Monday, May 9, 2011

TONSIL (amaran: entri panjang)

Entri ni khas untuk menjawab soalan kak Ati Masrif, yang sering kali kena tonsil (tonsilitis).
Mungkin ada yang tak tahu, apa itu tonsil, di manakah ia..

Ini tonsil...dalam keadaan normal.
Tonsil ini terbentuk daripada lymph tissue, iaitu dari sistem pertahanan tubuh.
Jadi fungsi tonsil ialah merangsang sistem immuniti tubuh badan menghasilkan antibodi bila badan diserang jangkitan.

Tonsil boleh meradang(inflammation) bila terkena jangkitan, samada dari virus, atau bakteria.
Keadaan keradangan tonsil ni dipanggil sebagai tonsillitis.

Tonsillitis boleh dibahagikan kepada 3 jenis, bergantung kepada bila dan berapa lama ia berlaku:

1- Acute Tonsillitis - baru berlaku.
2- Chronic Tonsillitis - tonsillitis yang dah lama berlaku
3- Recurrent Tonsillitis - tonsillitis yang berulang ulang

Tonsillitis selalunya berlaku di kalangan kanak-kanak, boleh juga berlaku kepada orang dewasa.
Amat jarang kanak kanak 2 tahun ke bawah mendapat tonsillitis ini.

Simptom Acute Tonsillitis:
-sakit tekak, susah menelan, demam, kelenjar di leher mungkin membengkak dan sakit, letih/lesu, dan simptom halangan pernafasan (eg; berdengkur, atau tiba tiba tersedar tak boleh bernafas masa tidur, sleep apnoea).
-dalam kanak kanak, kadangkala simptom utamanya ialah mereka enggan makan, sebab tekak mereka sakit!
-acute tonsillitis berlangsung selama 3-5 hari...dan paling maximum boleh menjangkau 2 minggu.

Apa itu Recurrent Tonsillitis ?:
- Apabila anda kena acute tonsillitis 7 kali dalam setahun, atau 5 kali dalam tempoh 2 tahun berturut turut, atau 3 kali dalam setahun, untuk 3 tahun berturut turut.
-Jadinya, moral di sini ialah, SILA KIRA berapa kali anda kena acute tonsillitis. Kerapkali aku jumpa patient yang tak aware tentang ini. Kenapa perlu kira? Kerana dengan kiraan inilah aku boleh justify, ianya recurrent atau tidak..dan perlukah kes di rujuk untuk pembedahan membuang tonsil.

Chronic Tonsillitis:
-bila mengalami simptom sakit tekak yang berpanjangan, lebih dari dua minggu, sakit menelan dan mungkin juga bengkak kelenjar di leher yang berterusan.


Bagaimana aku men diagnos kes acute tonsillitis?

-Semestinya, kena tanya sejarah pesakit dulu( history). Jadi, pesakit kena lah bercerita serba sedikit tentang simptom yang di alami. Sesetengah pesakit yang dah otai (selalu sangat kena, recurrent tonsillitis) straight away masuk bilik consultation dan cakap "doc, tonsil i bengkak" ...mudah kan kerja aku? ekekeke...
Lepas dah dapat semua sejarah pesakit, kita proceed ke pemeriksaan fizikal.

Pemeriksaan fizikal standard ialah memeriksa :
-Suhu badan : demam atau tidak
-Tekanan darah
-Kemudian, melihat ke dalam mulut pesakit yang di suspek ada tonsillitis..beginilah rupanya..:
tonsil yang merah menyala, membengkak...sakit wooo

-kadangkala, boleh ada tompokan putih/putih kekuningan di tonsil yang membengkak merah itu, dipanggil sebagai exudate.



Rawatan:

-Acute tonsillitis ini boleh jadi kerana jangkitan virus, atau bakteria. Cara yang sebetulnya ialah dengan mengambil sedikit coletan(swab) dari tonsil yang bengkak, dan di hantar ke makmal untuk melihat ada atau tidak pembiakkan bakteria. Ini dipanggil sebagai throat swab culture. Kalau positive jangkitan bakteria, maka antibiotik akan diberi, untuk dimakan selama 5- 7 hari selalunya. Di sesetengah pusat, mereka ada kemudahan untuk buat Rapid Screen Test. Rapid test ini menguji kehadiran bakteria jenis streptococcus yang menjadi antara penyumbang utama jangkitan tonsil.

