Thursday, January 31, 2013

Prolonged Swollen Tonsils

My son is 10 years old and has suffered from extreme swollen tonsils for over 2 months. He has had repeated strep tests, which all came back negative and the doctor said no other bacteria showing up on test when it comes back from lab. However, antibiotic helps them to shrink, then within 10 days of being off antibiotic they are extremely swollen again. Lymph nodes in neck are swollen as well. He saw an ENT who put him on steroids while on antibiotic, they did shrink down, but again within 10 days were swollen again. One of his neck lymph nodes did go down while on steroid, but other was still swollen. He is on his 4th antibiotic since the end of November. Tonsils first time when didn't start antibiotic right away did get yellow pus on them, now we start antibiotic when they are extremely swollen but before pus appears on them. No other symptoms, no fever. His voice is very muffled when they get swollen, and that is usually how I know. He doesn't complain of a sore throat. I am worried about what could be causing this, and if there are any tests we should do to try and rule out anything too serious. No other health related concerns. He did test positive for the EBV several years ago, so the doctor said we know he must of had mono at some point in the past. ENT is comfortable to just keep watching and prescribing antibiotics and see if cycle eventually stops. I am OK with this, as long as we are not missing something more serious, such as a lymphoma. Any suggestions is greatly appreciated. Should he have a CT scan of his neck? Thank you for your time.  

Patrick Ha, MD, FACS replies...
It sounds like he is having recurrent low grade infections of the tonsils that are causing them to 'swell.' We are usually less concerned about the threat of a malignant process such as lymphoma when they are symmetric, if they enlarge and shrink, and if he doesn't have any persistent lymph nodes elsewhere in his neck. 

Ultimately, if he is on repeated courses of antibiotics, or missing school frequently, or if he is symptomatic in other ways, it may be worthwhile to discuss removal of his tonsils with your physicians. However, it doesn't sound like at this time that much further workup is required.

Patrick Ha, MD FACS
Associate Professor
Johns Hopkins Department of Otolaryngology
Johns Hopkins Head and Neck Surgery

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