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Noticed white spots on tonsils. Getting headache and blurred vision. What could be the problem? Any cure?

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I have one very large tonsil. It is my left tonsil. In general, my right tonsil seems fine. I have no pain, but I do have a small white-ish/yellow-ish spot on that same tonsil. I have had bad tonsil stones in the past, so I know what those are and know had to recognize them. This spot is most certainly not one and resembles more of a canker sore (which I also get frequently). However, the "sore" has not gone away in over 3 months. I don't think it has grown, but it hasn't shrunk. There is no real pain from it, but I do have a constant feeling of something being caught in my throat behind that tonsil and I'm certain this is from its enlarged size. I dont think I have swollen lymph nodes. I have also been feeling abnormally run down lately, and extremely anxious feeling for no good reason. On top of all of this, I have been getting all-day headaches and my right eye occasionally goes blurry for a few minutes then comes back to normal. I am leaning more towards my eye and the "constant anxiety" to be just from stress, but just in case it was related, I wanted to mention it. Mostly, I am deeply concerned about my now 3 month long swollen/yellow-sored/painless tonsil. My biggest fear is tonsil cancer. I am 25 and have smoked regularly since I was 14. I am a female and in otherwise good shape. I stopped smoking a few months ago though, and am worried that this throat problem is due to the smoking. If you could give me some advice I'd greatly appreciate it.


Posted Fri, 9 Nov 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. There is no definition of a normal throat. There is usually a difference in the apparent size of the tonsils in any individual, however, a gross difference is not very common and must be investigated.

2. A differential will include mostly benign conditions such as as chronic tonsillitis, tonsilloliths, areas of lymphoid hypertrophy, accessory lymphoid tissue, ulcerated minor salivary gland tissue, foreign body granuloma/ulcer . Rarer still will be the possibilty of a recurrent small abscess in the peritonsillar space. However this would be unusual without local inflammation and lymph node tenderness in the neck.

3. 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. This may cause a local swelling. Sores and ulcers are possible if the crypt gets blocked by infection and then ruptures. The constant action of saliva prevents quick healing.

4. 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.

5. The simplest course of action will be to get this examined by an ENT Specialist and ask for a prescription of a course of antibiotics, anti-allergics, anti-inflammatory agents and medicated gargles. If there is no improvement, a needle biopsy or an excision biopsy and a histopathological examination which will reveal the true diagnosis of the bump. As long as it is a limited ulceration, surgery will be minor. You may follow up with the HPE report here. Herpetic, fungal and chronic disease such as tuberculosis should be ruled out with cultures.

6. For recurrent large tonsilloliths, ulcerations or peritonsillar abscesses, the only definitive treatment is tonsillectomy. As you have halitosis (bad breath), you may try regular use of a medicated gargle and continue manually expressing them while brushing your teeth.

7. The blurring of vision occurs in the right eye , while your tonsil hypertrophy is on the left. This difficult to co-relate. A Neck USG (Sonography) may be done and CT / MRI Scans may be advised by your physician after the opinion of a Eye Specialist and a Neurologist.

8. I must emphasize that the chance of a cancerous growth at your age is rare. Tonsilloliths may be ignored and treated with simple medication as above, however the non-healing ulcer should be shown to a doctor.

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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