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One Tonsil Bigger Than the Other in a Child? When to Check | London & Essex ENT

  Why Is One Tonsil Bigger Than the Other in My Child? A Parent’s Guide You ask your child to open their mouth because they have complained of a sore throat. Then you notice something unexpected: One tonsil looks much bigger than the other. It is an understandably worrying discovery. Parents may immediately wonder whether the tonsil is infected, whether it should be removed—or whether an uneven tonsil can indicate something serious. The reassuring message is that tonsil asymmetry in children is often benign . Tonsils are not perfectly symmetrical structures. They sit in spaces on either side of the throat called the tonsillar fossae, and differences in the depth and shape of these spaces can make one tonsil appear larger even when their actual volumes are quite similar. A UK evidence-based review published in the British Journal of General Practice in 2024 notes that most apparent unilateral tonsillar enlargement is associated with benign explanations such as anatomical v...

Swallowing Difficulty (Dysphagia): Causes, Warning Signs and When to See an ENT Specialist

 

Swallowing Difficulty (Dysphagia): What Causes It and When Should You Be Concerned?

Most people swallow hundreds of times every day without noticing. When swallowing becomes uncomfortable, difficult or feels abnormal, it can quickly affect eating, drinking and quality of life.

Some patients describe food “sticking” in the throat, while others notice coughing during meals, discomfort swallowing tablets or a persistent sensation of tightness in the throat.

The medical term for swallowing difficulty is dysphagia.

Swallowing problems can range from mild irritation to more significant conditions requiring specialist investigation. This article explains common causes of dysphagia, symptoms to look out for and when to seek ENT assessment.

What is dysphagia?

Dysphagia means difficulty swallowing.

It may involve problems with:

  • Swallowing solids
  • Swallowing liquids
  • Initiating a swallow
  • Sensation of food sticking
  • Pain during swallowing
  • Coughing or choking while eating

Symptoms may occur occasionally or worsen over time.

What does swallowing normally involve?

Swallowing is a complex process involving the:

  • Mouth
  • Tongue
  • Throat muscles
  • Voice box (larynx)
  • Food pipe (oesophagus)

These structures must work together in a coordinated way to move food safely from the mouth into the stomach while protecting the airway.

Problems affecting any stage of this process can lead to dysphagia.

Common symptoms of swallowing difficulty

Patients may describe:

  • Food sticking in the throat
  • Difficulty swallowing tablets
  • Coughing during meals
  • Needing repeated swallows
  • Pain when swallowing
  • Weight loss
  • Avoiding certain foods
  • Sensation of a lump in the throat
  • Regurgitation of food
  • Voice changes after eating

Some people also develop recurrent throat clearing or chronic cough.

Common causes of dysphagia

1. Laryngopharyngeal reflux (silent reflux)

Reflux can irritate the throat and voice box, leading to inflammation and discomfort during swallowing.

Symptoms may include:

  • Globus sensation
  • Throat clearing
  • Hoarse voice
  • Chronic cough
  • Burning throat discomfort
  • Bitter taste or reflux symptoms

Reflux-related irritation may fluctuate and often worsens after meals or when lying flat.

2. Globus sensation and throat muscle tension

Some patients feel a persistent “lump” in the throat despite swallowing normally.

This is called globus sensation.

It may be associated with:

  • Reflux
  • Stress or anxiety
  • Muscle tension
  • Chronic throat irritation
  • Frequent throat clearing

Although usually benign, persistent symptoms should still be assessed carefully.

3. Inflammation or infection

Conditions affecting the throat or tonsils can temporarily make swallowing painful.

Examples include:

  • Tonsillitis
  • Viral throat infections
  • Pharyngitis
  • Ulcers or inflammation

Most infectious causes improve with time, but persistent symptoms may require further assessment.

4. Structural narrowing or obstruction

Occasionally, narrowing within the throat or oesophagus can cause food to stick.

Symptoms may gradually worsen over time and may initially affect solid foods before liquids.

Investigation is particularly important if symptoms are progressive.

5. Neurological or muscle-related conditions

Swallowing can also be affected by conditions involving the nerves or muscles controlling the throat.