-Namun di sini, doctor selalu buat short cut. Sebab untuk membuat culture tu semua, mengambil masa dan kos. So, selalunya ianya bergantung kepada budibicara doktor yang merawat, untuk menilai sendiri tahap keseriusan tonsillitis nya, samada perlu atau tidak antibiotik.

-Bila dah diberi antibiotik, sila makan hingga habis. Perangai manusia ni ialah suka culas makan ubat :P
Memang selalunya dalam masa 2-3 hari selepas pengambilan antibiotik, tonsillitis akan sembuh/mengecil.

-Selain antibiotik, pesakit perlu mengambil ubat ubatan untuk mengurangkan simptom..contohnya:
a) ubat demam untuk demam/sakit badan
b) lozenges untuk melegakan tekak
c) minum jus buah buahan segar dan sejuk untuk melegakan tekak
d) berkumur kumur dengan air garam suam, atau apa apa gargle solution
e) makan ice cream perisa vanilla
f) elak mengambil makanan berasid, yang membuatkan tekak lebih tak selesa

Bila Perlu Buang Tonsil? 
-pembedahan membuang tonsil dipanggil tonsillectomy. Pembedahan ini secara umumnya selamat. Risiko terbesar pun ialah perdarahan, yang mana amat amat jarang berlaku. Tempoh sembuh selepas tonsillectomy ialah antara seminggu ke dua minggu.
-Bila nak buang? Bila jadi kes recurrent tonsillitis. Sebenarnya tiada satu hukum muktamad mengatakan bahawa dalam sesetengah keadaan, tonsil itu wajib dibuang. Yang ada hanyalah guidelines yang memandu doktor untuk membuat keputusan.  Guideline terkini dari pelbagai badan induk ENT seluruh dunia secara dasarnya bersetuju bahawa tonsillectomy perlu dalam situasi berikut:

a) recurrent tonsillitis yang berlaku lebih dari 7 kali dalam setahun, atau 5 kali dalam setahun untuk dua tahun berturut turut, atau minimum 3 kali dalam setahun, untuk 3 tahun berturut turut.

b) tonsil yang besar/bengkak menyebabkan masalah pernafasan semasa tidur (sleep apnoea) atau berdengkur yang kuat.

c) episode tonsillitis yang ada komplikasi seperti peritonsillar abscess(nanah di sekeliling poket tonsil). Jangkitan ke dalam rongga sinus(sinusitis) pun boleh jadi..dan jangkitan ke telinga..
komplikasi tonsillitis -


Mitos tentang tonsillectomy:

- Ini yang paling biasa aku dengar dari pesakit...bila tonsil dibuang, nanti senang mendapat jangkitan. Patient atau parents beranggapan sebegini sebab mereka di dedahkan bahawa tonsil itu penting dalam memainkan peranan dalam immune system. Benar. Namun sebenarnya, banyak lagi kelenjar di sekitar leher yang boleh ambil alih tugas tonsil. Dan tubuh badan kita ada sistem immune yang terbaik untuk menampung ketiadaan tonsil. Malahan dalam kajian yang dijalankan ke atas kanak kanak seawal usia 3- 4 tahun yang dibuang tonsilnya, mendapati peratusan jangkitan kuma  ke atas mereka adalah sama sahaja dengan yang masih ada tonsil. Mitos ini di kuatkan lagi dengan keengganan majoriti pakar bedah membuang tonsil dalam kes kes recurrent tonsillitis yang aku refer kepada mereka. Rata rata kebanyakkan pakar bedah di sekitar Klang Valley memberi alasan kepada parents bahawa 'kena tunggu anak mereka besar..kena tunggu sekurang kurangnya umur 8-10 tahun' . Anggapan sebegini  sebenarnya kurang tepat. Andaikata dah teruk sangat recurrent tonsillitis nya, dan menyebakan terganggu kualiti hidup ( terpaksa cuti banyak kali, terpaksa bergantung kepada antibiotik terlalu kerap), maka tonsillectomy ialah pilihan terbaik.

