It was blistery cold outside, and the strong winds shattered against our windows. Yes it was winter, and fairly close to Christmas. The office was lit up with decorations in anticipation for the holiday season, and my staff worked like little elves trying to get everyone taken care off. We were almost there. I still needed to do my Christmas shopping and was hoping to get to the stores after work. A far as the BIG Christmas dinner was concerned, my kids insisted on a complete homemade meal rather than catering this year. We came to a pact – ‘Home-Made’ – YES! – but with LOTS of help in cooking and cleaning up after dinner. Now, all I had to do was to make the grocery list; hopefully my sweet husband would do the shopping.
Things were moving along smoothly in the office when my staff informed me of a call asking if I would see a patient with a peritonsillar (throat) abscess. I hesitated for a split second but then agreed knowing this person too would want to enjoy a good meal during the holidays.
“Cecilia” arrived in the office about half an hour later.
Something struck me as odd because she did not have any of the symptoms characteristic of a peritonsillar abscess, for instance – fever, thick voice, drooling, or severe throat pain. She complained more of right ear pain (which she had suffered for months) and been diagnosed with ear infections previously. Her ears looked normal but my heart sank when I checked her throat. Yes, the right tonsil was indeed enlarged, but this was no abscess – rather it looked like a cancer. What horrible news to give a patient, especially near Christmas. I tried to break the news to her as gently as I could. She stared at me as if I were from another planet, and then burst into tears. I quickly passed her the Kleenex® box, and we sat together quietly for a few minutes. Once composed, she admitted being relieved to finally have a diagnosis for her chronic symptoms.
It has now been more than two years since that dreadful diagnosis. Cecilia has undergone successful treatment and is doing very well with no evidence of recurrent tumor noted on her recent follow up. I hope and pray that she will continue to enjoy all the holidays with her family.
Ear pain is very common but does not always arise from the ear itself. It can be referred from various structures within the head and neck. A thorough exam is therefore crucial to determine the source of pain.
A Peritonsillar Abscess is an uncommon but very painful condition. It affects swallowing, and the affected tonsil can migrate towards the midline pushed by pus trapped behind it’s capsule. In adults, the tonsil abscess can be sometimes drained in the office, although a tonsillectomy is often recommended as this condition tends to recur. Interestingly, such patients usually have less pain after surgery, and are in good spirits because they feel so much better. If untreated the infection can spread into the airway, neck, and chest and become a very serious condition. Early recognition and treatment is therefore the key.
Written by my collaborative physician, Dr. Neeta Kohli – Dang.
Kari Kingsley, MSN, CRNP works as an otolaryngology nurse practitioner in collaboration with Dr. Neeta Kohli-Dang. Together they share nearly forty years of ENT experience. They treat dizziness, ear infections, hearing loss, nasal congestion, sinus infections, thyroid nodules, tonsillitis, neck masses, hoarseness, trouble swallowing, and a multitude of other ear nose and throat conditions. Please call 256-882-0165 to schedule an appointment with Dr. Neeta Kohli-Dang and Kari Kingsley or visit Huntsville ENT.