As I was taking out enormous tonsils from a young child yesterday, I was reminded of a young female college student that I treated many years ago who came to see me with severe tonsillitis. She had severe throat pain, difficulty swallowing, diffuse and tender swollen neck glands, and couldn’t sleep at all. Due to the severity of her "infection," I prescribed a course of oral antibiotics, as well as a short course of anti-inflammatory steroids, to get rid of the swelling in her throat. The next day, she reported that she was feeling dramatically better and sleeping better as well. When I saw her three days later, her tonsils were not touching in the midline anymore, and her neck glands were much smaller. Upon further questioning, she did state that she’s always had large tonsils, but they became much bigger with this infection.
You may think that the antibiotics helped to fight the infection, but typically, it takes 2-3 days for antibiotics to reach significant concentrations to begin to work. What actually helped her feel better, faster, was the steroids, which begins to work within a few hours.
In retrospect, she probably had mono. But because it resolved rather quickly, it would be classified as a routine throat infection that resolved with antibiotics. However, since mononucleosis is a viral infection (the Epstein-Barr virus), antibiotics won’t really make a difference. Had she not been given oral steroids, her symptoms probably would have continued for weeks to months, despite being given multiple rounds of antibiotics. Most of these patients eventually start to feel better after some time, but some never feel better. This is the classic mono condition that you hear about. Some are later diagnosed with chronic fatigue syndrome.
The reason for these persistent symptoms is that the Epstein-Barr virus preferentially infects the lymphoid tissues in your body. Since your tonsils are lymphoid tissues, they will swell up. Having larger tonsils all of a sudden will narrow your upper airway, causing frequent obstructions and arousals when in deep sleep due to muscle relaxation.
Frequent obstructions also causes stomach juices to be suctioned into the throat, which causes more swelling and inflammation of the tonsils, leading to a vicious cycle.
You may be thinking that it’s a good idea to take out your large tonsils, since it’ll prevent this situation from happening the next time you get a cold. For the most part, it should help, but don’t think of it as a cure. Studies performed in children who undergo tonsillectomies showed that only about 2/3 improve significantly. Many of these non-responders will go on to have obstructive sleep apnea later in life. Even the "responders" will have a slightly increased risk of obstructive sleep apnea, since their jaw structures are more narrowed, which lead to enlarged tonsils.
Do you have large tonsils and have severe or recurrent throat problems every time you get a cold? If so, please enter your experiences below in the comments box.