Medical (ENT) Case of the day

  This is a knobbly back end of the inferior turbinate - a bone that runs from the front of the nose to the back. It's called "Mulberry" because of its appearance. This finding is associated with the symptoms of post nasal drip and catarrh. Treatment is with posterior laser turbinoplasty.

Just another picture of a sore tonsil with holes in it causing tonsil stones? NO!! This was fascinating as it was taken by me via Zoom, on a linked disposable digital endoscope that the patient used to examine herself via Zoom. 200 miles away. Groundbreaking stuff?

 This patient complained of chronic left nose blockage causing mouth breathing and snoring. Examination showed a septal deviation (left side of picture) and an enlarged left inferior turbinate (right side of picture). Steroid sprays had not helped previously. The patient opted for laser turbinoplasty under local anaesthetic as a lunchtime procedure. Septal surgery in the form of septoplasty may also be required.

  These big tonsils are causing all sorts of problems, from reccurring sore  throats, snoring and sleep apnoea to bad taste and bad breath. This man needs significant tonsil reduction to improve his airway and drastically reduce sore throats.

 This is a strange one. It looks like a tonsil stone, but it is poking through the back of the soft palate into the post nasal space. So not really that close to the tonsil. Which means some tonsil stones don't arise in the tonsils at all. That's why it's always necessary to have a good look with a high definition scope as in this case.

 Snoring and sleep apnoea are caused by blockage of the airway. Here is a picture of the back of the throat where the tonsils are so big they are virtually meeting in the middle of the throat. The whole thing is made worse by a thick and long uvula (the hanging down thing in the back of the mouth). All in all this patient has loud snoring and sleep apnoea and definitely needs intervention in the form of surgery to open up the back of the throat. This will mean laser tonsillectomy and palatoplasty, all under local anaesthetic.

  Tonsil stones, or tonsilloliths, are formed when food gets squeezed  into cracks or holes in the tonsils during the second phase of swallowing, where quite high pressure form in the back of the mouth, right next to the tonsils. This food, being organic, decays with time, and starts to taste and smell bad. The decaying process can also set up an inflammatory reaction and trigger a sore throat or tonsillitis. This picture shows a crack in the right tonsil (arrow) , zoom in and you'll see greyish round lumps inside the crack. These are tonsil stones.