Hypertrophy of tonsils shown on CT scan...but I don't have tonsils

@mrowland08. I happened to see this while replying to someone. Here is what it says online about your condition:
It is understandable that these results feel confusing, especially since you had your tonsils and adenoids removed decades ago.

The two main findings on your CT scan essentially mean that your body is acting as if it is fighting something, even if your bloodwork isn't showing a typical infection. Here is a breakdown of what that report is saying in plain English:

1. "Scattered sub centimeter cervical lymph nodes... reactive in etiology"
Sub centimeter: The lymph nodes are smaller than 1 centimeter. Doctors generally consider nodes "suspicious" when they are larger than 1.5 or 2 centimeters.

Reactive: This is a reassuring term. it means the nodes are "reacting" to something—like a minor virus, local inflammation, or even a dental issue—rather than being enlarged due to a growth or malignancy.

Etiology: This just means "cause." So, the cause is likely a normal immune reaction.

2. "Diffuse tonsillar hypertrophy without obvious mass lesion"
This is likely the part that surprised you most since you had your tonsils out in 1998.

Tonsillar Hypertrophy: This means the tonsil tissue is enlarged.

How is this possible? When tonsils (which are lymphoid tissue) are removed, it is common for small amounts of "base" tissue to remain. Over time, this "lingual tonsil" or residual tissue can grow back or swell. This is called Compensatory Hypertrophy. Since your adenoids and palatine tonsils are gone, the remaining lymphoid tissue in your throat (the "Waldeyer's Ring") sometimes works overtime and gets bigger to compensate.

No obvious mass lesion: This is good news. It means the radiologist did not see a tumor or a specific growth; the tissue just looks "diffuse" (evenly enlarged).

Why do you feel like something is "stuck"?
The sensation of something stuck in the throat is called globus sensation. In your case, it is likely caused by that "tonsillar hypertrophy." Because that tissue is enlarged, it can physically press against the back of your throat or interfere with the way the "flaps" we discussed earlier move, creating that annoying feeling that you need to swallow something away.

Next Steps: "Direct Visualization"
The radiologist recommended "direct visualization." This is the standard next step for a 47-year-old with these symptoms.

What it is: You will likely see an ENT (Ear, Nose, and Throat doctor).

The Scope: They will perform a "laryngoscopy" or "nasopharyngoscopy." They use a tiny, flexible camera (about the size of a spaghetti noodle) to look through your nose and down your throat.

The Goal: Because CT scans are just 2D pictures, the doctor needs to actually see the color and texture of the tissue to confirm it is just "regrown" tonsil tissue and not something else causing the inflammation.

Has your doctor already referred you to an ENT, or are you still waiting to discuss these results with your primary care physician?

@thomason Thank you so much for the reply! I truly appreciate it! I have seen an ENT and have been scoped. He said my lingual tonsils are swollen. And my palentine tonsil tissue has grown back just a little. I was put on prednisone to help the inflammation. After that they swelled again. Went on a 2nd round of prednisone and that ended yesterday. So here' my thinking... all of this started at the tail end of a respiratory illness. I had ear pain and a swollen neck lymphnode and that is what started all of this. The ENT suggested possible LPR as a cause for all of this, but I'm leaning more towards the illness as a cause of this. Any thoughts?

A Message for @mrowland08: Trust Your Instincts
Hi! Here are my thoughts—right or wrong—but I admit I am biased when it comes to "acid reflux." I’m skeptical because doctors used that diagnosis to explain away my progressing ear and throat pain, and it was just one of many wrong guesses.

The Cycle of Misdiagnosis
Before I got the truth, I was told it was:
Eagles Syndrome (even after a CAT scan!)
Arthritis
Infection
Tonsillitis
The "Grand Finale": I was eventually referred to a psychiatrist, implying I was simply imagining the unbearable pain.

A Decision Based on Faith
The ENT who diagnosed me with arthritis scheduled me for a tonsillectomy. Regardless of your beliefs, I personally believe in God, and my husband and I prayed deeply about this. An "unheard voice" directed me to cancel that surgery.

Looking back, I can't imagine what that surgery would have done to me. As it turns out, there was a cancerous tumor growing below my tonsils. Had I gone through with it, the surgeon would have been removing healthy tissue while the real threat remained. I later found out from the ENT who finally discovered the cancer that my tonsils were actually non-existent due to atrophy.

Once again, I will scream this from the highest rooftops: Please get several opinions. If I had not listened to that still, small voice to keep going, I would not be here. The pain was so bad toward the end, I could not swallow or sleep. Thank you, God. My husband and I try to pray each night with the TV off and Bible open. We will pray for you to find your answer. Talking to God will lead you to the answer. It took several different ENTs before finding the one that saw the tumor immediately during the scoping--the same scoping as all the others--go figure!

Have you considered purchasing a small red-light wand and aiming it in your back of throat area for the recommended time? It is a proven method to reduce tissue inflammation.

Even though AI is wrong sometimes, I plugged in your symptoms and here is what Gemini AI had to "say!"

This sounds incredibly frustrating for your friend. It is very common for patients to feel like they are "ping-ponging" between different diagnoses when a simple illness turns into a long-term problem.

The short answer is: It’s likely both. The respiratory illness likely caused the initial swelling, but LPR (Silent Reflux) may be the reason it won't go away.

Here is a breakdown of why this is happening and why the Prednisone isn't quite finishing the job:

1. The "Post-Viral" Lingual Swelling
Your friend is right to lean toward the illness as the cause. Lingual tonsils (at the very base of the tongue) and the remaining palatine tissue are part of Waldeyer’s Ring, the body’s first line of defense.

