Q. Kindly tell me about the white areas in the tonsils.

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 18, 2019

Hello doctor,

I am concerned about my tonsils. I honestly need them removed but have other health issues and just cannot right now. I had a cyst last year that slowly shrunk away to nothing, I have tonsil stones. The full range of issues. Right now I have these large white areas toward the bottom of my left tonsil. They are not stones and will not move. But I also do not have any pain or discomfort. What is this? It is really worrying me.



Welcome to icliniq.com.

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?

Thank you doctor,

I have pretty severe IBS. I am not on immunosuppressants but I have been told I likely have a bad immune system. I get tonsil stones, but only this tonsil has these strange immovable spots. They have been there for a long time but were not this white and large before. No difficulty swallowing, and I think my tonsils are pretty even although they are both large, always have been. If they were pus, I could wipe them right? I have been able to do it in the past. These are fixed. It will not budge, but they are larger than in the past.



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.

Thank you doctor,

In the past when I have had tonsillitis, it has come with pain and soreness. I am not having pain with these. No symptoms of illness either. Does this make it more likely that they are the keratin patches? They seem hard. I have also done many gargles and they remain there. They have been there for a year, and are only recently larger spots.



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.

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