Hi.
I've had nasal allergies and cryptic tonsils for most of my adult life. I have seasonal allergies as well as allergies to dogs, cats and most animals.
I'm 33 years old and recently went in for a check up. This new doctor didn't pay much attention to my left tonsil until I mentioned it to him that it has been enlarged for many years. He recommended a CT scan because of a slight swelling on the left side of my neck. I've had this swelling on and off for a few years.
My left tonsil has been enlarged for many years as well. My tonsils would get deep crypts in them and pocket yellow balls that would give off a very offensive odor. I used to pick at my tonsil crypts daily with a Q-tip to get these things out. I know that this was not very wise. Since 1995 these crypts seem to have disappeared. I have been seeing a board certified otolaryngoligist for the past 6 years and he has seen this condition. I've also had swelling on the left side of my neck which would subside after antibiotic treatment. The swelling never fully went away and the tonsil remained large the reset of the time.
Is it critical that I have my tonsils removed at my age and also the swelling in my neck? Could this stem from my chronic condition of infections in my tonsils and nasal allergies?
Reply: -------------------------
The first issue to address is your description of what sounds like asymmetry in the size of your tonsils with the left being apparently substantially larger than the left. Significant asymmetry in tonsil size will occasionally warrant a tonsillectomy for biopsy purposes to rule out a malignancy known as lymphoma. Lymphomas occasionally occur in tonsil tissue and may be essentially asymptomatic other than the asymmetric enlargement. However, it is important to consider that many individuals who still have their tonsils have varying degrees of tonsillar asymmetry. Often the tonsils will look quite asymmetric in size but in fact are virtually identical in size, differing only in their location thereby giving the illusion of size difference. Palpation of the tonsils is occasionally necessary to demonstrate this. Additionally, inflammatory processes may lead to asymmetry in the appearance of the tonsils. Your history suggests the latter is the most likely cause for the appearance of your tonsils. If you have already been evaluated by an otolaryngologist, the need for removing the tonsils for biopsy purposes has already most likely been addressed.
This leads to the other issue, namely - is there a need to remove the tonsils based upon the inflammatory process you have described. Adults who still have their tonsils will occasionally develop chronic tonsillitis due to accumulation of debris in deep tonsillar crypts. This condition will often lead to the symptoms of chronic, perhaps even daily, mild sore throat as well as halitosis. The decision as to whether tonsillectomy should be performed is a personal one for you. It depends on how much the condition is bothering you and affecting your daily living, as well as how it has responded to non-surgical treatments. I usually recommend aggressive oral hygiene measures on a daily basis for many months before suggesting the possibility of tonsil surgery. Such measures include vigorous gargling with weak saline solutions or antiseptic rinses such as Cepacol. Occasionally I will recommend the use of a water-pik device to accomplish what you have previously been doing with a Q-tip, in other words to irrigate the debris from the tonsil crypts.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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