I have swollen tonsils with red spots at the back of the tonsils. Please help.

Hi,

Welcome to icliniq.com.

Thanks for providing detailed history and photo of the area in concern (attachment removed to protect patient identity). Your tonsils are definitely enlarged and I would classify them to be grade 2 hypertrophied. However, the tonsils do not seem to have acute inflammation and the reason for having this recurrent irritation in throat with a feeling of a lump or something obstructing while swallowing can definitely be a feature of chronic silent GERD with LPR (gastroesophageal reflux with laryngopharyngeal reflux). Even though you might be asymptomatic and never had gastric issues earlier, the inflammation in the throat often exists in the hidden form and can resurface when adequate care is not taken. Why does hidden acid reflux become so problematic? As you know the stomach usually has got cells which release hydrochloric acid and thus keep the gastric environment acidic in nature. Your entire mucosal lining from the mouth throat and food pipe (esophagus) is not meant to handle anything acidic. Of the three structures, the throat is the most sensitive due to its rich nerve supply. If in a given situation, your mouth, throat or food pipe chronically comes in contact with acidic contents, an inflammation starts which the body initially takes care of, but once this compensation wears out, you start developing symptoms that you have mentioned. Please try to follow the advice mentioned below: 1. Maintain a strict diet, eating on time. 2. Avoid spicy oily and cold food/drinks. 3. Keep a gap of two hours between meals and going to bed. 4. Do not overeat, rather keep your stomach half empty and have regular intermittent light food like fresh cut fruits in between major meals. 5. Salt water gargling 8 to 10 times a day for 15 days. 6. Avoid alcohol and smoking as it can potentiate reflux. Treatment plan: Tablet Pan D (Pantoprazole) 40 mg (or its equivalent) once in the morning before breakfast for one month, syrup Mucaine gel (or its equivalent) one teaspoon three times a day 20 minutes before meals for one month. Make sure you follow the precautionary measures as much as possible as mere medications would not fetch long term relief. This typically takes two to three weeks for things to normalize and for symptoms to subside. There is absolutely nothing that you need to worry about as this is a treatable entity and things will be fine in a few weeks duration. I hope this helps.

Hi,

Welcome back to icliniq.com.

With the symptoms you have mentioned, I would not consider cancer or malignancy as my first differential diagnosis as they usually present in a slightly different fashion. Feeling of a pea-sized lump inside Adam's apple could definitely be a feature of GERD with LPR. The symptoms take a while to subside, I would say around two to three weeks on an average, but it chiefly depends on how much precautionary measures you were able to follow along with the medications mentioned. Pea-sized lumps can also sometimes be lymph nodes which would have transiently increased in size due to recent infection and underlying inflammation. Try to avoid palpating it regularly to check if it has reduced in size. In addition, I would also like to mention that even if you happen to have as less as 20 percent improvement in the next two to three weeks or earlier. We can consider that the treatment has started taking effect and we are on the right path. Make sure to continue the precautionary measures as much as possible without keeping a rigid time frame with respect to how long these measures should be followed. In a few patients it has taken as long as three months for things to resolve, so it is better to wait. However, if you feel that there is absolutely no improvement as far as the symptoms are concerned in spite of following the measures, it is always better to get it investigated with appropriate radiological and laboratory investigations. I hope this helps.