The "Memory" Effect: After a bad respiratory infection, this lymphoid tissue can become "hypertrophic" (overly enlarged). It essentially gets stuck in "defense mode" even after the virus is gone.

Compensatory Growth: Since your friend has had their palatine tonsils removed (or mostly removed), the lingual tonsils often grow larger to "compensate" for the missing tissue. When an illness hits, they swell even more than normal.

2. The "Prednisone Bounce"
Prednisone is a powerful "reset button" for inflammation. However, it often only treats the symptom, not the trigger.

If the swelling returns the moment the steroids stop, it means the underlying irritant is still there.

If the virus is gone, the body is either still overreacting (chronic inflammation) or a new irritant has moved in to keep the tonsils angry.

3. Why the ENT is Suspecting LPR
This is where the "1860 vs 2026" perspective is helpful. In the past, we just called this a "lingering cold." Today, we know that illness can trigger LPR (Silent Reflux).

The Cycle: A respiratory illness causes coughing and throat clearing. This physical "pumping" action can actually force stomach acid and enzymes (pepsin) up into the throat.

The "Irritation Loop": The throat tissue is already raw from the virus. Even a tiny amount of "silent" acid (which you can't feel as heartburn) is enough to keep those lingual tonsils swollen and prevent them from healing.

The ENT's Logic: They often suggest LPR treatment because if you "dry up" the acid, the tonsils finally have the quiet environment they need to shrink back down.

What your friend might want to ask the ENT:

Since they are leaning away from the LPR theory, they could ask these specific questions to see if there's another path:

"Could this be a persistent 'occult' (hidden) infection?" Sometimes a low-grade bacterial infection hitches a ride on a viral one and needs a specific antibiotic, not just a steroid.

"Could it be Mononucleosis?" Mono is famous for causing "Prednisone-resistant" tonsil swelling and neck lymph node pain, even in adults.

"Is it worth a 'Reflux Trial'?" Even if they don't believe it's LPR, taking a PPI (like Prilosec) or an H2 blocker (like Pepcid) for two weeks is a low-risk way to see if the swelling finally stays down.

I am sorry this is so long. In the next column are some "old school" methods to help with throat swelling. Best wishes to you.

@mrowland08 Here are some methods to reduce swelling besides Red-Light Therapy:
There are several "old-school" and "new-school" approaches that can help break the cycle of inflammation.

Since the ENT mentioned LPR (Silent Reflux), these ideas focus on reducing both the post-viral irritation and the acid-related triggers.

1. The "Mechanical" Soothers
Sometimes the tonsils stay swollen simply because the throat is too dry or irritated by the air we breathe.

Warm Saltwater Gargles: This is the #1 doctor-recommended natural remedy. The salt literally "pulls" excess fluid out of the swollen tonsillar tissue through osmosis. Use 1/2 teaspoon of salt in 8 ounces of warm water several times a day.

Humidifier at Night: Dry air (especially in winter) acts like sandpaper on sensitive throat tissue. Keeping the air moist helps the lingual tonsils stay lubricated so they can finally shrink.

Voice Rest: This sounds simple, but lingual tonsils sit at the base of the tongue. Every time we talk or whisper, that tongue movement "rubs" against the swollen tissue. Giving the voice a total rest for 48 hours can sometimes break the inflammatory cycle.

2. Natural Anti-Inflammatories

Turmeric "Golden Milk": Turmeric contains curcumin, a powerful natural anti-inflammatory. Mixing it with warm milk (or a dairy-free alternative) is a gentle way to coat the throat.

Licorice Root Tea: Licorice root is famous for its "demulcent" properties, meaning it creates a protective film over the throat. It can be very effective at soothing the "lump" feeling caused by swollen lingual tonsils.

Slippery Elm: Available as a tea or lozenge, this is another natural "coater" that protects the throat from irritants like acid or lingering viral particles.

3. Addressing the "Silent Reflux" (LPR) Suspect
The "Three-Hour Rule": Do not eat anything within 30 minutes of lying down. This prevents stomach enzymes from traveling up to the throat while they sleep.

Alkaline Water: Drinking water with a pH of 8.8 or higher can actually deactivate pepsin (the stomach enzyme) that gets stuck to the throat and causes lingual tonsil swelling.

Avoid "The Big 4": For just a week, try cutting out caffeine, chocolate, mint, and citrus. These all relax the valve that keeps stomach contents out of the throat.

4. Over-the-Counter Options
NSAIDs (Ibuprofen/Naproxen): Unlike Prednisone (a steroid), NSAIDs work on a different inflammatory pathway. Taking a steady (not "as needed") dose of Ibuprofen for 3–5 days (with food!) can sometimes provide the "low-level" anti-inflammatory support needed after the Prednisone is gone.

Throat Sprays: Look for sprays containing phenol or benzocaine to numb the area but also check for zinc-infused rinses which can help with tissue healing.

Since you had a respiratory illness right before this, the lymphatic system might just be "congested." Try gentle lymphatic neck massage (stroking downward from behind the ears toward the collarbone) to help the fluid drain away from those swollen nodes and tonsils. This may GREATLY help you. Do you have an electric neck massager? That machine helped me so much, and maybe a good neck massage will move all that lymph fluid down. They are numerous on eBay. I attached a photo of a vintage neck massager and a red-light wand, if you are interested.