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Dr. Andrew Rynne

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Have enlarged tonsils with red marks on it and swollen neck. Is it tonsillitis?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2551 Questions

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Posted on Wed, 12 Dec 2012 in Ear, Nose and Throat Problems
Question: please help. i have very bad health insurance and i am having this problem in my throat. i have swollen glands often, get tonsilloths on the regular, ie my tonsils are always enlarged. last year i had tonsillitis a few times due to my right tonsil. it seems when i try to gently pull the debris off of my tonsil with a qtip, i end up making it worse. i think i now have puss on my right tonsil, plus a red circle and it bleeds a little sometimes for no apparent reason. this bout of tonsil issues has been going on for about two weeks, but for about 6 days in the middle, it didn't hurt at all. currently, my right side of my neck is so swollen because of that tonsil that its actually visible to others who know me. i am wondering, do you have any idea what this is? i have no fever or anything, i am thinking its tonsillitis but is it possible to be the non contagious kind because its self inflicted almost? also, last year i had this issue and it was accompanied by a high fever- i had a good health insurance then, and the drs had to put me on steroids so i could swallow. am i going to develop a fever if i dont get on meds? also, long term, am i going to need to get my tonsils out in order for this not to continue occuring? please help!!!! its sooo painful to swallow and my left tonsil is completely fine.. I have a picture but not sure how to upload it into here, is it possible to send you a picture? Also, am i contagious? i assume not but i have family members with weakened immune systems and i dont want to get them sick over thanksgiving if i am
doctor
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your query.

1. You seem to have developed Acute Tonsillitis on the Right side. A few follicles are seen. upper pole is obscured by the uvula (soft palate). A large number of viruses and bacteria may cause this. Injury and abrasions while removing Tonsilloliths may have caused this one sided inflammation by allowing the infection to spread into the injured tonsil tissue. An antibiotic may not be of much help in an early viral tonsillopharyngitis. Sometimes the antibiotics only help prevent secondary bacterial infection. Ideally a combination of amoxicillin (beta lactam / penicillin group) would be the antibiotic of choice. However since you have penicillin and sulfa drug allergy, Azithromycin (z-pack, macrolide group) will be safer. This will not be as effective. Hence you will also require supportive treatment with a medicated mouth washes such as Betadine or Chlorhexidine ( Peridex / Periogard), anti-inflammation and anti-allergic medication. Discuss this with a physician.

2. In addition to your symptoms mentioned above, do you have any pain referred to the ear or trismus (unable to open the mouth / jaw fully)? The neck swelling is due to enlarged lymph nodes in the neck. Are they tender on touch?

3. The right tonsil is enlarged but not pushed towards the mid line. Hence there seems to be no peritonsillar abscess (Quinsy). You have a history of removing tonsilloliths yourself. This may introduce gram negative type bacteria into the throat (where they are usually not found). You may require additional antibiotic groups such as an metronidazole (imidazole group).

4. Usually antibiotics require 24 to 48 hours to be effective. If you are feeling worse even after 48 hours, you may request a throat swab and plan a change of antibiotic.

5. The tonsils have a major role in signalling the rest of the body against infection and allergy. This causes a massive release of chemical messengers into the blood stream and makes one feel miserable. Hence supportive medication mentioned above is required.

6. In extremely severe cases, or those with complications, I admit patients for intravenous antibiotics and indoor care. The possibility of Infectious Mononucleosis (viral) must always be kept in mind. In some severe cases (as you have experienced in the past), steroids given under antibiotic cover may also help. Your diet should be totally bland, mashed if possible and no cold or sour food should be taken.

7. 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.

8. 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 development of immunity.

9. It is good to hear that you do not have fever. A self inflicted infection is unlikely to be contagious. Infectious Mononucleosis and viral infections are contagious.

10. For recurrent large tonsilloliths or peritonsillar abscesses, the only definitive treatment is tonsillectomy.

Hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti 3 hours later
Hi Dr. Bhati,

First of all, thanks for the detailed response, I appreciate it very much. Further into your response, are antibiotics/medicines crucial to my recovery? Or is it possible for this to get better on my own? In the beginning of your first point, you said it may not be necessary to go on antibiotics, but further points seem to prove otherwise. Do I risk developing the peritonsillar abscess (which seems to be much more serious), if I dont go on antibiotics? Any home remedies to avoid antibiotics? Is viral tonsillopharyngitis the same thing as acute tonsillitis?

In Answer to number 2, I can fully open my mouth but the pain definitely goes up to my ear a little bit. I assume because the glands go through the throat ear and neck, this would be common. The neck is DEFINITELY tender to touch- should I look out for anything developing there?

In response to number 3, how will I know if I require addtl meds such as those you mentioned? Any warning signs to look out for?

In number 5, you mentioned the medicine being required, is it the only way I will feel better?

With number 6, why you no cold or sour foods?

Number 9- How will I know if a viral infection has formed?

Lastly, number 10- would you recommend a tonsillectomy? This is very painful and has happened 2-3 other times in the past year. I did read that if you remove your tonsils, tonsilloths can still occur. Any experience with that? Any further details you could provide would be much appreciated.

Thanks again for your help!

Best,
XXXXXXX



doctor
Answered by Dr. Sumit Bhatti 7 hours later
Hi,

Thank you for writing back.

1. Since you have a neck swelling (which will be regional lymph nodes), you may start the antibiotic. Without regular direct observation, it is not possible to differentiate viral from bacterial tonsillitis and to avoid antibiotics. It is safer to take antibiotics and other medications to reduce the chance of this worsening or complications such as Quinsy.

2. Turmeric Power in warm milk is an excellent home remedy.

3. Yes, your ear pain is likely to be a referred pain. The ear should be examined and be normal. Any increase in swelling in the neck is a sign of worsening of the condition.

4. You must start supportive medication. However, this should be under the supervision of a local physician. this will make you feel better.

5. Cold and sour foods will worsen your sore throat. Avoid these during the sore throat.

6. Viral infections are usually accompanied by high fever with chills, bodyache, flushing, fatigue and blood tests can also help differentiate.

7. Tonsillectomy is advised if there are more than 5-6 attacks of tonsillitis over 2-3 years. Tonsillectomy is performed at east three to six weeks after an acute infection subsides. Tonsilloliths will not persist after a tonsillectomy unless a part of the tonsil tissue has been left behind.

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 : Dr. Chakravarthy Mazumdar
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