Hi,

Thank you for your query.

1. The appearance, size, exact location of the raw hole, behavior, growth rate or a close up image will help give a better understanding as to the nature of this lesion. You may share a close-up image here.

2. A differential will include mostly benign conditions such as tonsillitis, a tonsillolith, area of lymphoid hypertrophy, accessory lymphoid tissue, inflamed minor salivary gland tissue, abscess in the lymphoid tissue. However this would be unusual without local inflammation and lymph node tenderness in the neck. The pain in your left face and ear are probably referred pain due to the sore throat.

3. You may take an OTC painkiller such as Tylenol or Advil / Motrin to tide over the immediate pain. You may repeat the dose 3times a day if the pain is severe. You should not take this medication on an empty stomach. I assume that you do not have any liver disease, kidney problems or asthma. Avoid alcohol when taking these painkillers.

4. The simplest course of action will be a course of antibiotics (preferably after a throat swab), anti-allergics, anti-inflammatory agents and medicated gargles. If there is no improvement or the lesion does not heal, an excision biopsy and a histopathological examination which will reveal the true diagnosis of the raw hole. As long as it is a limited area, surgery will be minor. You may follow up with the HPE report here.

5. I must emphasize that the raw area and hole should be shown to a doctor as soon as possible.

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

Regards.

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Hi,

Thank you for writing back.

You may follow up here with the results of your treatment. If you have any further questions, I will be available to answer them.

Wishing you a speedy recovery.

Regards.

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Hi,

Thank you for writing back.

1. The hole in the images appears to be a large tonsillar crypt. Tonsilloliths are concretions of food particles and pus lodged in the natural crypts of the palatine tonsils. The white discharge is sometimes referred to as 'cheesy' or even 'toothpaste' like in consistency. The largest crypt is known as the crypta magna and is located near the upper pole of the palatine tonsil.

2. When we swallow, our palatine tonsils rub against the food bolus and pick up food particles. This food debris decays there while it is analysed for antigens, foreign bodies and organisms by the lymphoid tissue which forms the bulk of the tonsils. Below the age of five years, this is especially important in the deveopment of immunity.

3. The reason for showing this to a doctor is that there are a few conditions in which such a lesion may develop. One is a XXXXXXX infection draining out, necrotic tissue due to a tumor and rarely an inner opening of a second arch branchial fistula (which is congenital or present from birth but sometimes discovered later in life).

Tonsilloliths or tonsillar crypts may be ignored and treated with simple medication

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

Regards.

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Hi,

Thank you for writing back.

1. A large amount of foul smelling diuscjarge is unnatural.

2. Insist on a sample being sent for antibiotic culture and sensitivity.

3. Get the cavity examined by an ENT Specialist.

4. Get a biopsy from the edge and interior of this lesion done if a course of the antibiotics (after culture) fail to heal this discharge.

5. Ask for a painkiller and medicated gargles to be prescribed.

If you have any follow up queries I will be available to answer them.

Wishing you good health.

Regards.

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