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Have small white spots on reddened palatoglossal arch, burning tongue. Negative for strep. Taking Z-pack

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ENT Specialist
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i have small white spots on a reddened palatoglossal arch, there is slight burning that seems to subside with eating and drinking. Also a slight burning across the middle of my tongue. The pain went away for a small period when I took an otc for gerd. However it has returned, after a stressful day in the heat. Was tested for strep i but was negitive; was given z-pack. Been on going for over 4 weeks.
Posted Fri, 24 Aug 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 6 hours later

Thank you for your query.

1. The small white spots and redness on the anterior pillar (palatoglossal arch) signify local trauma and inflammation either from repeated palpation, chewing on rough, hard foodstuff or a chronic tonsillitis or pharyngitis (sometimes viral).

2. Get a throat swab taken from the precise area under vision to rule out a local bacterial or fungal infection. Check if it bleeds or appears traumatized after the swab.

3. A differential will include mostly benign conditions such as an area of lymphoid hypertrophy, accessory lymphoid tissue, inflamed minor salivary gland tissue, allergic reaction, local fungal infection, local aphthous ulceration (stress related ) and so on. Have you had any recent dental work? Have you noticed any decreased salivation or halitosis (bad breath)?

4. Since the burning pain is relieved with eating and drinking, there is definitely dryness in the oral cavity and throat. This may also explain the discomfort in the tongue. Acid reflux and anxiety cause such symptoms.

5. Besides the culture, routine blood tests may be advised by your physician.

6. The simplest course of action will be a course of antibiotics (z-pack may not be ideal), anti-allergics, anti-inflammatory agents and medicated gargles and anti-reflux mediction. If there is no improvement or the area of the patch increases, an excision biopsy and a histopathological examination which will reveal the true diagnosis of the patch. You may follow up with the culture and HPE report here.

7. I must emphasize that the chance of a cancerous growth at your age is rare. Cancer will be progressive and will not respond to medication. It is good to hear that your strep test is negative and that the pain went away with an OTC GERD medication.

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

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