These may lead to:

  • Choking episodes
  • Coughing while eating
  • Difficulty coordinating swallowing
  • Aspiration (food entering the airway)

Some patients may require multidisciplinary assessment.

Could swallowing problems affect the airway?

Yes. Some patients with dysphagia may accidentally inhale food or fluids into the airway.

This can lead to:

  • Coughing during meals
  • Chest infections
  • Voice changes after swallowing
  • Breathlessness during eating

Persistent choking or aspiration symptoms should not be ignored.

When should you see an ENT specialist?

You should seek ENT assessment if you have:

  • Persistent swallowing difficulty
  • Food sticking in the throat
  • Pain when swallowing
  • Ongoing globus sensation
  • Hoarse voice
  • Chronic throat clearing
  • Recurrent choking episodes
  • Weight loss
  • Smoking history with throat symptoms
  • Symptoms lasting several weeks

Swallowing symptoms should always be assessed carefully if they are worsening or associated with weight loss.

How is dysphagia investigated?

Detailed history

Assessment includes discussion of:

  • Type of swallowing difficulty
  • Solids versus liquids
  • Duration of symptoms
  • Weight changes
  • Reflux symptoms
  • Smoking history
  • Voice changes
  • Coughing or choking episodes

Examination of the throat and neck

The mouth, throat and neck are examined carefully for swelling, inflammation or abnormalities.

Flexible nasendoscopy

A thin flexible camera may be passed gently through the nose to examine the throat and voice box.

This allows assessment of:

  • Vocal cords
  • Swallowing structures
  • Signs of reflux
  • Pooling of saliva or mucus
  • Structural abnormalities

The procedure is usually quick and well-tolerated.

Additional tests

Some patients may require further investigations, such as:

  • Swallowing studies
  • Imaging scans
  • Barium swallow tests
  • Endoscopy of the oesophagus
  • Speech and language therapy assessment

The choice of tests depends on symptoms and examination findings.

Treatment options for swallowing difficulty

Treatment depends on the underlying cause.

Reflux management

This may include:

  • Avoiding late-night meals
  • Reducing caffeine and alcohol
  • Weight management where appropriate
  • Acid-reducing medication
  • Dietary modification

Swallowing therapy

Speech and language therapists can help improve swallowing coordination and safety in selected patients.

Voice and throat care

Patients may benefit from:

  • Good hydration
  • Reducing throat clearing
  • Managing allergies or nasal symptoms
  • Voice therapy if muscle tension contributes

Surgical or procedural treatment

In selected cases, procedures may be needed to address structural narrowing or other abnormalities.

Management is individualised depending on the diagnosis.

Safety-netting: when to seek urgent medical attention

Seek urgent medical help if you develop:

  • Difficulty breathing
  • Inability to swallow saliva
  • Sudden complete blockage when eating
  • Severe choking episodes
  • Coughing up blood
  • Rapidly worsening swallowing difficulty
  • Significant unexplained weight loss
  • Persistent neck swelling
  • Severe pain with swallowing

For severe breathing or choking symptoms, seek emergency medical assistance immediately.

Why choose Mr Gaurav Kumar for swallowing and throat assessment?

Mr Gaurav Kumar is a Consultant ENT Surgeon with experience in assessing:

  • Swallowing difficulty (dysphagia)
  • Globus sensation
  • Chronic throat clearing
  • Hoarse voice
  • Laryngopharyngeal reflux
  • Chronic cough
  • Voice disorders
  • Throat discomfort and swallowing concerns

Patients can access consultant-led ENT assessment in London and Essex with tailored investigation and management plans based on their symptoms and examination findings.

Book a swallowing and throat consultation in London or Essex

If you have persistent swallowing difficulty, globus sensation, throat clearing or voice changes, a specialist ENT assessment can help identify the underlying cause and guide treatment.

To arrange a consultation with Mr Gaurav Kumar, please contact the practice team or use the online booking system.

This article is for general information only and does not replace personalised medical advice. If symptoms are severe, progressive or associated with breathing difficulty, seek urgent medical care.

Call 07494914140
Book Online





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