Persistent Throat Pain After Tonsillectomy: Causes and Solutions

Throat issues

Hello Doctor, I have been suffering from chronic inflammation of the left tonsil and underwent a bilateral tonsillectomy on April 1st.
It has been over a month and a half since the surgery, but I still experience pain in the area where the left tonsil used to be.
Additionally, about a month ago, I suddenly developed tinnitus in my left ear, which has been constant for 24 hours.
Two weeks ago, I also experienced vertigo when lying down, and I have difficulty standing without feeling unsteady.
I also feel a sensation of something stuck in my throat when swallowing saliva, but I cannot pinpoint the exact location.
I have undergone several examinations, including otoscopy, hearing tests, and tympanometry.
I was prescribed anti-vertigo medication for five days, but the ENT specialist mentioned that my tinnitus and dizziness do not seem to be related to an ear issue and referred me to a neurologist.
On the day of my appointment, the neurologist conducted some simple tests and noted that my balance was poor and that I had difficulty standing.
They ordered further tests, but due to the outbreak of the pandemic, I was unable to complete them.
The doctor initially suggested a CT scan to check for any issues before proceeding with an MRI, but I expressed my desire to self-pay for the MRI to avoid multiple hospital visits.
I have completed the MRI and am waiting to review the results once the pandemic situation improves.
I have several questions for you, thank you for your assistance:
1.
Since I have had my tonsils removed, why do I still feel discomfort in the area where they were located (I am unsure if this is referred to as the gland area)? There was previously a white lesion there, and the biopsy indicated no issues, but since then, that area has been persistently painful.
The surgeon noted some inflammation prior to surgery, possibly related to the tonsils (but I still feel pain in my mouth and the area where the tonsils were, as well as throat pain).
2.
Could the sensation of a foreign body in my throat be a result of the surgery? Is it possible that it could be related to a thyroid issue or an esophageal problem? (I had an endoscopy in March that showed no issues with the esophagus.) I have undergone a nasopharyngoscopy, which did not reveal any significant problems, only mild swelling in the throat.
3.
Regarding the 3D MRI I had, does it only assess the brain for issues, or does it also examine other areas, such as the tissues in the ear or the neck?
4.
I am unclear about the location of my throat pain, but it feels like persistent stabbing pain in the area where the left tonsil used to be.
Swallowing saliva also causes pain.
What could be the cause of this? Is it possible that the surrounding tissues were affected during the tonsillectomy, or could there be other issues? Sometimes the pain radiates to my ear, which is quite distressing.
(I had already experienced a sensation of pain in the tonsils that radiated to my ear before the surgery.) I am unsure what further examinations I should pursue since my tonsils have already been removed, yet I still experience pain.

Please help me analyze this situation or suggest any additional tests I could undergo.
Thank you.
(I have attached images of the area biopsied before surgery and the current state of my oral cavity post-surgery.) I truly feel helpless and do not know how to seek further medical assistance.

Miss Lin, 40~49 year old female. Ask Date: 2021/05/22

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
Currently, there are no significant abnormal findings in the photographs.

2.
There are many factors that can cause a sensation of a foreign body in the throat, including postoperative effects, post-nasal drip, gastroesophageal reflux, or sensitivity to air pollution.
The thyroid gland typically needs to be enlarged to cause a sensation of pressure.

3.
If an MRI of the head and neck is scheduled, it will include the neck in addition to the brain; however, if it is just a head MRI, the neck will not be included.

4.
The cause of the pain is currently unclear, and it is recommended to return for a follow-up consultation to evaluate the examination results.
Wishing you safety and health,
Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare,
Dr.
Jue-Yi Cheng

Reply Date: 2021/05/22

More Info

After a tonsillectomy, it is not uncommon for patients to experience persistent throat pain, which can be distressing and confusing. Your symptoms, including ongoing pain in the area where the tonsils were removed, ear ringing (tinnitus), dizziness, and a sensation of something stuck in your throat, warrant a thorough examination and understanding of potential causes.

1. Postoperative Pain: After tonsillectomy, it is typical for patients to experience pain in the throat as the surgical site heals. However, if pain persists beyond the expected recovery period (usually a few weeks), it may indicate complications such as infection, inflammation, or even nerve irritation. The presence of white patches in the throat area that were biopsied and deemed non-cancerous could suggest residual inflammation or irritation from the surgery.
2. Throat Sensation: The sensation of a foreign body in the throat can be attributed to several factors. It may be related to the healing process, where scar tissue forms and can create a sensation of tightness or discomfort. Additionally, the throat and ear are closely connected anatomically and neurologically; thus, issues in one area can manifest symptoms in another. The fact that you are experiencing ear pain and tinnitus could suggest that the inflammation or irritation is affecting the Eustachian tube or the surrounding structures.

3. Potential Thyroid or Esophageal Issues: While your previous endoscopy showed no issues with the esophagus, it is still possible for other conditions to arise. Thyroid problems can sometimes present with throat discomfort, but they typically involve other symptoms such as changes in weight, energy levels, or temperature sensitivity. If your symptoms persist, further evaluation of the thyroid may be warranted, especially if you have a family history of thyroid disease.

4. MRI and Other Imaging: A 3D MRI primarily focuses on the brain and surrounding structures, but it can also provide insights into the cervical spine and soft tissues in the neck. However, it may not give a comprehensive view of the inner ear or throat structures. If your symptoms persist, consider discussing additional imaging studies, such as a CT scan of the neck or a dedicated ear examination, to rule out any underlying issues.

5. Management and Next Steps: Given your ongoing symptoms, it is crucial to maintain open communication with your healthcare providers. If your ENT specialist has ruled out significant issues, consider seeking a second opinion or consulting a pain management specialist. They may offer therapies such as physical therapy, medication for nerve pain, or other interventions to help manage your symptoms.

In summary, persistent throat pain after a tonsillectomy can arise from various factors, including surgical complications, residual inflammation, or referred pain from nearby structures. It is essential to continue working with your healthcare team to explore these symptoms further and find an effective management plan. If you feel your concerns are not being adequately addressed, do not hesitate to seek additional opinions or specialists who can provide further insights into your condition.

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