Hi, I am Dr. Atul kumar nimawat MS ENT.
Unilateral tonsil enlargement persisting for over 2 years, especially when accompanied by occasional pain or pricking/needle-like sensations, should be carefully evaluated to rule out both benign and potentially serious conditions.
Possible causes include:
1. Chronic Tonsillar Hypertrophy:
Sometimes, one tonsil remains persistently enlarged due to repeated infections in the past. This asymmetry can remain stable for years without necessarily indicating active disease.
2. Tonsillar Cyst or Lymphoid Hyperplasia:
Benign cysts or localized overgrowth of lymphoid tissue can cause long-standing, painless enlargement with intermittent discomfort.
3. Glossopharyngeal Neuralgia:
Sharp, needle-like pain near the tonsillar area may result from nerve irritation, especially if the pain is episodic and triggered by swallowing or talking.
4. Dental or Orofacial Referred Pain:
Sometimes, pain from nearby dental or jaw joint (TMJ) issues can be referred to the tonsillar region.
5. Post-Tonsillitis Fibrosis or Scarring:
Scarring from past infections may cause asymmetrical tonsillar appearance or a sensation of tightness or prickling.
6. Tonsillar Neoplasm (to be ruled out):
Although rare, persistent unilateral tonsillar enlargement
especially if it is hard, irregular, or increasing in size.
Next Steps
Recommended Evaluation:
Thorough ENT examination including indirect laryngoscopy
Neck palpation to check for lymph nodes
Imaging (if indicated): CT or MRI neck
FNAC or biopsy if there’s clinical suspicion
Throat swab or culture (if associated with recurrent infections)
Health Tips
Progressive increase in size
Associated symptoms: weight loss, voice change, persistent throat pain, or ulceration
Firm or fixed mass on palpation