Having respiratory issues , nose blocking, tonsillitis, adenoidal inflammation - #15532
Patient Summary for Medical Consultation Patient: Noor Main Concern: Recurrent throat blockage, chronic sinus issues, and recent white spot on tonsils. 1. History of Present Illness Chronic Issues • I have had tonsils since childhood, never caused major problems before. • Since last winter (1 year ago), I developed: • Chronic sinusitis • Adenoidal inflammation • Occasional night-time breathing difficulty • Dry throat especially during winter nights • In summer (humidity environment), symptoms significantly improved. Recent Episode (Last 2 weeks) • 14 days ago I had a viral infection (common in family/community). • After recovering from viral infection: • My throat still feels dry at night • Breathing feels blocked when lying down • Voice becomes low, I can't speak easily due to nose/throat blockage • Mucus continues production throughout the year • No fever. • No significant pain while swallowing, but slight effort is needed. • Mouth gets dry during sleep (in winter). 2. Tonsils and Pus • Today I noticed: • One small white dot of pus on the tonsil • No large patches • Tonsils are swollen looks red • Breath does not smell so much bad but feels slightly nausea since yesterday • I am feeling slight nausea since yesterday. (I ate fish yesterday and did vomit 3 times may be due to smell of fish or mucus production) 3. Previous Severe Episode • Last year 2024 November I had a very severe throat infection (no antibiotics taken). • I could feel a tear/wound inside the throat, and nose bleeding also occurred. (May be I am the only person in this world who can touch the throat by tongue, so when I touched at that time something teardown and I got slight bleeding from nose too) • Since that illness, I am having repeated: • Sinus congestion • Adenoid swelling • Night breathing difficulty 4. Treatments Tried I have been doing regularly: • Warm saline gargles (salt + turmeric) • Nasal saline rinses (wuzu style) • Steam inhalation • These give temporary relief for 15–20 minutes, but symptoms return at night. 5. Previous Online Doctor Opinion A doctor reviewed my throat picture and said: • Most likely GERD + chronic sinusitis • Not an active infection • Treatment suggested: • Antacids / PPIs • Nasal decongestant spray • Diet precautions • 2-month follow-up 6. Current Questions for Physician I would like your medical guidance on the following: • Considering my 1-year chronic throat + sinus issue, and now fresh small white pustule, which antibiotic is more appropriate? • Cefixime 400 mg once daily • OR Augmentin (Amoxicillin–Clavulanate) lower-dose option • Is this recent white spot a sign of acute bacterial flare-up on top of my chronic condition? • Should I also continue: • Fluticasone nasal spray (once daily) • Daily saline rinse • Could my symptoms still be due to GERD + chronic sinusitis, or is this now mainly a tonsillar infection? • Is surgery (tonsils/adenoids) needed if medical treatment works, or can I manage medically? I am sharing video links embedded in pdf and photos for your evaluation. Note: "I just had my first episode of watery loose motion a short while ago. I also felt dizzy while offering prayer." (I am allergic to metronedazole group medicines)
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Doctors’ responses
Hello Noor By going through your history and evaluation of your health status I must say that nothing to Worry you will get fine soon. I am suggesting you following treatment as follows - Rx - Cap Pantop dsr - daily before breakfast Tab Amoxicillin 625 mg - once a day for 7 days Mouth gargle - Chlorhexidine - 2 time a day Tab Montac lc - at night for 7 days Tab Acelofenac+ pcm - one at morning one at night for 7 days Nasal drop - Xylometazoline -2-2 drops for 7 days
Take these following medicine and avoid intake of cold things and wear mask when goes out .
Thank you
Your single small white spot on the tonsil after a viral illness is most likely a mild tonsil flare-up or sinus-related irritation, not a serious infection. If symptoms increase, Augmentin is generally more suitable than Cefixime, but your main issues still fit chronic sinusitis + GERD, so continue saline rinse and fluticasone. Please consult an ENT specialist to confirm the cause, adjust medications, and decide if antibiotics are actually needed.