-Tonsil hanya akan dibuang kerana kes recurrent tonsillitis. Ini kurang tepat sebenarnya, kerana tonsil juga dibuang dalam kes mereka yang semulajadi lahir memiliki saiz tonsil yang besar. Mereka yang terlalu kerap kena tonsillitis, dan kemudian sembuh, juga akhirnya boleh memiliki saiz tonsil yang besar. Kenapa saiz tonsil yang besar ialah satu masalah, dan perlu dibuang? Ini kerana ia boleh menyebabkan masalah pernafasan semasa tidur, seperti berdengkur dan sleep apnoea. Pelbagai kajian membuktikan bahawa masalah pernafasan semasa tidur ini jika dibiarkan boleh menyebabkan masalah kurang kualiti tidur, kencing malam bagi kanak kanak, dan juga masalah perangai (child behaviour). Di US, ~ 75% tonsillectomy ialah atas sebab saiz tonsil yang besar, bukan kerana hanya tonsillitis! Bercakap tentang berdengkur dan masalah tidur dalam kanak kanak ni, aku dah jumpa banyak kes. Bunyi dengkuran kanak kanak ni setanding atau mengalahkan dengkuran orang tua.

                                                                    Tonsillectomy
                                                    Tonsil yang telah dipotong
                                                          

Banyak lagi benda tentang tonsil dan tonsillectomy ni kalau aku nak tulis.
Tapi rasanya ini dah cukup lah untuk korang semua baca...nanti rasa macam baca buku teks pulak..ekekeke..

150 comments:

  1. Kakak suka membaca N3 macam nie. Kekadang kakak surf google utk apa juga tentang kesihatan.

    Lain kali doc ada masa buat N3 tentang resdung pula ye....

    ReplyDelete
  2. alhamdulillah.
    menambah ilmu.

    ReplyDelete
  3. bagus.tapi saya lebih percaya bomoh kampung dan kuasa ghaib.dijamin pulih dan bebas bedah.

    ReplyDelete
  4. Salam Bro...aku pun ada gak menda alah ni...yg teruknya kalau aku kena sakit tekak mesti kena asma...tapi aku dah biasa dah...lagi satu selalu doktor yg cek aku kata, besarnya tonsil..tapi aku tak oenah tengok pun, so tak tau berapa besar...hehhehe

    ReplyDelete
    Replies
    1. Hubungi saya 010-9333205, insya'allah saya akan bantu..

      Delete
  5. ubat strepsils tu agaknya diambil daripada perkataan streptococcus tu kot.. thanks yer utk info yg baik ini..

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  6. erk....tang ada exudate tu yg wa tak sanggup nak tgk lelama tu

    ReplyDelete
  7. ada org mudah kena tonsil ni..sesuai dgn kerjaya anda..bnyk² lagi info ttg kesihatan okeh..

    ReplyDelete
  8. memang panjang entri DZ kali ni.. thanks for the info.. setakat ni Alhamdulilah, saya takde masalah tonsil lagi..

    ReplyDelete
  9. uihhh..
    mcm tu rupenye..terkesima saya bc n3 ni sbb saya pun selalu kena tonsil ni..bengkak sampai keluar putih2 tu..mmg sakit nak menelan..
    info yg sgt bermanfaat..thanks doc..

    ReplyDelete
  10. mmg panjang!!!!adehhh...
    doc...dulu muaz tu ingatkan tonsil rupanya adenoid...dr kecik sampai la umur nak masuk 4 tahun baru dapat kesan...odc2 sebelom ni ingat dia ade semput, asma biasa jek...

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  11. ooo itu ke tonsil, . makcik pulak suka kena dalam mulut pecah, bila nak suap benda yang sikit pedas pun dah terasa pedih.Hari tu pegi ngadu ngan doktor tu dia wat bodoh je.Keraplah makcik kena cam tu, sampai takut sangat nak makan benda-benda yg pedas.

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  12. trime kasih doc atas penerangan ini..baru jelas, terang dan nyata bila ditulis dalam bahasa melayu standard...

    ReplyDelete
  13. Dua pupu saya kena sakit tonsil. 6 bulan tak campur org huhuhu

    Minggu lepas baru jumpa dia di rumah saudara yg buat majlis kahwin. Dah keluar dari pertapaan kata dua pupu saya tu.

