Dr. Syed Peerzada Tehmid Ul Haque
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
Hello doctor,
I had been having slight trouble with left tonsil. I suffer with tonsil stones and started to get yellow/green semi-solid fluid forming bottom of tonsil. This was easy to get out with cotton bud. It smelt so knew it was tonsil fluid/stone. I have always had lots of bouts of tonsillitis and suffered more that side. The fluid stop but a reddish patch come where the fluid come out of flap. It goes up and down as blood vessels in that area. The tonsil same size, no pain all other issues with it. Just this little irritated patch that does look a little couple bumps but flat and hardly noticeable. I suffer from lichen planus and geographic tongue. I have been to GP and he put me in ten days Penicillin but that did not make the patch go. It is reddish in morning and fades as day goes on but not disappear. I have been referred to ENT.
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 hypertrophied nor is there any membrane or pus filled clefts or crypts. There is nothing to worry. 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 peritonsillitis with bad breath or halitosis, tonsillectomy may be considered at a later date.
Patient's Query
Thank you doctor,
Could I send you another picture so you can see red patch better. If I press it with cotton bud it does have little orange fluid sometimes as if it is irritated. I am worried that it could be cancer.
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 left tonsil and your left tonsil is enlarged (Grade 2 hypertrophy). That appears to me a simple aphthous ulcer or what we call 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 past like Kenocort. Keep observing, if it does not heal or it increases in size, changes its look 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
Patient's Query
Thank you doctor,
Do you mean little white thing side of tonsil that always been there? I mean where veins are at bottom of tonsil.
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 localised lesions of varied morphology. Can appear to be reddened or erythematous lesion or punched out ulcers or grossly swollen or congested. Need not to worry.
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Otolaryngology (E.N.T)
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