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Suffering from recurrent fevers, tiredness, swollen lymph nodes and tonsils. Suggested removal of tonsils. What to do?

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Practicing since : 2009
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Hi, for as long as i can remember i have suffered with allergies, asthma, post nasal drip etc etc...After reading up on Lymphoma i have been to see 18 doctors a heamotologist and an ent about my recurrent fevers, tiredness and swollen lymph nodes and tonsils. As a child i had constant ear and tonsil infections and now have huge tonsils filled with crypts which are full of tonsil stones (you can not see them until they fall out but i can taste and smell them) the back of my throat is red with big red veins running through the tonsils and i have a stiff and sore neck from the lymph nodes (one under chin is pea size and pretty firm, one behind ear is hard and immovable and pea size but hurts and throbs especially if you touch it)..Anyway: i saw an Ent 2 days ago who told me he thinks it is all caused by my tonsils and we should remove them (they stink and give me ear ache, ear itching, eye watering, yellow tongue, dry and sore throat etc etc etc etc) but my questions are this: one of my tonsils looks bigger but if you shine a light in there you can see my left is long and has a head that then goes off into a long swollen body (if you get what i mean ) so, i think they are similiar in size but different that possible with tonsil stones? and why am i getting these fevers all the time????? Thank you
Posted Mon, 24 Jun 2013 in General Health
Answered by Dr. Luchuo Engelbert Bain 2 hours later
Hi and thanks for the query,
It is very important to note that swollen lymph nodes and fever deserve a proper evaluation. I ma happy that your ENT surgeon has taken off time to do an in depth investigation with respect to this, but I still other suggestions.

To begin with your main worry, what you describe is very compatible with tonsil stones. However, recurrent fevers in association to these stones imply there is an infectious focus that must be well evaluated for. Enlarged tonsils and this clinical picture could be quite indicative of an abscess within, either hot or cold. It would also be interesting to know exactly whether the periods when you have fever strongly coincide with tonsil pain or aggravation of the swelling or not? If this is the case, it would imply that you are simple experience recurrent infections due to the same germ.

However, the combination of recurrent fever, tonsil enlargement and lymph nodes elsewhere deserve other in depth investigations. Removal of these tonsils and doing a proper biopsy to exclude any tumors (lymphoma) or tonsil tuberculosis are very important. Removal of the tonsils shall be certainly a definitive treatment in case its a recurrent infection from a particular germ, stones or an abscess. Added to this, other less common but serious possibilities like the lymphoma and lymph node/tonsil tuberculosis would be excluded. Other examinations to evaluate
the integrity of nearby structures like the chest X XXXXXXX could be very important. A full blood count with white blood cell levels could give indirect ideas of other possible causes.

I suggest you comply with the suggestion of your ENT specialist. The surgery is not very invasive today and offers both treatment and diagnostic opportunities.

Thanks and hope this helps. I should be honored to address any further concerns if need be.

Best regards,
Luchuo, MD.
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Follow-up: Suffering from recurrent fevers, tiredness, swollen lymph nodes and tonsils. Suggested removal of tonsils. What to do? 5 hours later
Thank you doctor. I have had a chest xray which came back normal and with no signs of disease, i have had regular blood tests and they have all came back fine also (doctor has literally done every blood test he could do, i have had 18 tests since january and they were all multiple samples taken), i have also had an ultra sound scan of my nodes in groin and all stomach area they said all are normal and i have one shotty node which is "tiny", i am booked in for another ultra sound to see if groin node has grown (doctor say it has not) and the ent has booked me in for an ultra sound on my throat also..oh and ps: the node behind my ear is still swollen but is moveable today (thankfully) you think i should still be concerned about lymphoma, given the fevers? Thank you for your time.
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the XXXXXXX update,

from the XXXXXXX reply you supply, its good most of these tests tests have been done already. Their being normal actually decrease the chances of a lymphoma, but I am afraid does not eliminate completely the possibility. But however, I still think a biopsy of these lymph nodes for pathologic examination still remains the mainstay to be completely sure it is not a lymphoma or some other serious disease (other kind of tumour, Lymph node/tonsil tuberculosis, sarcoidosis) that could still present as such.

I still hold to the ENT specialists opinion of surgery, pathologic examination of the removed tonsils and a lymph node biopsy for proper histopathologic examination to be very sure and exclude any serious disease.

Thanks once again and hope this helps. I am ready to respond to your queries if you got any, so feel very free.

Wishing you good health.
Luchuo, MD.
Above answer was peer-reviewed by
Follow-up: Suffering from recurrent fevers, tiredness, swollen lymph nodes and tonsils. Suggested removal of tonsils. What to do? 2 days later
Thank you very much. So, today i had an ultrasound and fine needle aspiration on a neck node that is about 2cm, they took a few samples and i have to wait a week for the results. The follow up question is this: Is fine needle aspiration going to be enough to tell me conclusively that i do not have lymphoma? I have read some horror stories online. Also, they told me the structure looks normal and it does look like a "reactive node" based on the fact that my tonsils are full of tonsiloiths/tonsil stones. Oh and my lump behind ear is a sebacious cyst they believe. Thank you for your time once again doctor. XXXXXX.
Answered by Dr. Luchuo Engelbert Bain 32 minutes later
Hi and thanks for the query,

The other possibilities proposed in this case are not to be completely discarded. But it is good and scientifically sound to exclude:

1. 1st conditions that are more common
2. 2nd conditions that could be more severe.

After exclusion of a lymphoma or other tumor, it would be more comfortable taking time to exclude or simple and easy to manage pathologies. I strongly believe the needle aspiration still has its place in the diagnosis of tumoral conditions. I suggest you wait for the results, though a biopsy is far more sensitive. However, as I said, the needle biopsy is still used, especially well done by experienced pathologists.

Thanks and best regards. Do not hesitate asking further questions if need be.

Luchuo, MD.
Above answer was peer-reviewed by
Follow-up: Suffering from recurrent fevers, tiredness, swollen lymph nodes and tonsils. Suggested removal of tonsils. What to do? 48 minutes later
One more question for you: my biopsy was done a few hours ago and i have noticed the lymph nodes around it have swollen up, i am assuming that is because of the biopsy? Thank you for all your advice doctor and best regards to you. XXXXXX.
Answered by Dr. Luchuo Engelbert Bain 2 hours later
Hi and thanks for the query,

If you have experienced some swelling, I am of the same opinion like you that it should be associated to the biopsy.

Thanks for the update and best regards,

Luchuo, MD.
Above answer was peer-reviewed by
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