Hello dear See after careful evaluation it seems you are having combination of nasal and gastric issues. You have already taken best medication and it seems reoccurrence due to incomplete infection removal or decreased resistance. Iam suggesting some tests. Please get them done for confirmation Antibiotic sensibility testing Viral culture Cbc Esr Fungal culture Allergy test( blood allergy) Skin prick test Lung USG if recommended by ent surgeon I request you to please share result with ent surgeon/ pulmonologist in person for better clarity Please donot start any medication without consulting the concerned physician Hopefully you recover soon Regards
Hello,
Your symptoms most likely come from: Chronic sinusitis plus adenoid swelling Post-viral irritation Possible GERD A mild flare of tonsil inflammation
The single white spot does NOT necessarily mean a serious bacterial infection.
🛑Antibiotics? You may not need antibiotics right now unless symptoms worsen (fever, more white spots, severe throat pain). Augmentin is usually better for sinus/tonsil infections, but it can worsen your current loose motion. Cefixime is milder but not first choice for tonsillitis. Should decide after examining.
🛑Continue: Fluticasone nasal spray daily Saline rinse 1–2 times/day Steam inhalation Warm salt-water gargles
🛑GERD could still be contributing
Night symptoms, dryness, and post-nasal drip fit GERD. A PPI trial may help discuss with your concerned doctor.
🛑Loose motion + dizziness:
Drink ORS immediately. Seek care if dizziness continues or diarrhea worsens.
🛑Surgery not needed now
Only if symptoms remain after 3 months of correct medical treatment.
Okay I trust this answers your concern Feel free to talk Thank you
Hello Noor, thank you for sharing your concern. According to what you explained you probably have a post nasal drip due to your sinusitis and adenoid issues. The single white dot on your tonsil is usually a small tonsillar exudate from irritation or mild bacterial superinfection after a viral infection. This does NOT always mean a severe tonsillitis. This looks like a flare-up over a chronic problem, not a new major infection. Here are my answers to your questions-
1. Augmentin is better and you should take it as you might have superinfection. And yes, the spot is an acute flare up on your chronic condition. Continue Fluticasone nasal spray and daily saline rinse. Your symptoms might also be due to GERD as well. I’ll prescribe you a medicine for that for now. Confirmation of GERD will be done by a physical examination by a doctor. Taking this medicine will be harmless and do only benefit. So, no issues. No surgery (tonsil/adenoid) is needed unless: 4–5 severe infections per year.Persistent nasal blockage not responding to treatment. Sleep apnea/snoring with choking. Recurrent pus on tonsils with fever. Sinus symptoms >3–4 months despite regular sprays + saline rinse. Your case is manageable medically. I am also adding medicines for your loose stool in the prescription below.
2. Here is the final prescription - - Tab. Augmentin 625ng twice daily × 5 days. - Cap. Pantoprazole 40mg before breakfast × 14 days (GERD) - Continue Fluticasone Nasal Spray - Tab. Cetirizine 10mg at night × 5 days (if nose is very blocked) - Tab. Lactic Acid Bacillus twice a day × 5 days - ORS.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Med
Based on the detailed symptoms you’ve described, it seems you might be dealing with a combination of chronic sinusitis, possible GERD, and an acute flare-up of tonsillitis. The recent viral infection likely exacerbated your existing issues. As for antibiotic selection for the white spot on your tonsils, a small white dot could suggest a bacterial component, possibly a secondary bacterial infection following the recent viral illness. In deciding between cefixime and Augmentin (amoxicillin-clavulanate), Augmentin is often preferred for bacterial tonsillitis due to its broader spectrum against common throat pathogens. However, it’s important to consult with your doctor for a prescription based on your full clinical picture and any specific allergies or contraindications you might have.
Continuing the use of a fluticasone nasal spray could help reduce inflammation and nasal congestion, while daily saline rinses are beneficial in managing chronic sinus issues. Regarding GERD, monitoring your symptoms and continuing with PPIs can help determine if it’s contributing to your symptoms. The symptoms you’re experiencing, including night-time breathing difficulties, could indeed be related to GERD, especially if there’s no significant pain swallowing.
Surgery is generally considered if conservative management fails after thoroughly trying medical treatments, or if complications like repeated severe infections occur. Given the chronic nature and multiple factors, surgery might be premature without further evaluation. Since you mentioned dizziness and loose motion, these symptoms are concerning and could be related to dehydration or electrolyte imbalance from your vomiting episode. It’d be wise to seek an in-person evaluation to exclude other potential causes and to ensure your current treatment plan addresses all your symptoms comprehensively. Meanwhile, maintain hydration and consider a light diet. Avoiding known allergens and irritants, alongside medical guidance, remains crucial.
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