How to manage enlarged lingual tonsils?

Question

Hello doctor,

I have been diagnosed with large lingual tonsils. I also had ACDF surgery (anterior cervical discectomy and fusion), which has left me with a paralyzed vocal cord. I have a lot of dysphagia. ENT tried 20 mg of Prednisone for three days and Ciprofloxacin 500 mg. Once off these, tonsils become very enlarged. Allergy testing is scheduled. What should I do next?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Since your lingual tonsils are enlarging again after stopping Prednisone and Ciprofloxacin, and you are experiencing significant dysphagia (difficulty swallowing) along with a paralyzed vocal cord, the next steps should focus on:

Further evaluation of the cause- Since your ENT has already scheduled allergy testing, that is a good step. But additional tests may be needed:

Flexible laryngoscopy – To see if the swelling is obstructing your airway.
Sleep study – If you have trouble breathing at night, obstructive sleep apnea (OSA) could be worsening the issue.
Imaging (MRI - magnetic resonance imaging or CT scan - computed tomography) – To check if there is another structural issue contributing to the enlarged tonsils.

Addressing dysphagia (difficulty swallowing)- Since ACDF surgery (anterior cervical discectomy and fusion) can sometimes lead to swallowing issues, a swallow study (modified barium swallow test) might help determine if the problem is mainly due to:

Vocal cord paralysis.
Lingual tonsil enlargement.
Nerve or muscle dysfunction from surgery.

If your vocal cord paralysis is affecting your ability to swallow or breathe, your ENT might consider:

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.