Enlarged Tonsils After Tonsillectomy: Possible Causes Explained

Tonsillitis with enlargement of the tonsils?

Hello doctor, the patient visited due to influenza and finished a three-day course of medication, but his throat still hurts.
Upon returning for a follow-up, the doctor mentioned that his tonsils are enlarged and inflamed.
However, he recalled that both tonsils were removed during childhood.
I would like to ask, if the tonsils have been removed, shouldn't there be no such thing as tonsillar enlargement or inflammation? If it is not the tonsils, what could be the cause? Thank you.

C, 30~39 year old female. Ask Date: 2024/05/16

Dr. Ji Zhaoyun reply Otolaryngology

Hello, generally speaking, if a person has had their tonsils removed in childhood, they are unlikely to experience tonsil enlargement or inflammation again.
However, there are some situations to consider: 1.
Residual tonsillar tissue: In certain cases, it may not be feasible to completely remove all tonsillar tissue during surgery, and any remaining small portions may become inflamed.
2.
Infection of surrounding tissues: Even if the tonsils have been removed, other parts of the throat (such as the pharynx) can still become inflamed or infected, leading to symptoms similar to tonsillitis.
3.
Lymphoid tissue swelling: There are other lymphoid tissues around the throat, such as the adenoids and lingual tonsils, which may also swell due to infection.
If the patient's sore throat persists without relief, it is advisable to return for a follow-up and inform the doctor about the previous tonsillectomy.
The doctor may perform further examinations, such as a throat examination or laryngoscopy, to determine the exact cause of the pain.
Possible causes include: - Viral infections (such as complications following influenza) - Bacterial infections (such as streptococcal pharyngitis) - Fungal infections (such as oral candidiasis) - Non-infectious factors (such as allergies, dryness, irritants, or acid reflux) Treatment will depend on the precise diagnosis.
If it is a bacterial infection, antibiotic treatment may be necessary; if it is a viral infection, symptomatic and supportive care will be the main focus; if it is due to other causes, targeted treatment will be required.

Reply Date: 2024/05/16

More Info

Enlarged tonsils or tonsillitis after a tonsillectomy can be perplexing, especially when one has undergone the procedure to remove the tonsils. It's important to understand that while the tonsils are removed during a tonsillectomy, there are still several factors that could lead to symptoms similar to tonsillitis or throat discomfort.

Firstly, it is essential to clarify that the tonsils are part of the body's immune system, and their removal does not eliminate the possibility of throat infections or inflammation. After a tonsillectomy, the surrounding tissues in the throat can still become inflamed or infected. This inflammation can be caused by various factors, including viral infections, bacterial infections, or even allergies.

1. Residual Lymphoid Tissue: Even after a tonsillectomy, some lymphoid tissue may remain in the throat. This tissue can become enlarged or inflamed, mimicking the symptoms of tonsillitis. This residual tissue can react to infections or irritants, leading to discomfort and swelling.

2. Pharyngitis: The inflammation of the pharynx, known as pharyngitis, can occur independently of the tonsils. Symptoms include sore throat, difficulty swallowing, and sometimes fever. Pharyngitis can be caused by viral infections (like the flu or common cold) or bacterial infections (such as streptococcal bacteria).

3. Infections: After a tonsillectomy, the body may still be susceptible to infections in the throat area. Viral infections are common and can lead to symptoms similar to those experienced with tonsillitis. Bacterial infections, such as strep throat, can also occur and may require antibiotic treatment.

4. Allergies and Irritants: Allergic reactions to environmental factors (like pollen, dust, or pet dander) can cause throat irritation and swelling. Additionally, exposure to irritants such as smoke or strong odors can lead to inflammation in the throat.

5. Gastroesophageal Reflux Disease (GERD): Acid reflux can cause irritation in the throat, leading to symptoms such as a sore throat or a feeling of swelling. This condition can be mistaken for tonsillitis, especially if the patient experiences discomfort when swallowing.

6. Post-Nasal Drip: Conditions such as sinusitis or allergic rhinitis can lead to post-nasal drip, where mucus drips down the back of the throat, causing irritation and inflammation. This can result in a sore throat and discomfort, similar to tonsillitis.

In your case, since you have already completed a course of medication for the flu and are still experiencing throat pain and swelling, it would be advisable to follow up with your healthcare provider. They may recommend further evaluation, such as a throat culture or imaging studies, to determine the exact cause of your symptoms.
In summary, while the removal of the tonsils reduces the likelihood of tonsillitis, it does not eliminate the possibility of throat inflammation or infection. Various factors, including residual lymphoid tissue, pharyngitis, infections, allergies, GERD, and post-nasal drip, can contribute to throat discomfort even after tonsillectomy. It is essential to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

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