    ReplyDelete
  14. geli lak aku tgk last pic tu...

    aku lak sekarang sedang merana kerana mata ikan...huwaaa!!!

    ReplyDelete
  15. cikgu, lepas ni exam subjektif ke objective, ekekeke..

    thanks doc :P

    ReplyDelete
  16. erk

    sy baru je lepas baik sakit tekak.

    xleh telan. sampai demam demam.

    ReplyDelete
  17. samalah kan mcm sakit tekak nak batuk ni.

    kalau cam tu akka makan vanilla ice cream..hilangg

    ReplyDelete
  18. mmg panjang jitu dan sangat difahami...doc citer pasal man u kene update juga skali skali lam blog doc nie..hahahahha

    yeayy..kite menang lagii..

    ReplyDelete
  19. anak makcik hari tu cek kat hospital,doc tengok tonsil membengkak besar..tapi x serius...dorang saran makan aiskrim vanila....tapi keadaan tetap same...mungkin sebab dia suka nangis dan jerit2 kot........

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  20. alamakkkk...

    besarnye tonsil tueeeeeee..

    glup glup..

    ReplyDelete
  21. paling tak suka mkn lozenges tu..sbb nak kena hisap2..
    tak boleh ke telan jer ??

    ReplyDelete
  22. oh,kena kira ye. baiklah kalau begitu jangan suka tukar2 doktor. sekarang kan semua rekod dalam komputer je. TFS doc!

    ReplyDelete
  23. terima kasih banyak2 ye doktor bapa
    kepada ziyyad yang comel tu...

    kita rasa kita ni yang Recurrent Tonsillitis tulah
    pasainya kerap sgt terjadi takpayah tunggu
    sampai 3 tahun ...setahun saje lebih 5 kali kena
    haru betui tekak ni...

    kadang2 kena gak yang ada spot putih2 tu
    lagi sakit...sampai demam di bueknya

    memang rasa nak bedah buang saje
    tapi....tapi....
    bila tengok pic mulut terngaga gitu
    masa bedah dan pic tonsil tu...
    jadi takuttt lah pulak...

    thanks again ye doc..nanti kita fikirkan

    nak tanya ni ..tak mau ke jadi tenaga
    pengajar pulak...ada bakat tu

    ^________~

    ReplyDelete
  24. soli ..

    lagi satu nk tanya..

    nape hanya ice cream vanilla doc?

    ^________^

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  25. Woi....!

    Disturbing images!

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  26. No pernah kena..sakit wooo tp biasa no amik lozenges je sbb tak teruk..tp klo kena pd anak2 memang kesian sangat2..eh, baru tau kena makan eskrim vanila..tp knp vanila ek bukan yg lain?..

    ReplyDelete
  27. ish...tgk gambor yg last tu cam ngeri pulak..

    tapi tulah masaalah yg menimpa anak dara saya (anak no. 2)... dari dia kecik dulu..

    doktor pun ada suggest operate..tapi bukan skrg..tgk keadaan dia bila nak membesar ni kot2 tonsil tu makin parah baru buang..
    asalkan tak menggangu sistem dia nak makan udah..

    ReplyDelete
    Replies
    1. Hubungi saya 010-9333205, insya'allah saya akan bantu..

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  28. alhamdulillah jarang kene tonsil ni....anyway..good info..

    ReplyDelete
  29. sy culas makan ubat.. hahaha//

    ReplyDelete
  30. trima kasih doc...info yg amat berguna, free lak tu

    syukur akak tak pernah kena.. tengok pun dah rasa sakit... mesti sakit sangat tu..kan doc

    ReplyDelete
  31. Thank a lot Doc....ilmu yang sangat berguna.

    ReplyDelete
  32. essay anda
    9.5/10 markah...
    ( saya ikut lecturer saya.. dia tak pernah bagi markah penuh.. kedekut!)

    ReplyDelete
  33. Ank sy baru lps tonsillectomy pagi td. Skg kena drip sbb dia x mkn n minum. InsyaAllah ok.

    ReplyDelete
  34. dah 4 hari tonsil saya bengkak n sakit..doc dah bagi antibiotik n dia pesan jgn minum ais atau ape2 yg br kuar peti ais..cam mana ni??

