Recurrent Tonsillitis [posted 11/5/98]
Question: I have had recurring tonsillitis since I was a child. I am now 30 years old and suffering from another case, my 4th this year. I am currently taking Augmentin, 250 mg. and have been doing so for three days, with no relief. My tonsils are covered with a pus-like coating and I feel a bit weary. When and under what circumstances do you recommend tonsillectomy, and is it true that if I remove the tonsils, I will be at a higher risk of acquiring Rheumatic Fever?

Answer: The risk of Rh fever will not change with whether you have tonsils or not. Recurrent infections with cryptic tonsils are usually grounds for removal. Some use 4 a year, some 6-8;but, you are pretty close. Sounds like they need to come out.

Throat Pain [posted 7/30/98]
Question: My girlfriend has a burning feeling in her throat. She says it burns like a burn on your skin from fire. She also says that her throat is cool like mints when she swallows sometimes too. She is currently on Triphasil-28 and has been on it for quite a while now so we do not believe that is the problem. Do you have any ideas as to what the problem could be?

Answer: Probably reflux acid. Other possibilities are a Zenker's Diverticula (a congenital "pouch" in the upper throat). Sometimes birth control pills will increase acid reflux disease. The esophagus is very poorly designed to resist acid and the "burning" can be intense. Other possibilities include referred pain. This is pain felt in the throat, but originating from the stomach, gall bladder or heart. Commonly felt in the throat.

Throat Obstruction
Question: I have experienced for at least 12 months a continuous sensation of something in my throat at or just below the voice box. The feeling is very similar to having phlegm in the back of one's throat except that coughing to expectorate the phlegm produces no effect. An ENT Doctor's visual examination of the upper throat, using a "light scope" threaded through the nose, resulted in a diagnosis of gastroesophogeal reflux effects that have irritated the esophagus at the upper sphincter area. I was prescribed Prilosec 20 mg, which I took for approximately 45 days. While all sensations of heartburn (which I also experienced) were eliminated, the feeling of something in my throat persists. Because of some discomfort with Prilosec, I was switched to Prevacid 15 mg, which I have taken for another 30 days. However, the throat sensation still persists. Is it common that the healing process of the esophagus lining (if that is what causes the "phlegm in throat" feeling) takes more than 8-10 weeks for relief to occur? Is it possible that the "inflammation" is a permanent effect? Can the effect be relieved surgically? Also, the feeling results in a desire to continually try to swallow down the "Phlegm-like feeling" and lately swallowing seems to cause a "clunking or hang up" sound or feeling in the adams apple area during swallowing. Should I just be ignoring all of this, or should additional diagnostics be performed? Also, are the medications defeated if a stringent acid-free diet is not adhered to?

Answer: The drugs you are taking would decrease acid, but not necessarily eliminate reflux. I'd get an overnight test (done by a GI specialist) or add propulsid at bedtime to your regimen (a motility drug to decrease reflux). Have you elevated the head of your bed? Four inches will do and is often very effective. I suspect this is the problem.

Excessive Phlegm
Question: I have been having excessive mucus or phlegm in my throat. This problem has been going on for 8 years and I have been to many doctors. I was taking claritin and it was working somewhat for about 6 months until it ceased working. I have to suck on candy or cough drops so I don't gag and vomit. I don't know if this is allergies or stress related.

Answer: There are several potential causes. First, is post nasal drip. This is common, but treatment is sometimes difficult depending on whether it is allergic or non-allergic. Allergic causes can be treated with nasal steroid spray, nasal cromlyn spray and anti-histamines. While Claritin does not sedate as much as relatively non-selective antihistamines, it also does not decrease secretions as much. Try getting tested for allergies and the sprays above and Benadryl 50 mg at bedtime. Non-allergic causes can respond to increased humidity at home and at work and the Benadryl. Second on the list is reflux from your stomach. This is a fairly common cause and if you're having any symptoms, especially at night, may be very helpful. Elevating the head of your bed, and taking H2 blockers like Tagamet or Zantac may be worth a try. Third, people increase their secretions as they age. There is little treatment for this. Fourth, chronic sinus infections can be the cause. Has a CT of your sinuses been performed?

Throat/Tonsils
Question: I am a 23 year old female who frequently has problems with my throat and tonsil area. I am a non-smoker. I often examine my throat and every so often , I am able to pull out white particles from the pores in my tonsils which have a foul-smelling odor. I am worried that this may contribute to bad breath. Formerly, I only saw these white particles when I was about to get a sore throat. I find them in my throat at all times. Could you tell me what these particles are called and how I can keep them from reappearing.

Answer: It is hard to say exactly what they are without seeing them, but it sounds like there are crypts in your tonsils which are trapping food, etc. These then either become infected or putrid with spoilage. The only answer is probably stringent cleaning of this area or surgical removal. Check with an ENT specialist.

Throat/Neck Tightness
Question: For the last six months I have had spells of tightness in my neck/throat area. My dr. has sent me for c-spine xrays, listened to my neck arteries, prescribed clonazepam, I have had an angiogram, ecg blood tests and we can't seem to get to the bottom of this. Other related symptoms are groin pain as well as pain and aches in the lower back/kidney area. My arms are also going numb and hurt doing the simplest tasks.

Answer: Possible causes are the stomach, esophagus and gall bladder. Due to the fact that the are connected to the vagal nerve they can be felt in the neck(like heart pain can) on occasion. This wouldn't explain the other pains-has a CT of the neck been done?
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