key: cord-0970150-pv4k6q3n
authors: Yoshida, Hirofumi; Kanamori, Maki; Sakemi, Hideta
title: Sore throat with normal oropharyngeal examination
date: 2020-07-28
journal: Am J Med
DOI: 10.1016/j.amjmed.2020.06.034
sha: c1341d5b28ada9fd0a7d5f9848c25e6a9493fd15
doc_id: 970150
cord_uid: pv4k6q3n

nan

To the Editor:

A 30-year-old healthy female presented with a two-day history of fever and severe throat pain. She reported dysphagia and odynophagia but denied dyspnea, trismus, or sialorrhea. Amoxicillin and clarithromycin had been prescribed by her primary physician but did not relieve her symptoms. Her school-age children had complained of similar symptoms, which resolved spontaneously several days before her presentation.

Her past medical history included palatine tonsillectomy nine years previously.

Physical examination revealed vital signs within normal ranges except for a body temperature of 39.6°C. Her voice was muffled, but the airway was patent without stridor. Her oropharynx appeared normal but the anterior cervical lymph nodes were tender to palpation. Acute lingual tonsillitis is an uncommon diagnosis for pharyngitis. However, given that some degree of inflammation will occur concurrently with other pharyngeal infections, 6 it has been under-reported probably due to the fact that this tissue can be visualized only with laryngeal mirror or laryngoscope, 1 making it difficult to evaluate. The condition should therefore be suspected in patients with a history of palatine tonsillectomy or adenoidectomy and negative oropharyngeal examinations despite the presence of a sore throat, odynophagia, or tenderness at the level of the hyoid bone. [2] [3] [4] [5] 7 The causative organisms of lingual tonsillitis are similar to those of other pharyngitis. Among bacterial etiologies, Streptococcus pyogenes is the most common agent. 6 Viral tonsillar disorder is treated with analgesics, while streptococcal tonsillitis must be treated with antibiotics. Lingual tonsillectomy may be considered for frequent recurrence. 3 However, surgery must always follow avoidance of aggravating factors such as dust, tobacco, alcohol and chemical compounds, which may reduce recurrences. 3, 4 

Lingual tonsillitis: an unusual presentation of mononucleosis

Lingual tonsils; a new evaluation

Lingual tonsillitis

The lingual tonsil. A neglected symptomatic structure?

Lingual tonsillitis

Lingual tonsillitis: an uncommon cause of airway compromise responsive to epinephrine

Acute lingual tonsillitis

Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

The irregular mass is seen at the base of the tongue.