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URI with eustachian tube dysfunction.

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Have a question for an ent specialist and/or oral surgeon. I and my wife have been suffering from swollen throat glands, earaches that alternate sides. I am looking for analysis of a picture. In the addition to these symptoms, vague sore throat and post nasal drip and squeaky eustacian tubes I have waht appear to be enlarged lymphoid follicles starting on the left side of my tongue, anterior to but touching foliate papillae. There are three or 4 prominent ones, extending into a cluster of maybe 6 more slightly smaller ones stretching back to what papers to be a ridge of similarly enflamed bumps extending back to the uvula then stretching across to the right side of the tongue at the level of the uvula nd then a bit forward. No prominent inflammation on anterior lateral tongue on right side. Tissue according to dentist looks normal, just kind of inflamed. No white or red or splotchy areas. No ulceration. Awaiting a visit with ent but looking for some info. Have uploaded pic. Might add that side of the tongue was lacerated when I kind of chomped on it and burst it with a fingernail when I had a canker last summer. Basically the shape is the same as it was when it healed then but puffy looking.
Perhaps worth mentioning I have also been getting recurring earaches that seem to start in that side Starting six months ago triggered by water. Seem to recur as slight earaches every month or so especially following outs of intense cardio(running in gym usually).
The junction of the jaw are that side also seems to get inflamed and feels puffy, sometimes seeming to "release" when flossed behind last molar where wisdom tooth was. Perhaps worth mentioning that I was told I might have ruptured something 16 years ago in a scuba diving incident. Sinuses ended up filled with water and infection for a week, drained only when flying home. Quite disgusting amount of fluid came out and was sick for few weeks following. Have always tend to get upper respiratory infections. Had pneumonia l14 months ago. Cleared up with antibiotics. Only dietary change has been addition of probiotic pills.

Category: ENT Specialist

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Category: ENT Specialist
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Thank you for using Doctor Spring for your query.

I can understand your problem, and will try to help you the best possible
Your present symptoms are sore throat, earache, postnasal drip and enlarged lymphoid follicle on left side of tongue. I have gone through the pics.

Sore throat and postnasal drip is most likely due to upper respiratory tract infection (URI) and ear ache due to eustachean tube dysfunction. So it can be treated with medication including: Please discuss them with your local physician -
Tab. Amoxicillin 500 mg two times daily for 5 days.
Tab. Levocetrizine 5 mg once in night for 10 days.

Lymphoid hyperplasia (I have seen both pictures) doesn’t require any treatment if it is asymptomatic. If any new symptoms develop then only we need to treat it (at present we can ignore it). Only thing you should not have adjacent sharp teeth, which will cause constant trauma to tongue lateral border.

To avoid very spicy food if you have abnormal burning sensation.
To start following treatment for sore throat (URI)
Tab. Amoxicillin 500 mg two times daily for 5 days.
Tab. Levocetrizine 5 mg once in night for 10 days.
To ignore lymphoid hyperplasia

Hope this helps. Feel free to ask if you have any further queries.

Thank you.

Patient replied :

To be absolutely clear. You are indicating that the follicle hyperplasia, though present mainly only on one side in foliate papillae, circumvate papillae, and lingual tonsils area. And a bit in central circumvate papillae, is not worrisome, does not seem to display worrisome tissue changes, and can be left alone and attributed to inflammation from infection, rather than anything more serious. And if it's asymptomatic doesn't require any particular attention.
The sore throat is very mild but glandular swelling under throat and at Adam's apple comes and goes, the ear pain seems to be abating or drifting back and forth between ears at least. Everything in mouth seems to be vaguely scratchy. Left and right sides. Upper and lower. I guess concern is that the ear symptoms are no lone genre terribly painful, but the follocle cluster still seems inflamed. How long will it take for them to return to their normal,, albeit slightly mangled, form?


Thank you for the follow-up and apologies for the delay with the reply.

Lymphoid hyperplasia can either be on one side or on both side can be kept under observation(if it is increasing in size or any other symptom develop then only require attention). But in you case as it is on lateral border of tongue will need to palpate the area, if consistenly is same as rest of tongue and if there is no induration then we can observe safely.
If it is firm or hard on palpation then we need to think about biopsy.

Hope this helps. Feel free to ask if you have any further queries.

Thank you.
Dr. Sunil Jalan

Patient replied :

i - thanks - it seems to me that the three/four other nodules sticking out at that location are the same firmness as the rest of the tongue tissue at that location, not hardened, and extending bacl into the top of the tongue.all of which are not as prominent in the photo as they appear in real life. One appears to have an almost tendril like appearance. The colour is unchanged, size seems unchanged - perhaps all seem slightly larger than observation a week ago. ear and throat gland that side now aching again. my patient wife also let me feel the inflamed paillae in her mouth and they seem equally firm.
One thing has jogged my memory os that the 2 larget of the protuberances were there before, I noticed them a year ago, as they were unusual and attributed it to a broken canker, which I burst and which had been very painful, and helaed into two ridges. but ther ewere no symptoms so I just forgot about it.

Hello and thankyou for your reply.
Since they have the same firmness as the rest of the tongue, color and size is unchanged you need not worry. They would most probably be due to the recurrent upper respiratory tract infection (URI) that is present. The earlier ones would probably would be due to trauma. As I said notice for any increase in size, if it becomes firm or hard. If that happens you will require to get a biopsy done.
For now you will have to get the upper respiratory tract infection treated. Avoid spicy food if there is any abnormal burning sensation.
And observe the lymphoid hyperplasia for any changes.
I hope this has helped.
Take care.

Dr. Sunil Jalan
Category: ENT Specialist
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
Dr. Sunil Jalan and 4 other Medical Specialists are ready to help you

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