Cause of sinus congestion, tonsillolith, ear pain, bad odor?

Question

Hello doctor,

I am a 25-year-old female. I am experiencing the following symptoms: Congested sinuses for about three years. I am on Fluticasone Propionate for this purpose (two sprays, twice a day), swollen tonsils for about one and a half years, tonsilolliths sizing from about 1-2 mm for about one and a half years, consistent sore throat (dry, feels swollen and difficult to swallow) for about four to five months, ear ache (particularly in my left ear) for about four to five months, bad breath for about one to two years. It is getting worse but I do brush and floss regularly. I am consulting the dentist every six months, and have tried mouth wash to resolve the issue, but the problem seems to come from the back of my throat and cannot be resolved. Consulted a doctor about one month ago for these symptoms and she gave Omeprazole 40 mg for nausea and heartburn. She mentioned that I have an eustachian tube dysfunction, which combined with my sinus issue and cause earache. She prescribed Fluticasone Propionate two sprays twice a day. My sore throat and earache have not gone away, I realized that the doctor did not check my throat. Can you please review the picture of my tonsils and let me know the cause of this discomfort?

Answer 1

Hello,

Welcome to icliniq.com.

I have read your symptoms in detail and also saw the picture that you have sent. (attachment removed to protect patient identity). We need to understand that the nose and throat are connected to the ear by eustachian tube. In your case tonsils are enlarged and have deep crypts which cause repeated tonsillolith and bad mouth odor. The congestion in sinuses leads to features of fluid in the ear which leads to pain and sometimes blocked sensation. My advice is: 1) If tonsillolith has been for long and repeated mouthwash does not take care of them then it is wise to undergo tonsillectomy. 2) As of now, your throat shows congestion as well so you will need a course of antibiotics like tablet Amoxyclav (Amoxycillin and Clavulanic acid) 625 mg twice a day after food for five days. 3) Your ear ache can be explained due to the recurrent sinus and throat infection that you are suffering. Once both are treated, your ear will be cured. Meanwhile, you will need Paracetamol and decongestant combination twice a day, and steam inhalation twice a day. 4) Regarding the sinus issue, Fluticasone spray will be effective if minimal tissue is present. For proper diagnosis, I will need a CT (computed tomography) scan of PNS (paranasal sinus), axial and coronal view. Based on its report it can be decided whether you need any endoscopic sinus surgery for the same. I hope this helps.