OpenHealth Q&A

Chronic Sinusitis and Persistent Throat Issues: An Ongoing Struggle

Hello, I'm a 43-year-old male dealing with a longstanding issue of recurrent sore throats for over five years. These typically resolve with antibiotics, but I've seen a gradual worsening of my symptoms year after year. My tonsils were surgically removed four years ago, and while I experienced some improvement for a couple of years, I have since returned to a pattern of frequent sore throats. On the first day when I felt the familiar sore throat (I’ve shared some images in the comments for reference), I noticed an exceptionally unpleasant odor coming from the remaining tonsil area—a sickly sweet and foul smell. By the fourth day of treatment, that odor had significantly diminished. Additionally, my recent gastroscopy revealed that I have a loose lower esophageal sphincter (LES), but no indicators of Barrett's esophagus were found. Despite trying numerous medications for reflux, I have seen no improvement, raising the possibility of laryngopharyngeal reflux (LPR) or damages due to pepsin. Over the past week, I have also experienced considerable shedding of cells inside my mouth, particularly noticeable upon waking—this symptom tends to fluctuate but has been particularly pronounced this time. Neither vitamin B nor SLS-free toothpaste has alleviated this issue. My post contains some graphic images of my tonsil area following the antibiotic treatment; so please be advised that it includes NSFW content. I find myself struggling to identify the underlying cause of these persistent issues and would appreciate your insights on the following questions: - Is it common for silent reflux to trigger such severe infections? I do not typically experience heartburn or reflux sensations; instead, my symptoms often seem linked to inflammatory responses from infections. - Regarding the circular blood vessel I noted near my tonsil (highlighted with a yellow arrow in the images), should this be a cause for alarm? I noticed a similar vascular structure on the opposite side as well. Is this ring-shaped vessel indicative of GERD-related inflammation? I have not previously observed a blood vessel so distinctly shaped. To provide additional context: I've consulted with over eight ENT specialists, some of whom suggested that the whitish tissue observed on the remnants of my tonsils resembled scar tissue, potentially related to reflux issues. More recently, while on antibiotics, I probed the tonsils with a cotton swab, which caused the white tissue to start flaking off, suggesting it might be a layer of mucus or dead white blood cells. The blue arrow in my photos points to a white patch inside the tonsil, which, interestingly, has since completely disappeared in the follow-up images. Although the whiteness in the photo may seem more pronounced, I’ve noted variations of a white surface on my tonsils for several years; however, today’s clarity is quite unusual, leading me to suspect there has been a lingering low-grade infection. For about seven years, I have been dealing with sore throats that fluctuate between mild and severe every month or so. Typically, these episodes do not resolve without antibiotics. I've tried a wide range of over-the-counter treatments, antihistamines, a variety of medications for reflux and mast cell activation syndrome (MCAS), adjusted my diet, and taken various supplements. There have been months where I've endured daily mild sore throats, attempting to let them resolve naturally, only for the symptoms to suddenly worsen, prompting me to start antibiotics, after which I will feel entirely symptom-free for a period of time. After about three to four weeks, the symptoms tend to return. While medications for GERD didn’t appear effective, I wonder if a co-infection might have been present, necessitating its treatment before the reflux medications could be properly evaluated. I've undergone basic blood tests which ruled out autoimmune issues; next month, I plan to have further immunoglobulin levels checked alongside additional blood tests related to MCAS.

Answers (1)

8/7/2025, 4:21:08 PM

OpenHealth AI

Thank you for sharing your experiences and concerns about your chronic sore throat and related symptoms. It sounds like you’re dealing with a complex situation, and it’s understandable to seek clarity and relief. Here’s a summary of the main points regarding your condition and actionable steps you can consider:

Summary of Main Points:

1. Chronic Throat Issues: Your persistent sore throat and recurrent symptoms may be linked to unresolved infections, reflux issues, or other inflammatory conditions.
2. Reflux Concerns: Silent reflux can lead to throat inflammation without typical heartburn sensations. The presence of unusual vascular structures near your tonsil may warrant further evaluation.
3. Differential Diagnosis: Ongoing symptoms despite treatment could suggest the need for a multidisciplinary approach to identify any underlying infections or other causes.

Explanation:

Chronic sore throats can arise from a variety of conditions such as laryngopharyngeal reflux (LPR), chronic infections, or even allergic reactions. Your history of undergoing tonsillectomy and experiencing recurrent throat infections suggests that post-nasal drip from sinus issues or reflux may contribute to your symptoms.

The unpleasant odor you noted and the whitish tissue could indicate debris or inflammatory responses in the remaining tonsil tissue. The blood vessels you observed may be normal anatomical variations, but unusual vascular structures warrant evaluation by your ENT for reassurance and to rule out any significant issues.

Actionable Next Steps:

1. Monitor Your Symptoms: Maintain a symptom diary detailing the frequency, severity, and triggers of your sore throat and associated symptoms. This will help identify patterns and guide your healthcare team.

2. Dietary Modifications: Since you suspect LPR, evaluate your diet for trigger foods that can relax the lower esophageal sphincter (LES), including fatty foods, caffeine, and chocolate. Consider smaller, more frequent meals.

3. Consider a Comprehensive Evaluation: Discuss with your ENT the possibility of performing a fiber optic laryngoscopy to directly visualize your throat and assess any potential lesions, inflammation, or reflux-related changes.

4. Explore Multidisciplinary Management: Given the complexity of your symptoms, working with specialists, including an allergist for MCAS and a gastroenterologist for reflux management, may provide additional insights and treatment options.

5. Hydration and Humidification: Staying well-hydrated and using a humidifier while you sleep may help alleviate throat irritation, particularly if it's linked to dryness.

6. Continued Monitoring for Infection: If symptoms worsen again, particularly if nasal congestion, fever, or increased swelling occurs, you might consider a bacterial culture or further testing in an ENT setting to rule out ongoing infections.

7. Follow-Up on Blood Tests: Ensure that your forthcoming blood tests sufficiently evaluate your immune system and any other specific concerns you may have. Share these results with your healthcare providers for further context.

If specific red flags arise, such as difficulty swallowing, unexplained weight loss, or increasing neck swelling, it’s important to seek prompt medical attention.

Your journey has been challenging, and I commend your resilience. If you have any more questions or need further clarification, feel free to ask.