Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have had these bumps on the back of my tongue and also, I noticed a flap near my airway in my throat. For about four months, I have been told that it is nothing to worry about, but it is affecting my eating habits, and I am losing weight because I cannot swallow properly. I have type 1 diabetes, underactive thyroid, and low folate, but my diabetes is under control, and I have been on medication for my thyroid and folate for two weeks. I am a smoker, too. Please help me. It started about four months ago on my tongue and has slowly worsened over time. I am currently taking Levothyroxine 50 mg once daily, Sodium feredetate (iron 27.5 mg/5 ml), and a sugar-free oral solution of 10 ml daily. I have tried medicated mouthwash. I have done tests for vitamin deficiency, thyroid, liver, HbA1c, and complete blood count.
Hi,
Welcome to icliniq.com.
I understand your concern. Please send a picture of the bumps and flap that you mentioned. Do you have any history of bleeding from the swelling? Do you smoke or use tobacco?
Patient's Query
Hi doctor,
Thank you for the reply. This is my bump and flap from two months back, and it is getting worse. I cannot even hold my mouth open to take a picture now. Also, there is occasional bleeding from the swelling when I clean my tongue, and yes, I smoke.
Hi,
Welcome back to icliniq.com.
I understand your concern. From the picture attached (attachment removed to protect the patient's identity), the flap that you are mentioning is called the epiglottis, which is a normal structure present in your larynx to prevent accidental entry of food into your airway and the bumps that you have mentioned are called lingual tonsils. These tonsils get hypertrophied in cases of allergies and smokers. I suggest you do the following: 1. Reduce smoking. 2. Do lukewarm saline gargling at least two to three times a day. 3. Avoid citrus fruits and bananas. You would have already been prescribed multiple antibiotic doses. So simple lifestyle modification would help reduce the size of lingual tonsils.
Patient's Query
Hi doctor,
Thank you for the reply. It started a few months ago after having COVID. I smoked for over 15 years and never had it this bad. It is uncomfortable to swallow, and all bumpy at the back, and the flap has never been noticeable before. And I always check my mouth regularly because I smoke. Will gargling with saline help? How long do you think it should take to resolve?
Hi,
Welcome back to icliniq.com.
I understand your concern. Since smoking is an irritant, it is natural that your lingual tonsils are enlarged. You see, these tonsils are a collection of lymphoid cells that guard you against infection and any irritants. So reducing smoking and doing saline gargling will reduce their size and they may subside in two to three weeks. The flap you have noticed recently will also be due to increased reactivity to allergens, that is, smoking, etc. And post covid, the reactivity of these tonsils would have increased, so do not worry, reduce smoking, and do gargling. I suggest you take a course of antibiotics and antihistaminics. 1. Tablet Amoxicillin with Clavunalic acid 625 mg twice daily. 2. Tablet Pantoprazole 40 mg once in the morning on an empty stomach. 3. Tablet Motelukast with Levocetirizine at night. All for seven days. Do you have any other palpable lymph node or gland in your neck?
Patient's Query
Thank you I do keep getting a swollen lymph node in my right neck but has been scanned and nothing is there and all blood tests Iv had done show no infection in my body apparently, I will show you my recent blood test I had done on the 11th of august for you to look over if possible and also what medications should I get sorry could you put them in separate bullet points so I know, this is becoming so bad that I’m barely able to eat and loosing weight quickly because of this, Also I find quite strange with my blood work is that my eosinophil count keeps going up each time I have blood 11/08/22 - 0.37 almost at the limit ,19/05/22 - 0.32, 06/01/22 - 0.25 Also my basophil count is also very high 11/08/22 - 0.09 ,19/05/22 - 0.1, 06/01/22 - 0.04 Hope I can get your insight into these too please, thank you
as i can see your eosinophil and basophil counts are high.. this is the picture usually seen in case of people suffering chronic allergic conditions.. which will also inturn increase the size of your lingual tonsils.. and since your usg neck seems normal..u need not worry about carcinoma. coming to the treatment 1)tab.AMOXYCYLLIN WITH CLAVULANIC ACID 625MG twice daily 2)tab.ACECLOFENAC WITH SERRARTIOPEPTIDASE TWICE DAILY 3)tab.pantaprazole 40 mg one in the morning empty stomach 4)tab.MOTEKEUKAST WITH LEVOCETRIZINE in the night.. the above meds for 7 days 5)tab.DIETHYL CARBAMAZINE 100 mg twice daily for 20 days
Patient's Query
hi cherrie.. please donot worry as there is a very well mechanism which is given by nature, present in our body so that accidentally also food doesnt enter your airway i.e trachea. see the epiglottis which i had told you earlier that closes your airway whenever you swallow and airway is secured.. since you are not experiencing any choking episodes i am quite sure the above said mechanism is working pretty fine.. Also taking steam inhalation 2 to 3 times a day will help in you breathing better.. always there to help.. contact me if you any other doubts.. thank you tc
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Otolaryngology (E.N.T)
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