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Tonsils, Mono, and Chronic Fatigue

Posted Dec 02 2009 6:11am 2 Comments
As I was taking out enormous tonsils from a young child yesterday, I was reminded of a young female college student that I treated many years ago who came to see me with severe tonsillitis. She had severe throat pain, difficulty swallowing, diffuse and tender swollen neck glands, and couldn’t sleep at all. Due to the severity of her "infection," I prescribed a course of oral antibiotics, as well as a short course of anti-inflammatory steroids, to get rid of the swelling in her throat. The next day, she reported that she was feeling dramatically better and sleeping better as well. When I saw her three days later, her tonsils were not touching in the midline anymore, and her neck glands were much smaller. Upon further questioning, she did state that she’s always had large tonsils, but they became much bigger with this infection.


You may think that the antibiotics helped to fight the infection, but typically, it takes 2-3 days for antibiotics to reach significant concentrations to begin to work. What actually helped her feel better, faster, was the steroids, which begins to work within a few hours.


In retrospect, she probably had mono. But because it resolved rather quickly, it would be classified as a routine throat infection that resolved with antibiotics. However, since mononucleosis is a viral infection (the Epstein-Barr virus), antibiotics won’t really make a difference. Had she not been given oral steroids, her symptoms probably would have continued for weeks to months, despite being given multiple rounds of antibiotics. Most of these patients eventually start to feel better after some time, but some never feel better. This is the classic mono condition that you hear about. Some are later diagnosed with chronic fatigue syndrome.


The reason for these persistent symptoms is that the Epstein-Barr virus preferentially infects the lymphoid tissues in your body. Since your tonsils are lymphoid tissues, they will swell up. Having larger tonsils all of a sudden will narrow your upper airway, causing frequent obstructions and arousals when in deep sleep due to muscle relaxation.


Frequent obstructions also causes stomach juices to be suctioned into the throat, which causes more swelling and inflammation of the tonsils, leading to a vicious cycle.


You may be thinking that it’s a good idea to take out your large tonsils, since it’ll prevent this situation from happening the next time you get a cold. For the most part, it should help, but don’t think of it as a cure. Studies performed in children who undergo tonsillectomies showed that only about 2/3 improve significantly. Many of these non-responders will go on to have obstructive sleep apnea later in life. Even the "responders" will have a slightly increased risk of obstructive sleep apnea, since their jaw structures are more narrowed, which lead to enlarged tonsils.


Do you have large tonsils and have severe or recurrent throat problems every time you get a cold? If so, please enter your experiences below in the comments box.

Comments (2)
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I have had a swollen right tonsil for years and suffer recurrent throat problems, expecially when I have a cold. My glands also seem constantly enlarged in my neck. I was diagnosed with post-viral fatigue earlier last year as I have been constantly fatigued for a year now, even though the fatigue onsetted many weeks after the virus.

I have also had a stiff kneck that has gone along with the fatigue and a feeling of pressure in my ears for many months. I have also had tight-chested breathing spells and stomach and chest pain, which may be unrelated.

Blood, chest x-ray, and urine tests have all been clear, as has ECGs. My GP has refused to send me for an MRI or CAT scan, and it has not been suggested to see an ENT specialist, even though my quality of life has significantly deteriorated.

I was diagnosed at 16 with mono and nearly died from it. I actually spit out my tonsils. I am told that what I now suffer from is Still's Disease and I am not convinced. I also match CFS symptoms. I was told I had sleep apnea and then 3 years later told that I don't. However was tested for COPD which was negative as I do not get enough oxygen to my brain. I also have fibromyalgia.  I am only 45 and have suffered for years from monthly cycles of fevers, joint pain that is totally dibilitating during a flare. I also have fevers off and on constantly and I do get a rash that hurts, burns and itches.

My 13 year old daugher has the antiboties for mono and also currently has mono and has had it for over a year now. She feels so bad she can't function at times. She also runs a fever off and on all of the time.

I hope I didn't pass something on to her but we are both so sick and tired of being sick and tired. I have applied for diablility 9 times and can't get it. I would rather go to sleep and never wake up than to deal with this and unfortunately my daughter feels the same way. I would never tell her that I feel that way but she has even said it to me. This is so awful and to watch your child suffer is terrifying. I just wish we new what is really going on. We hurt all of the time and exhaust with little effort. Life is just so pitiful for us and no one seems to listen or are able to help.  I was told that she also has fibromyalgia but they didn't want to call it that because of insurance.  Where can we get help to find out what kind of freaks we really are and could I have possibly passed something on to her.  


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