Q. What is the treatment for granular pharyngitis and tonsillitis?

Answered by
Dr. Vinay S Bhat
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 05, 2018 and last reviewed on: Aug 19, 2019

Hello doctor,

I have been diagnosed with granular pharyngitis and tonsillitis, but I do not have any post-nasal drip or cold. I have pain while swallowing certain oily and spicy food.

What should be the treatment? In the last three months, I have got tonsil infection a couple of times.



Welcome to icliniq.com.

Granular pharyngitis occurs because of chronic irritation to the pharynx. It is commonly seen in patients with chronic rhinosinusitis, smokers, and nowadays, one of the most common cause for granular pharyngitis is laryngopharyngeal reflux disorder.

The usual symptoms of laryngopharyngeal reflux disorder are a mild burning type of throat pain, especially, on swallowing, foreign body sensation in lower part of throat, constant throat clearing, and sometimes early morning voice change.

There may not be any symptoms of gastroesophageal reflux disorder, such as heartburn and abdominal pain. It is common to have recurrent attacks of throat pain which mimic bacterial pharyngotonsillitis in patients with laryngopharyngitis reflux disorder.

I suggest taking anti-reflux medications, at least for three weeks. You can take tablet Pan D (Pantoprazole and Domperidone) 40 mg twice daily for three weeks.

For more information consult an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

Thank you doctor,

I have been to a GI and had done an endoscopy, which showed no signs of reflux or hernia or relaxed LES. Also, I have taken Esomeprazole medicine for three months. My PNS scan report shows I have it, but I have no symptoms of cold or PND. See the attached report of my PNS scan. I used to get severe headaches during flight travel, so an ENT had asked me to get it done.



Welcome back to icliniq.com.

As I have already mentioned, LPRD can occur without signs of gastritis or GERD (gastroesophageal reflux disease). I have seen the attached report (attachment removed to protect patient identity).

A CT PNS reported by a radiologist is not very reliable as clinical signs should match CT findings. Minimal thickening of the mucosa of sinus cavities is not really an abnormal finding. It can occur in any person with a minimal allergy.

Treatment of LPRD is not only with medicines, but dietary modifications play an important role. Along with medications, you should have food at regular timings, and do not sleep soon after having dinner. Wait for at least two hours.

I suggest taking medicines with anti motility drugs, such as Domperidone or Levosulpiride. Medicine such as Nexpro RD or Nexpro L 40 mg works very well if taken two times daily. Last cause for granular pharyngitis can be environmental pollution, which needs to be avoided by use of masks.

As per your CT, you have very minimal changes. If you are asymptomatic as far as nose symptoms are concerned, then you need not worry. Such CT findings are common even if you have minimal mucous in your nose during CT scan.

For further queries consult an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

Hi doctor,

Thank you for your suggestions. I will follow as you suggested. I hope granular pharyngitis is not a very serious illness because I am a little scared.



Welcome back to icliniq.com.

It is a simple pharyngeal inflammation. My medical advice to you is as follows:

  1. Tablet Nexpro RD (Domperidone and Esomeprazole) 40 mg, two times daily before food for three weeks.
  2. Furamist nasal spray (Fluticasone) once in the night in both the nostrils for a month. It is a steroid nasal spray, which will take care of the sinus inflammation. It is absolutely safe to use.
  3. Oxum solution for mouth gargling two times daily for a week. It is a Hydrogen peroxide solution, which has to be diluted 1:4 with clean water before gargling. It will take care of already formed granules over the pharynx.

Granular pharyngitis is nothing to worry about. Once predisposing factors are treated, it will go on its own.

For more information consult an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

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