Chronic hardened tonsil (?)

Hello.

I am a 30 yr old healthy female.  As a child I had numerous episodes of strep throat that finally subsided around the age of 15.  My tonsils were never removed.  The last 4 years I have felt a pea size, hard lump on the right side of my neck that doesn't move.  It has ocassionaly gotten sore and slightly enlarged and then resumed to it's pea size shape.  Over the years I have asked my family dr. about it a couple of times, but he can't feel it and says that it is probably a hardened lymph node and not to worry.  

I saw an Ear, Nose and Throat Specialist about 2 years ago for ear pain and drainage - he told me I kept my ears too clean.   I asked him about the hardened lump and he laughed (as he tried to feel it with rubber gloves (?) and said it was nothing and said "but we can biopsy it if you want to."  Of course, since he thought it was funny, I said, "no, that's okay."  I still ocassionaly have ear pain with some drainage (worse in cold weather). So, I am not sure if the lump is related to my ears.  I have not really noticed that it enlarges when my ears act up.

Today I have finally discovered that the hard lump must be my tonsil.  I have had a sore throat-complete with blisters, for a couple days and have noticed that the lump has probably enlarged to twice it's normal size and is tender to touch.  This infection is more than likely viral since my toddler was seen a few days ago for the same symptoms - she tested negative for strep.

Could this be my tonsil?  If so, what would cause it to be hard?  Should I request an ultrasound?  I do not have difficulty swallowing or breathing.  

I would really appreciate any insite that you may have to share.  I realize that you can not give me a diagnosis, but I am hoping you can tell what you think it could be or what to do next, if nothing at all.  It does worry me to some extent.  My doctor obviously doesn't think it is anything to worry about, as he thinks it is a lymph node.  Now, if it IS my tonsil, would that make a difference?  You know, the first thing you think of when you feel a lump is cancer!! Although I tell myself surely I would have felt sick over the last 4 years if it was cancer, or the lump would have gotten bigger?!?

I sincerely thank you for you time!

[Kevin Pho, MD]

Hello - thanks for asking your question.

As you have mentioned, it is difficult to tell what it is without examining you.  There are several considerations - including an enlarged lymph node or thyroid mass (depending on where it is).

Typically lymph nodes in the neck enlarge with acute infection (i.e. viral infections or strep throat) and decrease as the infections subsides.  If it has persisted and hardened (as you have described), then a lymph node biopsy may be considered to make sure it is not cancerous.

Lymph nodes have many textures, ranging from soft and movable to hard and fixed.  

Depending on where this lump is, you may also want to consider a thyroid mass.  If that is suspected, an ultrasound can be performed to determine if it a thyroid cyst, or something more concerning like cancer.  

You may want to discuss these options with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

the one thing it's not, if you are feeling it by touching your neck, is a tonsil. A round moveable sometimes tender lump in your neck could be anything from a skin cyst, to a lymph node, to a benign (harmless) tumor of some sort. What you describe is highly unlikely to be serious; but the only way to know is to have it looked at again. If it worries you enough, it might make sense to have it removed, which ought to be a simple office procedure if it's not deep in the neck.