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Non smoker and light drinker. Have red and swollen tonsils. Should I be worried for throat cancer?

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My tonsils have been swollen (and/or enlarged) for over three years. They are both about the same size, but they are noticeably large and redder than most other people's. I feel the need to constantly clear my throat. I'm mainly worried about throat cancer. Are these symptoms? I asked my family doc about it and he said "wow" you have big tonsils (biggest he's seen), but he said its not cancer. I think I should get a second opinion but I'm not sure.

I attached a photo of my throat. My throat is often mildly sore, but nothing major. However I have very thick mucus and it always feels like I need to swallow to drain the mucus from back of throat. The problem is worst at night when I lay down, probably because sinuses are emptying. I do voluntarily cough a lot to clear the throat. I had bloody mucus one day in October accompanied by a bad taste in my mouth which was very noticeable. However it cleared up within 24 hours. I am a non-smoker, light drinker.
Posted Tue, 19 Feb 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. The physical appearance or size of the Palatine Tonsils is one of the least important criteria for diagnosing Chronic Tonsillitis.

2. There is anterior pillar congestion in the image. The right tonsil appears larger than the left. However this is common. These are definitely not the largest of tonsils. Do you snore at night during sleep?

3. If you have more than 5 to 6 attacks of tonsillitis in the last 3 years and if the JD (Jugulo Digastric) Lymph Nodes (under the angle of the jaw) are enlarged, palpable and non-tender, then the above four criteria may be together considered as Chronic Tonsillitis.

4. If you have only mild sore throat, it may not be Chronic Tonsillitis. This is because the Palatine Tonsils form only a part of the entire lymphoid tissue in the throat. Besides the Palatine Tonsils there are the Lingual Tonsils (covering the entire posterior third of the tongue), the Adenoid tissue (in childhood), Tubal Tonsils (at the inner opening of the Eustachian Tube), Posterior and lateral pharyngeal bands and countless small islands of lymphoid tissue all over the the oral cavity and throat.

5. There is congestion of the posterior pharyngeal wall and Granular Pharyngitis (cobble stone appearance) in the image. This usually results from the Post Nasal Drip (PND) that you have mentioned (from the sinuses, increasing on lying down). Allergy and Acid Reflux may worsen this.

6. The chance of throat cancer is negligible. A cancerous tonsil will go on increasing in size and ulcerate. Throat cancer may have many other symptoms such as change in voice and difficulty in breathing and swallowing, an so on. Regular follow up can rule out throat cancer.

7. The bloody mucus is commonly due to gum disease or Vitamin C deficiency. Some times this delicate lymphoid tissue is injured due to forceful clearing of the throat. A single episode many months ago is not significant.

8. You may start with regular steam inhalation, medicated gargles till you get a detailed examination by an ENT Specialist and a Dentist. The treatment of the sinusitis and the PND may be require anti-allergy medication, steroid nasal sprays, mucolytics and decongestants.

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

Above answer was peer-reviewed by
Follow-up: Non smoker and light drinker. Have red and swollen tonsils. Should I be worried for throat cancer? 22 minutes later
I am glad you are mostly ruling out cancer, thank you for your advice on that matter.

I have had about 4 bad sore throats in the past three years. My main concerns are that I have the feeling of something 'blocking' the area directly behind the nose and just above the opening to the throat (i.e. the back of my throat, but above the tonsils in the sinus that leads up into the top of the head. I constantly feel like I have to swallow to get rid of mucus. I also cough and clear my throat several times an hour. When I lay down to sleep the sensation gets worse. I do have moderate sleep apnea, I was tested for it. Furthermore, when I drink cold liquids my throat is very sensitive.

I believe that getting my tonsils and adenoids out will rectify these matters completely. Is this correct? Are there long term downsides to doing this? What suite of medications can you recommend I talk to my doctor about which will completely solve the above problems without undergoing an operation? I don't mind if my tonsils stay large (I would prefer them to shrink down to their normal size of 3+ years ago), however I really do want this congested feeling to go away, and I want to be able to breath at night and stop clearing my throat. What do you recommend (I will also consider new/novel treatments that just came on the market).
just remembered a few things.

First when I had the bloody mucus I had an extremely bad taste in my mouth for over a day. It was very unpleasant and something I had never encountered before. This happened about 3 months ago.

Second, about 4 years ago I was in the shower and I felt congestion in my right nostril. I blew my nose and then this huge gush of blood flowed out of my nose for at least 20 seconds before it finally stopped. It was as if someone turned on a faucet! I was literally afraid I might bleed to death, the stream was so large and long in duration. This was definitely not a typical nose bleed. I feel as if a large pool of blood built up in my sinuses (over a relatively long period), and it finally released in the shower. Can you please give your advice on what happened that day? It hasn't happened since.

Third, at night (and this usually always happens ever night) either my left nostril/nose sinus OR my right nostril/nose sinus swells up such that I can't breathe out of it. It only happens after I lay down. It rotates back/forth -- one night its the left nostril, the next its the right, and so on. Do you know why this happens and how I can prevent it?

Finally, I have indeed tried the steroid nasal spray (twice in the past two years). It didn't have any effect, and I did use it properly and for the prescribed time period. That's why I'm worried going back on the spray won't solve my problem.
Thank you,
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. Get a plain CT PNS (Para Nasal Sinuses) pre and post decongestion with Xylometazoline Nasal drops and compare the images. A Lateral Skull X-ray for Adenoid tissue may help rule out any persistent nasopharyngeal block but I would recommend a plain CT Scan since you have had a one sided nasal bleed in the past.

2. The blocked sensation after lying down (and moderate sleep apnea) can also happen due to blood pooling in the posterior ends of the nasal turbinates. This may be accompanied by a Deviated Nasal septum (DNS) and Sinusitis. All this and more can be seen on a CT Scan.

3. Chronic Lymphoid Hypertrophy makes the throat sensitive.

4. Getting your Tonsils and Adenoids (if it still persists) out may reduce the symptoms but may not eliminate them completely as there is an abundance of lymphoid tissue as explained earlier. Also if there is some other reason as explained above, you may not have targeted the exact problem.

5. Tonsil and Adenoid tissue is of less use in the development of immunity after the age of five. Early removal before the age of five affects immunity and sometimes the other lymphoid tissue such as the Lingual Tonsil hypertrophies (trying to replace the function), which is more difficult to treat.

6. An anti-histamine, an anti-leukotriene, a steroid nasal spray, regular steam inhalation and a medicated gargle is recommended. Which nasal spray have you used? Oral steroids may help if a local steroid spray has failed in the past. Combined use of these drugs is more effective than each used alone. Fungal sinusitis must be ruled out.

7. Hypertrophied lymphoid tissue does not shrink to its original size easily. Sustained treatment is necessary, and sometimes, surgical reduction.

8. Newer surgical options include radio-frequency ablation, co-ablation.

9. Bloody mucus will taste salty and metallic. Dental and Sinus infections (bacterial and fungal) should be ruled out.

10. Being close to the brain and since it heats, cols and humidifies the air we breathe, the nose has a large blood supply from multiple blood vessels. It can bleed like a tap from even a single ruptured blood vessel. This is not unusual.

11. There is a nasal cycle that shuts down and opens the nose alternately every two to seven hours. In addition, the nasal turbinates on the dependent side that we lie down on gradually swell up. This is normal though the cycle may get deranged. This is also a proposed mechanism by which we turn sides in our sleep.

12. Regarding the steroid spray, refer to the explanation given above.

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

Above answer was peer-reviewed by
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