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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is A Tonsillectomy Recommended Here?

Hi, My tonsils have been infected since May 5th, It started off as a sore throat, and then i seen white spots on them, i went to the walk in that night, and was put on amoxicillin, it did nothing for me. I then went back to the walk in, and they put me on augmentin, 10 days of that, 2 days after i was off it, the swelling and white spots came back. for 5 days it didnt hurt, they were just swollen and still had white spots. on the 6th dayof this happening, the pain came out of no where. It was so extreme i ended up in the ER. They took strep and mono, and blood testing, and everything came back negative. A few days later i went to my parents house which was 5 house from where i was living, and my mom bought me to another walk in, i was then put on a steriod and 2 days later went to an ENT where i was diagnosed with sever tonsilitis. He told me to finish the steroid, and then put me on clindamyican. i took that 3 times a day for 10 days. I took it for the full 10 days, an again 5 days after i was off the medication, it came back. I went back to the ENT and he said i now have cryptic tonsils and have to gargle with salt water and peroxide to prevent bacteria from getting into my tonsils. I have been doing that for a week. it then got bad, so again i was in the ER, and they perscribed me more clyndamiacin, and i have been taking that for 7 days as of today. I noticed tonight that the veins on my toncils were dard read, and i dont know how to explain the white marks on my toncils, but it looks like white marble, but its under the skin, its not the bacteria. My ENT said he would not do a tonsilectmy
Wed, 10 Sep 2014
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ENT Specialist 's  Response
Hi. It appears that you have had a very bad sequence of acute bacterial tonsillitis and the cryptic tonsils explain why you get them so frequently and why they are difficult to treat.

Crypts in the tonsils, if get big and deep (appears to be so in your case) easily trap food particles and become sources for infection. Every infection actually makes these crypts larger and deeper, making you more susceptible to infections. It may also be difficult for medications to reach in adequate amounts due to the crypts and hence delay recovery.

A tonsillectomy may be indicated for you based on the recurrent nature of the tonsillitis (> 3 infections in 4 months), the precipitating crypts and severe nature of the infection. However I would not recommend the tonsillectomy now, especially when you have an active infection or are recovering from a recent episode. There is a high risk for bleeding and postoperative complications if tonsillectomy is performed at this stage.

I would therefore recommend the tonsillectomy after 6 weeks only if there has been no new tonsillitis in between. You may have to take good care by maintaining oral hygiene and performing gargles with chlorhexidine or betadine before and after meals for the entire duration to keep the crypts clean and prevent the recurrence of a new episode. A course of antibiotics and anti-inflammatory medications may be necessary by your ENT specialist if you have an active infection at present.
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Is A Tonsillectomy Recommended Here?

Hi. It appears that you have had a very bad sequence of acute bacterial tonsillitis and the cryptic tonsils explain why you get them so frequently and why they are difficult to treat. Crypts in the tonsils, if get big and deep (appears to be so in your case) easily trap food particles and become sources for infection. Every infection actually makes these crypts larger and deeper, making you more susceptible to infections. It may also be difficult for medications to reach in adequate amounts due to the crypts and hence delay recovery. A tonsillectomy may be indicated for you based on the recurrent nature of the tonsillitis ( 3 infections in 4 months), the precipitating crypts and severe nature of the infection. However I would not recommend the tonsillectomy now, especially when you have an active infection or are recovering from a recent episode. There is a high risk for bleeding and postoperative complications if tonsillectomy is performed at this stage. I would therefore recommend the tonsillectomy after 6 weeks only if there has been no new tonsillitis in between. You may have to take good care by maintaining oral hygiene and performing gargles with chlorhexidine or betadine before and after meals for the entire duration to keep the crypts clean and prevent the recurrence of a new episode. A course of antibiotics and anti-inflammatory medications may be necessary by your ENT specialist if you have an active infection at present.