    ReplyDelete
    Replies
    1. Hubungi saya 010-9333205, insya'allah saya akan bantu..

      Delete
  35. apakah pantang larang pemakanan orang yang ada sakit tonsil ni?supaya cepat sembuh

    ReplyDelete
  36. :( sepatutnya pagi ni saya operate tonsil..smlm dh jmpe doktor..tengah tunggu giliran utk urusan admission, sembang2 jap dgn hubby.baru tau yg dia xambik cuti utk temankan saya operate..nak nangis rse.dahla mggu lps, tiap2 hri saya dok tanye dia psl operate ni.asik ckp ok, ok..tp hri kejadian?teman g hospital pn, sibuk layan internet kat handphone. Allah je tahu perasaan saya. Saya mengidap sakit tonsil ni sejak umur 9thn. Skrg ni umur saya dah 31. Sdhnyela.1 sen pun saya xmntk dgn dia.cukupla temankan saya. Tp dia endah x endah je. Dah nsb bdn saya. Nmpknye buat mse ni, tanggung je la skt ni. Suami pn ckp, tonsil saya nmpk mkn ok walaupn sbnrnye stiap kali tonsil ni sakit, saya rse mcm nk mti. :( ye la, dhla skit, nk uruskan, diri n takkan nk baring2 je kn mcm org bujang.. :(.. Sdhnyela.nnt bile saya dh kuat semangat, i syaAllah nak buang gak tonsil ni, i syaAllah kali ni saya msk hospital sndri n buat sendiri semuanye..semoga Allah bg kekuatan kpd saya..insyaAllah..

    ReplyDelete
    Replies
    1. Byk2 bersabar. Allah menduga kita dgn mcm2 jenis dugaan. Suami bkn x ambil kisah ttg sakit yg puan hidapi.........tapi mmg kebykkan lelaki x pandai menunjukkan kasih sayang padahal mereka sayang dan risau.

      Delete
    2. Byk2 bersabar. Allah menduga kita dgn mcm2 jenis dugaan. Suami bkn x ambil kisah ttg sakit yg puan hidapi.........tapi mmg kebykkan lelaki x pandai menunjukkan kasih sayang padahal mereka sayang dan risau.

      Delete
    3. sabar kak.. dia x kena dia x tau.. menelan sakit mcm telan pisau.

      Delete
    4. Hubungi saya 010-9333205, insya'allah saya akan bantu..

      Delete
  37. salam,,,,slalu juga kne tonsil....kdg3 x deman...cuma suara hilang + tekak gatal2,,,batuk x boleh tido....

    ReplyDelete
  38. salam..sy nk tye tentang tonsil....tonsil sy berlubang...sy search dlm google xde pon..bole tau tentang tonsil berlubang nih???

    ReplyDelete
  39. salam doc..anak lelaki sy umur 7 tahun, selepas demam, tonsil dia bengkak..bila sy tgk rupanye tonsil tuh dh menghimpit anak tekak...refer ke klinik mmg doktor akan bg antibiotik..setakat nih dh 3 botol antibiotik dlm ms 1 bln...sy agak risau bila ade anak buah kawan2 sy kena buang tonsil..hrp doktor blek komen..

