Managing Persistent Tonsil Stones and Inflammation: A Patient's Journey

Unilateral tonsillar swelling with stones?

On April 9, I discovered that my left tonsil had some redness and swelling, so I sought treatment from a traditional Chinese medicine practitioner.
Since the symptoms were not very pronounced, the doctor indicated that the throat issue was not serious.
By April 13, inflammation had started, and the tonsil stones had increased, leading to a feeling of foreign body sensation.
I visited an ENT clinic for treatment to suction out the tonsil stones, but due to the excessive amount, not all stones were removed, and many remained lodged.
After returning home, I attempted to remove the largest stone stuck in the crypts myself.

On April 14, I had no pain and thought I was recovering, but due to being busy, I missed two doses of antibiotics that day, although I did manage to take all my medications on time.
On April 15, I took my medications as scheduled but noticed a decrease in effectiveness, and other cold symptoms (nasal discharge and reflux issues) persisted.

In the early morning of April 16, the tonsillitis worsened, waking me up in pain.
That evening, I returned to the original ENT clinic to report that the tonsillitis pain had intensified.
The doctor prescribed the same antibiotics and advised me to return for a follow-up after finishing the medication.
However, there was still no improvement, and one side of my tonsil was swollen, causing excruciating pain when swallowing, as if my throat were being cut.

On April 19, after struggling to complete three days of medication, I decided to visit a nearby hospital.
The doctor there questioned why I hadn’t sought treatment at a small clinic, despite explaining that I had visited four times without resolution.
I described the severe throat pain and mentioned that the soluble antibiotics were causing diarrhea.
The doctor prescribed a different antibiotic (Clindamycin capsules) and added a stronger pain relief component (Tramadol), giving me a five-day supply.

By April 22, on the third day of medication, I experienced severe diarrhea, leaving me very weak.
Due to the inconvenience of my location, I went to a nearby pharmacy to ask the pharmacist if I could stop the medication.
The pharmacist explained that antibiotics should not be discontinued without guidance and provided me with an anti-diarrheal medication, advising me to take it at least half an hour apart from other medications.
The pharmacist also suggested that if my condition did not improve, I should seek care at a larger hospital for further evaluation.

As of April 23, I am on the fourth day of medication.
Although I am no longer in pain, the swelling on one side of my tonsil has not subsided, and the stones remain lodged.
I cannot extract them with a cotton swab.
The tonsillitis and stone issue has persisted for over two weeks.
I am now considering whether, after completing this five-day course of antibiotics without pain, I still need to seek further medical attention or if I should go to a larger hospital, given that the stones are still lodged and the swelling has not decreased.
I am also experiencing gastrointestinal discomfort from the antibiotics, which is quite concerning.
I kindly ask for your guidance on what steps I should take next.

Yin, 20~29 year old female. Ask Date: 2018/04/23

Dr. Zheng Jueyi reply Otolaryngology

Diarrhea may be related to antibiotics.
If symptoms such as sore throat or diarrhea persist without improvement, it is advisable to return to the original hospital to see if medication adjustments are needed, or if hospitalization for intravenous treatment is necessary, or if a referral to another hospital for further management is required.
Wishing you safety and health.
Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare, Zheng Jue-Yi.

Reply Date: 2018/04/23

More Info

Managing persistent tonsil stones and inflammation can be quite challenging, especially when symptoms worsen over time despite treatment. In your case, it appears that you have been dealing with tonsil stones and associated inflammation for several weeks, and your experience highlights the complexities of managing this condition.

Tonsil stones, or tonsilloliths, are calcified debris that can form in the crevices of the tonsils. They can cause discomfort, a sensation of something being stuck in the throat, and sometimes even bad breath. When inflammation occurs, it can lead to more severe symptoms, including pain, difficulty swallowing, and fever. Your journey through various treatments, including traditional Chinese medicine and multiple visits to ear, nose, and throat (ENT) specialists, reflects the common frustrations many patients face when dealing with this condition.

From your description, it seems that the initial treatment with antibiotics did not yield the expected results, and the inflammation worsened. This can happen for several reasons. First, if the tonsil stones are not fully removed, they can continue to irritate the surrounding tissue, leading to persistent inflammation. Second, the choice of antibiotic may not have been effective against the specific bacteria causing the infection. It's also important to note that antibiotics can disrupt the balance of gut flora, leading to gastrointestinal side effects such as diarrhea, which you experienced.

Given that you have been on antibiotics for several days without significant improvement, and considering the ongoing symptoms of swelling and discomfort, it may be prudent to seek further evaluation. If the tonsil stones remain lodged and are causing significant inflammation, a more invasive procedure, such as a tonsillectomy (removal of the tonsils), might be necessary. This is especially true if the stones are recurrent and causing ongoing issues.

In terms of your current situation, if you finish the course of antibiotics and still experience swelling or discomfort, it would be advisable to consult a larger hospital or a specialist who can provide a more comprehensive evaluation. They may perform imaging studies, such as a CT scan, to assess the extent of the tonsil stones and the surrounding inflammation. Additionally, they may consider other treatment options, including surgical removal of the stones or even the tonsils if they are a recurrent source of infection.

It's also important to manage your expectations regarding recovery. While some patients may respond well to conservative treatments, others may require more aggressive interventions. Listening to your body is key; if you feel that your symptoms are not improving or are worsening, do not hesitate to seek further medical attention.

In summary, your experience with persistent tonsil stones and inflammation is not uncommon, and it highlights the need for a tailored approach to treatment. If symptoms persist after completing your current antibiotic regimen, consider seeking further evaluation from a specialist who can provide a more definitive treatment plan. Your health and comfort should always be the priority, and there are effective treatments available for managing tonsil stones and their complications.

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