Five smooth granite pebbles (stock)
My 27-year-old granddaughter is plagued by tonsil stones. Her consultant said her tonsils could be taken out, but that she would have to pay for it privately. What causes tonsil stones? Is there anything she can do?
Our tonsils aren’t smooth, but are covered in nooks and crannies where food, dead cells and other debris become trapped, forming hard deposits. Yellow or white in colour, these range in size, from being so small the person isn’t aware they are there, to the size of a large grape.
The largest on record, reported in 1936, measured a whopping 14½ cm.
As many as one in ten of the population has tonsil stones, or tonsilloliths. They are more common in teenagers and young adults and often occur after recurrent bouts of tonsillitis. They’re not harmful, despite their unpleasant appearance, and, if they aren’t causing any symptoms, they should be left alone.
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In some cases, however, the stones can attract bacteria, leading to bad breath, embarrassment and distress. Antibiotics do not help — despite the involvement of bacteria — and are not recommended.
Some people try to clear them away with their finger or a cotton bud, but I would advise against this, as it can damage the throat.
Instead, I suggest a daily, vigorous gargle with warm, salty water. If this is done regularly, the tonsilloliths will eventually dislodge. Continuing the gargles, in tandem with frequent brushing and flossing of the teeth (not the tonsils, I must stress), will stop the stones recurring.
Removal of the tonsils is carried out less commonly these days and the NHS usually reserves this for patients with recurrent tonsillitis.
It is not regarded as a treatment for tonsil stones, since these mostly can be treated successfully at home.
I HAVE age-related macular degeneration and wonder if laser treatment would help. A relative had it, but my consultant says it’s not an option for me and recommends a diet of eggs, leafy green vegetables and oily fish. I am 84 and awaiting cataract surgery.
Mrs J. D., London.
Senior woman’s eye (stock)
Age-related macular degeneration (AMD) is a disease that blurs central vision and makes everyday activities, such as reading and watching TV, difficult.
Caused by the death of cells in the macula, the part of the retina we use to see straight ahead, AMD is the main cause of sight loss in the UK, affecting more than 600,000 people, and is most common in those aged 65 and over.
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There are two types of AMD — dry and the more severe wet type, which is mainly treated with injections into the eye. These injected drugs, called vascular endothelial growth factor inhibitors, prevent the growth of the abnormal blood vessels that are behind this form of the condition, stop the deterioration of sight and, in some cases, even improve vision.
Laser treatment on the blood vessels can be used, but it has largely been replaced by the injections.
Your relative probably had wet AMD, however, from what you say in your longer letter, I am hopeful you have the dry type.
While there is no treatment, it progresses more slowly and causes less severe vision loss. It is linked to a build-up of waste products in the eye.
Do heed your consultant’s advice about diet. Fruit, leafy green veg, eggs, fish and nuts contain nutrients that help delay damage to the retina and so preserve sight for longer.
Cataracts are a separate condition in which the eye’s clear lens clouds over. Surgery to replace the lens is the most common operation in the UK and the success rate is high.
I hope that, after cataract surgery, you will experience a considerable degree of improvement in your eyesight, despite your AMD.
In my view . . . it’s crucial we prescribe the right antibiotics
The deaths of 12 people in Essex from a rare, invasive bacterial infection, caused by the group A streptococcus bacterium, in June should concern us all.
Most group A strep infections cause mild illnesses, such as strep throat and skin infections — but these recent cases, which mainly occurred among elderly patients in care homes, sadly proved fatal.
We must ask why. I suspect one factor is the modern failure to test before prescribing antibiotics.
The Mid Essex Clinical Commissioning Group received reports of 32 invasive Group A streptococcus infections in its area, with 12 patients dying (stock image of streptococcus)
There was a time when doctors would take a swab from a patient with a severe sore throat; people with urinary symptoms had to provide a clean catch of urine; and those with a productive cough would be asked for a specimen of sputum. These would then be sent off to a laboratory for analysis.
This meant a decision to treat with antibiotics could be based not only on symptoms, but the bacteria cultured, and the patient would be given antibiotics lethal to that particular infection. Sure, it would mean a wait to get the result — but it was only 48 hours.
This system required a follow-up phone call to the patient to advise them of the result of the analysis and, where necessary, to arrange for a correct prescription.
But now, instead, because of that ‘nuisance’ value and, no doubt, the cost, diagnosis is based on guesswork and dreaded NHS algorithms.
If an antibiotic is prescribed, it’s often the same tired old regimen of amoxicillin or trimethoprim banged out on reflex, rather than utilising the correct drug for the scientifically identified bacteria.
Is this why sepsis is on the rise in England? Cases have more than doubled in three years. Shouldn’t we be doing the best for our patients, taking a bit more time and trouble — and hang the cost?