    ReplyDelete
  40. Salam Dr tks byk atas sharing mgnai tonsilitis ni..aduh memang memeritkan dan sakitnya terasa sluruh badan turut bengkak dibuatnya ..sy mengalaminya sejak berumur 8 tahun kini sy dah 40 thn ..semasa kecil iaitu 8 thun Dr dah buat keputusan nak buat tonsilectomy di mana hampir setiap dua bulan ia bengkak lagi..hinggakan time tu kerap sgt la sy xdpt hadir sekolah..emak bersetuju utk buat tonsilectomy tetapi bapa pula xsetuju..so smpai ke sudah rupanya ia kerap berulang..bila ia attack terasa sukar sgt bernafas dn degup jantung jadi laju malah persekitaran leher dan tengkuk terasa mcm kena cekik..Sprti yg sy mksudkan semasa kecil kerap sgt kena, ttpi bila dewasa dn dah tau mengamalkan food supplement tak la sekerap dlu..Tapi dlm thun 2012 ni dah dua kali ler kena dn ketika ini juga sy mengalaminya lagi dah hampir seminggu..sy tak ambil antibiotik kerana bila melihat di bhgian tonsil ,kali ini ia tak pula kelihatan bengkak dn merah sgt sprti yg lepas2 ttpi sakitnya sama dgn simptom2 tonsil.. dan akhir sblm ini pd may '12 time tu sy out stn di luar msia..last2 bila dah sakit dn demam yg tinggi lgsung keja tak bole nak buat..pergi klinik kat sana mcm biasa Dr hanya bg antibiotik dn paracetamol.Pertanyaan sy Dr 1)kenapa degup jantung sy lebih laju semasa tonsilitis ? 2) adakah ia bole mnjadi faktor genetik kerana ketiga2 anak lelaki sy juga mengalaminya tetapi tidak kepada kedua2 anak perempuan sy? Tks DR..

    ReplyDelete
  41. salam saye pon nak tanye bende same....tonsilitis nih de kaitan dgn faktor genetik ke..sebab keluarge sebelah suami dan suami sendiri de masalah tonsilitis gak..so due2 anak lelaki saye juga menghidapnya....dan yang kecil sekali tuh kene mase berusia 8 bulan lagi.....cara untuk prevent die dari peringkat awal selain tonsilectomy pe die ek, doc??

    ReplyDelete
  42. Besar jugak rupanya tonsil ni eh. Anak sy dh didiagnos dgn tonsilitis ni since 1-2 years ago. Dah lama sgt dh. only now baru doctor sepakat nak operate, sebab sleep apnea.

    ReplyDelete
  43. Sy tgh kne tonsil ni dh masuk hari ke4 dh...mmg perit la nk telan air liur pun sakit apatah lagi nk telan pil ubat..rase sempit je kt kerongkong tu...hari2 mkn bubur itupun xlalu...

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  44. Baru seminggu keluar hospital because make tonsil surgery. And sakit :(

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  48. Saya jadi takut nak tido,cmane ni?ble bru nak lelap trus rase lemas kene cekik,tulung

    ReplyDelete
  49. Anak girl saya 6thn baru 5hr operate buang kissing tonsilnya..yg mana tonsilnya bercantum mcm kiss..
    Dia x pernah demam berulang ataupun jarang sekali dia demam dan sebelum ni kalau demam pun x penah lg dr cakap ada tonsil.
    Tiba2 sebulan sudah, dia demam n bila check tiba2 dr ckp dia ada tonsil. And it called 'kissing tonsil'.
    Bila dah confirm mmg teruk dia berdengkur.kualiti tidur mmg teruk.
    Suka buat perangai juga. Ada je x kena sbb mkn pun dah x dak selera..kesian dia..
    And we decided to go for surgery n what we've been told is my girl tonsil is in the higher stage..
    Tp my girl mmg kuat semangat. Dia yg x sabar nak admit n to do the procedure.
    Bila kena puasa dia sabar wpun dia x pernah belajar puasa lg. Sampai detik dia ke OT, dia masih ok..
    Bila semua selesai, alhamdulillah...syukur sgt2..my girl mmg seorang yg tabah n berani.
    X da langsung rungutan dr dia yg berumur 6 thn (actually still 5 sbb lahir on dec)..
    Walaupun br 2hr keluar hospital dia xnak cuti dah.isnin dah ke sekolah pun.
    Saya sebagai ibu, hanya pastikan ubat sentiasa ikut jam, mkn mknan yg lembut dan minum air mineral byk2. Dan alhamdulullah, sekarang tidurnya lebih sempurna dan berkualiti.
    Jgn takut utk membuat keputusan yg kalau kita lihat hasilnya lebih byk memberi manfaat kpd kita.
    Ops!!sebelum terlupa menurut ent specialist yg saya rujuk,tonsil x akn tumbuh lg bila dah dibuang dan ia mmg genetik. Suami sy penghidap tonsil selama 11 thn. 2010 dia pun dah buang dan semenjak itupenderitaannya berakhir dan dah semakin sihat..demam berulang sebulan sekali dah x ada...sgt2 bersyukur..

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