Hi XXXXXXX

Thanks for the query

The red patches with white centers are aphthous ulcers.

An aphthous ulcer also known as stress ulcer is a type of mouth ulcer that presents as a painful open sore inside the oral cavity. Sometimes, taking certain oral medications such as antibiotics for a long duration can cause this ulcer. Other causes include stress, reduced immunity in the body, dry mouth, taking spicy/hot food and beverages, alcohol consumption, smoking, etc.

Do not worry, it can be easily treated. Drink plenty of water; avoid coffee/tea/spicy food. Also, avoid hot and cold drinks for few days. Oral vitamin B12, topical corticosteroids, short course of oral steroids and pain relievers (such as diclofenac or ibuprofen) remain the mainstays of treatment.

Antifungal medicines will not be effective as the red patches are not fungal lesions.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi,

Thank you for your query.

1. The appearance, size, exact location of the congested red patch, behavior, growth rate or a close up image will help give a better understanding as to the nature of these sore red patches. You may share a close-up image here. The red patches are most likely signs of chronic inflammation which has spread beyond the tonsil area following multiple bouts of tonsillitis. This is seen in chronic tonsillitis as tonsil pillar congestion and is one of the criteria when chronic tonsillitis is diagnosed.

2. 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. Similarly, there are thousands of lymphoid follicles scattered throughout the throat and back of the tongue, which may trap food debris.

3. 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. This may also happen with other lymphoid tissue. Below the age of five years, this is especially important in the deveopment of immunity.

4. A differential will include mostly benign conditions such as a tonsillolith, area of lymphoid hypertrophy, accessory lymphoid tissue, inflamed minor salivary gland tissue, biopsy and a histopathological examination which will reveal the true diagnosis of the white spot and red patch. As long as it is a limited patch, surgery will be minor. You may follow up with the HPE report here.

6. For recurrent large tonsilloliths or peritonsillar abscesses, the only definitive treatment is tonsillectomy. If 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 worsening of symptoms after exercise is not clear. It may be due to a post nasal drip, acid reflux or dryness of the throat due to mouth breathing (nasal obstruction) due to exertion.

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 sore red patches 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.

Regards.

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Hi

Thanks for writing back

You can definitely continue with the above antibiotic Levofloxacin, as your symptoms are improving after taking the medicines and hence you need to complete the course.

Along with that, please do follow the advice as per my previous response, you will recover faster.

Wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi XXXXXXX

Welcome back

Q: I have several bumps at the base of the tongue on the underside next to my back teeth.

A: That bumps what you are noticing over the back of the tongue are enlarged taste buds and lymphoid follicles in response to the infection and inflammation in the throat. They are relatively harmless.

Q: there is some yellow flakey stuff in the saliva in the same area at the bottom of the tonsil / base of tongue.

A: The yellow flaky stuff what you have noticed could be the accumulated food debris coming out from the crypts of the tonsils.

Q: my throat is just a bit sore, mostly where the bottom jaw joins the top. the whole area looks red. i still dont feel 100% ????

A: The soreness you are still having in the throat is the residual inflammation of the mucosa. You will require a short course of oral steroids to reduce the inflammation and make you feel better. Continue drinking plenty of warm water for another couple of weeks, you will be alright.

Hope this answers your queries.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi XXXXXXX

Try taking medicines such as oral Prednisolone or Dexamethasone, both are equally effective. You need to take it for 3-4 days and your symptoms will reduce. You can request your doctor to prescribe the same.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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