OpenHealth Q&A

Understanding Lingual Tonsil Asymmetry After COVID-19

Greetings, following my battle with COVID-19 in January 2024, I have experienced a persistent sensation as though something is lodged in my nasopharynx. It often feels like thick mucus is present over my uvula, although such a condition is rarely the case. When it is, it's typically a small quantity encountered in the morning—clear and somewhat tacky—but the discomfort remains even after clearing my throat. This perplexing situation has lingered for over 14 months despite various treatments, leading to three MRIs of the soft tissues in my throat to explore the issue. The initial MRI, carried out in February 2024 without contrast, yielded normal results according to the radiologist's report. However, a follow-up scan in September 2024, conducted with contrast, revealed what was described as a “slight asymmetry of the adenoid tissue at the base of the tongue” by a different radiologist. Interestingly, this radiologist noted the same asymmetry observed in the earlier scan, which was not documented in the first report. Given the absence of additional pathologies, my ENT specialist opted for a conservative approach, advising a wait-and-see strategy. In January 2025, I underwent an NBI endoscopy with an oncologist, who found no suspicious signs and determined that a biopsy was unnecessary. He confirmed the asymmetry but suggested it might be a case of hypertrophy resulting from COVID-19, or perhaps it had been present unnoticed for a longer period. He pointed out that the tissue seemed soft enough to shift and even disappeared momentarily during the examination of the epiglottic vallecula. The third MRI took place in February 2025 (without contrast due to a mild allergic reaction). This time, the radiologist compared the new images with the previous scans and reported that in the left base of the tongue and retrolingual fossa, there was a tissue bulging into the pharynx with measurements approximately 15x8x4.5 mm (transverse x cc x ap). The finding was likely indicative of adenoid tissue asymmetry relating to the lingual tonsil and warranted clinical evaluation, possibly including sample collection in suspicious areas, at the discretion of the attending ENT specialist. Notably, the size and shape of the tissue had remained unchanged compared to the scans from February and September 2024, and no other neck structures showed abnormalities. This report was challenging to translate since the medical terms were in Polish; I used Google Translate to assist. Additionally, throughout this year, no pathologies were noted, nor did I experience any lymph node enlargement, which was further confirmed by an ultrasound in February. Upon reviewing the latest MRI, my ENT performed another nasal endoscopy, checked the radiological findings, and took the oncologist's assessment into account. He reassured me that since a whole year had passed with no alteration in the appearance or structure of the tissue, there was no cause for concern, and he deemed a biopsy unnecessary. What are your thoughts on this situation?

Answers (1)

3/30/2025, 9:30:44 PM

OpenHealth AI

Thank you for sharing your detailed experience. It sounds like you've been through a lot with your health since contracting COVID-19, and you have valid concerns regarding your persistent symptoms and the findings from your MRIs and endoscopies.

Main Points:

• You have experienced a sensation of something stuck in your throat, correlated with asymmetry in the lingual tonsils and adenoid tissue post-COVID.
• Multiple assessments have shown no alarming findings, and your ENT specialist has reassured you about the stability of the tissue over time.

Explanation:

Your ongoing sensation could stem from post-COVID changes such as inflammation or hypertrophy of the lingual tonsil area, which can occur after respiratory infections. The asymmetry noted on your imaging has not changed significantly and was deemed non-suspicious by multiple specialists, suggesting it might be a normal anatomical variation or a post-inflammatory change rather than a pathological condition.

Next Steps:

1. Symptom Management: Since you’re experiencing discomfort, consider the following:

   • Hydration: Drink plenty of water to keep the throat moist and help alleviate the mucus sensation.
   • Humidification: Use a humidifier at home to add moisture to the air, particularly if you're in a dry environment.
   • Saline Rinses: Use saline nasal sprays or rinses to help clear mucus from the nasopharyngeal area.

2. Monitoring: Keep a journal of your symptoms, noting when they worsen or improve, any associated activities, or dietary triggers. This info could provide insights if further evaluation becomes necessary.

3. Follow-Up Appointments: Stay in regular contact with your ENT specialist. If your symptoms change, worsen, or if new symptoms develop (such as difficulty swallowing, persistent pain, or breathing changes), discuss these during your visits.

4. Managing Anxiety: As lingering symptoms can be frustrating, it may be beneficial to seek support, whether through mindfulness, stress-reduction techniques, or speaking with a counselor or therapist.

Your active involvement in your health management is commendable. Continue to trust your specialist's guidance while ensuring you are comfortable with your treatment approach. If you have further questions about symptom management or if new concerns arise, feel free to ask.