What causes reddish flap in the tonsil area?

Question

Hello doctor,

I had been having slight trouble with my left tonsil. I suffer with tonsil stones and started to get yellow/green semi-solid fluid forming at the bottom of the tonsil. This was easy to get out with a cotton bud. It smelled so, I knew it was tonsil fluid/stone. I have always had lots of bouts of tonsillitis and suffered more on that side. The fluid stops, but a reddish patch comes where the fluid comes out of the flap. It goes up and down as blood vessels in that area. The tonsil is the same size, with no pain all other issues with it. Just this little irritated patch that does have a couple of little bumps but is flat and hardly noticeable. I suffer from lichen planus and geographic tongue. I have been to the GP, and he put me on ten days of penicillin, but that did not make the patch go away. It is reddish in the morning and fades as the day goes on but does not disappear. I have been referred to ENT.

Answer 1

Hello,

Welcome to icliniq.com.

The picture you have attached does not show any lesion (attachment removed to protect patient identity). It is a normal-looking tonsil showing tonsillar crypt (Crypta magna), which is normal. As of now the tonsils are normal-looking. They are not hypertrophied nor is there any membrane or pus filled clefts or crypts. There is nothing to worry about. However, it is at times possible that one may be able to express purulent discharge from tonsillar surface even if it is normal looking. Even then there is no need to worry. All you need is a course of antibiotics which you have completed. You only require topical antiseptic mouth gargles like betadine or chlorhexidine. They are not even that hypertrophic to merit tonsillectomy. However, if there are recurrent attacks of tonsillitis or peritonsillar abscess with bad breath or halitosis, tonsillectomy may be considered at a later date.

Answer 2

Hi,

Welcome back to icliniq.com.

Now I think I can see what you are worried about. There is a small superficial mucosal ulcer at the lower border of the left tonsil, and your left tonsil is enlarged (Grade 2 hypertrophy). That appears to me to be a simple aphthous ulcer, or what we call a canker sore. It can occur in a setting of acute tonsillitis. It does not appear to be anything sinister (malignancy). It should heal in a while. In the meantime you can use Difflam (Benzydamine Hydrochloride) oral rinses or sprays twice or thrice a day. You do not seem to have oral lichen planus. You may also try applying topical steroid ointments if you are able to access the lesion (Triamcinolone 0.1) oral paste like Kenocort. Keep observing; if it does not heal or it increases in size, changes its look, or becomes more infiltrating, or if you develop hard neck nodes, then it may need further evaluation. As of now it does not seem to be anything sinister

Answer 3

Hi,

Welcome back to icliniq.com.

I am also talking of the same lesion. Relax, it is nothing serious. The tonsillar surface is highly vascular. Any inflammatory insult can produce localized lesions of varied morphology. Can appear to be reddened or erythematous lesions or punched-out ulcers or grossly swollen or congested. Need not worry.