Kindly tell me about the white areas in the tonsils.

Hi,

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They are pus or keratotic patches (attachment removed to protect patient identity). If pus, then it should be painful. Most likely keratotic patches over the tonsil. Can you take pictures where both tonsils can be visualized? Do you have such spots on the other tonsil as well? Do you have any difficulty in swallowing? Is one tonsil larger than the other? What chronic illness do you have, if at all you do? Are you on any kind of steroids or immunosuppressant medications?

Hello,

Welcome back to icliniq.com.

Your tonsils are really big. We would call them a grade 3 hypertrophy, one less than grade 4 (kissing tonsils). The white spots most probably are pus or fibrous tissue studded in the tonsillar crypts. The crypts are normally occurring pits inside the tonsil, which when infected throw pus outside into the oropharynx. In the case of long-standing recurrent tonsillitis, the pus gets dried and thickened and may not get wiped off easily.

Sometimes long-standing post nasal drip can cause the same changes over the tonsillar surface. But that should go away with gargles. Keratotic patches and fibrous tissue are also consequences of the long-standing tonsillar disease. In these cases, it is better to get the tonsils surgically removed. Such big tonsils at your age can act as a constant source of infection to other areas in ENT like the nose, sinuses, eustachian tube, ears, chest, larynx, etc. They can frequently get infected and cause soreness and bad breath.

Although it is difficult to pinpoint the exact nature of the white spots, it is advisable to get your tonsils removed. Biopsy of the tonsillar tissue will lead us to the exact diagnosis of the spots. Additionally, you must get rid of post nasal drip. Let us know if there is any nasal symptoms like running nose, sneezing, nose block or itching or nasal discharge. In these cases, you would need an anti-allergic medication with some steroidal nasal sprays which will remove the post nasal drip.

Hi,

Welcome back to icliniq.com.

I would say, you should wait and observe, because of the constraints you told me now. In the meantime, you must switch over to Benzdymine gargles, an antiallergic, and a steroidal nasal spray. The gargles are to be diluted in water and done thrice daily. After a week you may do the gargles once a day. Drink plenty of lukewarm water. Take a good dose of Multivitamins and plenty of fruits and vegetables.

A combination of Fexofenadine 120 mg and Montelukast 10 mg taken once daily in the evening will help relieve the post nasal drip. Mometasone furoate nasal spray should be used to remove intranasal inflammation. Take two puffs in each nasal cavity in the morning. Do not breathe in immediately after taking the puffs as that would suck the medicine into the throat. After using the spray rinse your throat and mouth with warm saline. Spray and antiallergic are to be continued for two months. I suggest you do these measures and observe and get back to us with fresh clear pictures after two months.