Chronic Tonsillar Hypertrophy
Jaclyn Chasse, ND
A woman, age 38, had been seeing me for management of migraine headaches and anxiety. During the course of a visit, she expressed anxiety surrounding her son’s upcoming surgery. When I inquired about the surgery, she explained that in the last year or so, her seven-year-old’s tonsils had swollen to the point where he was having difficulty breathing. The specialist he was seeing had recommended a tonsillectomy and they had scheduled surgery for three weeks out.
I asked questions about what had been done to treat her son thus far, and learned that little had been done to find the cause of the tonsillar hypertrophy. My patient asked if I would see her son to try to alleviate the condition before the surgical procedure took place. I explained that the likelihood of complete resolution in less than three weeks was remote, but that we may began to see improvement.
Later that week, the boy came into my office with both his mother and father. He was very quiet, sat on the couch in my office and silently listened as his father gave the boy’s history. The onset of his symptoms had been 18 months prior. He began to complain of frequent sore throats, and that spring he had been diagnosed with pharyngitis multiple times by his pediatrician. His symptoms were usually the same – he would experience burning, stinging pains in his throat that were better with cold drinks, and usually worse on the right side. He normally also had ear pain concurrently, but never with any visible signs of otitis on exam. He had never tested positive for Streptococcal pharyngitis, and his pediatrician noted that his pharyngitis was likely due to recurrent viral infection. After about six months of frequent doctor’s visits, the pediatrician observed that the patient’s tonsils were hypertrophic bilaterally. He referred the patient to an ear, nose and throat (ENT) specialist at that time. The ENT noted that the boy’s tonsillar size was 4+ (grade 1-4) bilaterally and told the family it was due to seasonal allergies. He recommended tonsillectomy. After hearing the recommendation, the family had waited to follow up with the ENT specialist for almost a year, due to their aversion to surgery.
The boy’s parents informed me that during that year there was no change in the size of his tonsils. However, he had begun to have difficulty breathing, especially at night. He always breathed through his mouth, and his breathing was so loud that his parents said they could hear it from their bedroom. They described how he would wheeze at night, occasionally stop breathing and then startle and gasp for air. The patient’s pediatrician had diagnosed him with sleep apnea and prescribed a CPAP (continuous positive airway pressure) machine for use at night. There was no improvement in his breathing with the device.
His parents described their son as lethargic and difficult to get going. His brother, age nine, was very high energy, and the parents noted the difference between the two. The patient preferred to sit and read and was not very physically active. He slept nine to ten hours each night, but still wished for naps during the day. He often complained of being tired. He ate a standard American diet and noted that his favorite foods were fruit, vegetables and cheese; he was generally not very thirsty. I asked the family whether anything significant happened around the onset of his pharyngitis symptoms. After some thought, his mother remembered that the patient’s grandmother had passed away about one month before his first sore throat. They were very close and he seemed to take her death harder than anyone else in the family. This was the first time he had lost a loved one.
The patient’s medical history was not strongly significant. He had a healthy, normal childbirth without complication, had been breastfed for 18 months after birth and had no history of allergies, eczema or asthma before age five. He had a history of infrequent antibiotic use. He also had a bilateral inguinal hernia at age two, which healed without intervention. His family history showed mild seasonal allergies on his mother’s side. His paternal grandparents both had a history of epilepsy as children, and his paternal uncle died of a brain aneurism at age 18. The patient had no known drug allergies and had been taking fish oil sporadically for the last year.
At first glance, this young boy’s demeanor matched his parents’ description. He sat very quietly but attentively, spoke only when spoken to and whispered his questions to his parents. His face appeared very edematous, and he had dark, swollen circles under his eyes. His eyelids were so edematous it appeared difficult for him to keep them open. His sclera were white and conjunctiva clear bilaterally. His tympanic membranes were retracted bilaterally and injected in the left ear. His oropharynx appeared normal except for hypertrophic tonsils, 4+ on the left and 3+ on the right. His respiration was labored and loud, and he had a mild expiratory wheeze heard over the left middle lobe of the lungs. The patient’s skin was clear and without rashes or lesions.
Thoughts and Treatment
My impression: I believed that this patient’s hypertrophic tonsils were caused by allergies, either environmental or food-related, or likely both. I also found it particularly interesting that his symptoms began with the death of his grandmother. After further inquiry, I learned that his behavior also changed after her death. The patient was at first inconsolable and hysterical, and slowly became withdrawn. This was also when his symptoms of lethargy began. He had not been himself since that event.
I treated this patient first with homeopathic Ignatia 200C. He received a single sublingual dose in the office. Reviewing his case later, I thought he certainly seemed to be physically more suited to Apis (recurrent pharyngitis with burning, stinging pain, throat pain radiating to the ears, edema, inflammation around the eyes, etc.) but the strong correlation of the onset of his symptoms with the death of his grandmother, along with the physical “lump in the throat” that he experienced shortly after her death, led me to prescribe Ignatia.
We also ran a 96-food IgG food intolerance panel and began him on a simple regimen focused on managing allergic response, decreasing histamine reaction and stabilizing mast cells. This included vitamin C (500mg BID), concentrated berry extract (1tsp QD), fish oil (1000mg QD) and quercetin powder (500mg BID).
At our first follow-up one week later, the parents were thrilled with their son’s progress. They noticed that he was breathing easier and more quietly at night. He was no longer gasping for breath and was sleeping very well. The father was excited to report that it appeared his son’s tonsils had shrunk by half within three days of beginning treatment. He also noted a dramatic increase in energy (which delighted the boy’s father and somewhat overwhelmed his mother). The patient’s mother described her son as having bounding energy and being a very “busy bee.” On physical exam, the patient’s tonsils had decreased by about 25% in size, but appeared to be more erythematous. His tympanic membranes appeared normal, and the edema in his face and around his eyes had improved. They had seen the ENT the day before, and he was amazed by the progress. He agreed to postpone surgery to see if we could continue to improve the boy’s condition without surgical intervention.
It was very interesting to see the patient’s change in demeanor after just one week of treatment. I believe that improved sleep and increased oxygen to the blood may have contributed, but I was also amazed that after prescribing Ignatia, the patient’s general demeanor was more similar to that of a constitutional Apis, which had matched his physical symptoms well from the start. I gave a single sublingual dose of Apis 200C in the office and encouraged the family to continue his current treatment plan.
This patient continued to improve over the next few weeks, but still had some tonsillar hypertrophy. His IgG food intolerance panel showed a strong reaction to all dairy products. Removal of dairy from his diet, along with continuation of the previous treatment plan, resulted in complete resolution of his hypertrophic tonsillitis within two weeks. We went through a proper reintroduction and challenge six weeks later, and reintroduction of milk caused his tonsils to increase in size for four days and resolve with avoidance of dairy.
This patient has continued to do well and exhibit normal tonsillar size since his last follow-up appointment. He reports high energy levels, sleeps well and has an improved ability to breathe. He has decreased the intake of vitamin C, quercetin and concentrated berry extract, and takes this only as needed during allergy season.
This case is a great example of how finding and treating the cause of disease can easily prevent unnecessary intervention and risks associated with invasive surgical procedures.
Jaclyn Chasse, ND is a graduate of Bastyr University and is the medical director of the Northeast Center for Holistic Medicine in Bedford, New Hampshire. Her practice focuses on pediatrics, infertility and women’s health. Dr. Chasse also currently serves as vice president of the New Hampshire Association of Naturopathic Doctors (NHAND).