, a bit about the amazing tongue itself. The tongue is a muscular mass of almost-prehensile flesh that lords over our mouths, the body’s primary entrance. While teeth do the primary crushing and gnashing work, the tongue does just about everything else: It manipulates food, moves it around the mouth, softens it, mixes it with saliva (which is full of enzymes that begin the digestion process), and moves food toward the throat for swallowing. And after that, the tongue tidies up, scooping up food remnants from the mouth’s gutters and cleaning the teeth.

The tongue is our primary organ of taste, its surfaced dotted with about 3000 taste buds. You’ve probably seen a map showing which tongue areas taste salty, sour, bitter, sweet and umami. But this map is actually nonsense: individual taste buds do perceive one specific taste out of the five, but the different taste buds are all mixed together all over the tongue.

And LANGUAGE! The tongue helps us form intelligible words out of the air exhaled from our lungs. The word “tongue” even means language in English, as well as in Spanish (lengua), Russian (язык), and Hindi (जीभ), and probably many other languages too.

The tongue is amazing, but can you swallow it? Isn’t that how Jimi Hendrix, Jim Morrison and Janis Joplin died? That was the rumor I heard when I was first getting interested in classic rock at the age of 13.

The mystery of the tongue’s attachment was solved when I went to medical school and looked at cross-sections of the human head split down the middle. The one above was drawn by the legendary medical illustrator Frank Netter. The tongue basically sits on a vertical column of flesh that goes through the floor of the mouth and all the way to the underside of the chin, where it is framed by the jaw’s U-shape. This column is made of muscle, connective tissue, fat and salivary glands, and it anchors the tongue to the floor of the mouth. To swallow your tongue, it would need to detach from this anchor and move down your esophagus into your stomach. Yes, you could bite off the tip of your tongue and swallow it, but I would not recommend it (tongues bleed like anything).

Swallowing your tongue is a total myth. It’s not a real thing that we ever talk about or worry about for patients in the hospital. I know you’re thinking: but what about this trick?

This guy is not really swallowing his tongue (though what he is doing is still impressive). He’s putting the front tip of his tongue back behind his tonsils and up toward the nasopharynx (the upper part of the throat). In other words, his tongue is taking the same path that vomited milk takes to come out of a baby’s nose. But his tongue is still clearly anchored to the floor of his mouth. Also notice that he has no trouble breathing even while “swallowing” his tongue.

So what’s the deal with tongue swallowing’s deadly reputation? If you’ve ever watched videos of athletes collapsing on the field, you might have seen first responders rush to the person’s side, reach into their mouth and attempt to prevent them from swallowing their tongue. You still see this often, even in today’s age of widespread awareness of cardiac arrest and bystander CPR. A 2022 study published in the medical journal Circulation analyzed 42 videos of athletes collapsing on the field: of the 37 videos in which it was possible to see what was happening, over 80% showed first responders focused on the person’s tongue [Viskin]. Only 1/3 of these athletes got CPR, which is what 100% of them likely needed.

The compilation of headlines and photos shows people unnecessarily futzing with the tongue, which is a waste of valuable time. Also, I should note, it is very difficult to grab someone’s tongue: I’ve tried many times while suturing deep gashes into the writhing organ. I’ve found that having an assistant grab it with gauze in their fingers helps a lot.

When athletes (or non-athletes) collapse and are unresponsive, it is usually due to cardiac arrest. Their heart is beating abnormally in some way – either too fast, too slow, or just chaotically. And whatever the heart rhythm abnormality, the common consequence is that blood is not being pushed out of the heart. As a result, blood pressure is near zero and no blood is reaching the brain, which is why people pass out and can’t wake up until the heart’s rhythm is righted. These people need chest compressions (which actually pushes blood out of the heart) and possibly an electrical shock (which can return the heart’s electricity into a normal rhythm).

Also FYI, you might see some people shake when they pass out, but it is usually not a seizure. This results from chaotic electrical signals put out by the brain in the first few minutes of being starved of blood flow and oxygen.

What about the tongue in unconscious people falling backward and blocking the airway causing suffocation? It is true that the tongue and all of the soft tissues of the throat and neck can smoosh the airway shut – this is basically what happens in obstructive sleep apnea. But this doesn’t cause death – it causes snoring.

These same tissues can fall back and smoosh the airway when someone is comatose from cardiac arrest or overly sedated from ingesting too much alcohol or drugs. But the problem here is not the tongue falling back. The problem is that the person is so sleepy that they cannot muster the energy to even try to open their airway and breathe.

If a person in this situation woke up, either because an electric shock restarted their heart or because a drug antidote like Narcan was given, they could then muster the energy, lift up their tongue and begin breathing. In the same way, when a person with sleep apnea wakes up, the airway obstruction immediately ceases and they breathe normally without snoring.

The problem with being comatose is one of two things: 1) a person simply stops breathing, or 2) they aspirate saliva or vomit into their airways and suffocate. Swallowing the tongue, or the tongue blocking the airway, is never a real concern. Aspiration happens because your throat defenses are down when you’re deeply sedated. And when aspiration happens, you’re too sleepy to sit up, start coughing, breathe more deeply and rapidly to compensate, and call 911. This leads to plummeting oxygen levels in the bloodstream which eventually stops your heart.

So, my favorite classic rock stars did not die from swallowing their tongues. Jimi Hendrix died because he took too many sedating drugs (barbiturates, which are like old-fashioned benzos) and aspirated his own vomit. Janis Joplin died by overdosing on heroin, and either she just stopped breathing or she aspirated, and Jim Morrison probably died in the same way. All three of these legends died at the same young age of 27. Prince died the same way as Joplin and Morrison, except he overdosed on the fancy new-fangled form of heroin called fentanyl, and he was 57.

In summary, people cannot swallow their tongues. And if you ever find yourself kneeling down beside a person who is completely unresponsive, forget about their tongue. Instead, check a pulse and if you can’t feel one after a few seconds, start chest compressions and call for help.

Have you seen any videos of people collapsing or being unable to breathe? Have you been present for such a scary situation? Share your stories in the comments and post links - I can walk through the anatomy and physiology of what is happening.

References

Dana Viskin, Abstract 14112: "Leave My Tongue Alone:" Is the Myth of Tongue Swallowing Still Preventing Proper Cardiopulmonary Resuscitation Efforts of Athletes With Cardiac Arrest? Circulation, Oct 30, 2022. Abstract here: https://www.ahajournals.org/doi/abs/10.1161/circ.146.suppl_1.14112