I have always had enlarged tonsils and multiple strep infect


Q: I have always had enlarged tonsils and multiple strep infections growing up; at least 3 times per year. I am now 31 years old and have occasional tonsil stones, cryptic tonsils, and have had tonsillitis 2 times this year already. I often wake up in the middle of the night feeling as if I can't breathe. I went to an ENT specialist last week who said they are definitely large and having them removed will increase my airway by twice the size it is now. I also have a chronically swollen lymph node in my neck that has persisted for 7 years. The specialist said I could either deal with these issues or have a t&a and fine needle aspiration on the lymph node to be safe.

I am concerned about complications and recovery from this surgery and do not know if the benefits will outweigh the costs (literally and figuratively). I just wanted to get a second opinion on this procedure at my age.

Thank you.

Symptoms:  Cryptic tonsils, tonsil stones, sore throat, trouble swallowing
I have always had enlarged ...-1

A:   Hi.
Thank for your query and an elucidate history ; you are well researched.
Really happy to know the indepht understanding you have and I shall go by the opinion of your ENT.
Seen the picture. It shows classically enlarged tonsils almost nearing the uvula, shows signs of chronic infection, you have a history of 3 attacks in a year and cervical lymphadenopathy. All indications to go for tonsillectomy.

Considering your age my advice would be to go for 3 weeks of antibiotic treatment as per the culture sensitivity report of a swab from tonsils, added anti-inflammatory antioxidants, probiotics, PPI like Omeprazole, FNAC of the lymph nodes to rule out any serious disease.
See the results.
At the same time to watch for any septic focus like sinusitis or caries tooth or so and get treated.
If everything gets under control, you may not need surgery.
If no complete relief, better to go for surgery.

I can understand that tonsillectomy at your age has more problems but that can cure the problem. It may be worth taking the risk if the treatment as mentioned above fails to resolve the issue.

I humbly hope this answer helps you in decision making.

Comments / Follow Ups

Patient: I appreciate your answer and I do agree that the tonsillectomy will be the ultimate cure to everything I have experienced for so long. I am a medical student and after shadowing during a t&a procedure I can see why the recovery is so painful. I by no means know everything or hardly anything at this stage in my education but the knowledge I do have can make me quite paranoid at times about complications.
I did try a one week course of steroids and a 10 day course of antibiotics during my last infection. The steroids did help quite a bit but I know that long term steroid use is not a viable option. I have not tried anti-inflammatory antioxidants but will definitely do so and follow your other recommendations before scheduling the surgery.
Do you think that my breathing problems at night and sometimes during eating are due to the size of my tonsils? That is honestly what bothers me the most. I do not suffer from
halitosis even when I have the occasional tonsil stone. It is the size of the tonsils, difficulty swallowing and breathing, and the frequent infections that bother me.
Also, if and when I do go through with the t&a procedure I fear that my voice might change due to the expansion of my airway. Is that something that is permanent or happens often?
Thank you for your time and I look forward to hearing back from you.
Doctor: Hi.
Being Medical Student, you must have seen the adult tonsillectomy patients.
Pain is more as there is fibrosis.
Chances of post-op bleeding are more for the same reason.
Voice might change, but who knows it will be better as it should have been or worse.
Voices usually change due to the trauma of intubation rather that the expanded airway. A good anesthetist with smooth intubation and extubation do not chase any voice changes.

The only sure way to know the role of the tonsil in breathing problem is sleep apnea study done at specialized center and I would recommend you to get one study done. If this is positive, then we have one more indication to get the tonsillectomy done, if negative, we have one more support against tonsillectomy- I hope you are getting my points.
The best medical practice depends upon by wither confirming the things or by ruling the things.

Rest: just follow the treatment schedule for 3 weeks and please give me feedback. Till then no surgery.

Have a great day .

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