There are many Tonsils in the human body.

The ones we commonly refer to the Tonsils are the palatine Tonsils which are paired organs in the throat, just behind our teeth.

The Tonsils are one of the body’s primary organs for maintain immunity.

They are strategically located at the entrance of the food and air passage and so work against both airborne particles as well as food antigens – thus performing a regional immune function.

They offer a dual Immune cover – not only do they offer mucosa associated lymphoid tissue, they are also involved in a systemic response and are linked to the lymphoid system. That is why an infection of the Tonsils causes the regional (Jugulo digastric) lymph nodes to enlarge – in an attempt to block the infection at a regional level and to prevent it from spreading.

Since they are directly involved in catching and killing viruses and bacteria, they need as large a surface area as possible. In order to increase the effective surface area of the tonsils there are deep crevices in the palatine tonsils called crypts. These narrow channel mucosal surfaces have an immunogenic function.

FORMATION OF TONSILLOLITHS

Sometimes food particles, saliva, along with bacteria getting trapped inside the crypts of the tonsils.

The usual cause of tonsilloliths to form are –

• Previous recurrent tonsillitis
• Poor oral hygiene
• Not rinsing the mouth well after a meal

FEATURES OF TONSILLOLITHS

• Throat discomfort/ soreness
• Appearance of white spots on the tonsils
• Halitosis – bad smell from the mouth. The action of bacteria on the organic matter in food causes a bad odour to emanate
• Dysphagia- when they become very large they may interfere with swallowing
• Otalgia- same sided ear pain in the presence of a secondary infection.

HOW TO PREVENT/ HOME REMDIES

• Thorough oral rinse after every meal, even snacks – to prevent food particles from getting stuck in the tonsils.
• Drink some aerated water – the gas in aerated water can sometimes dislodge a Tonsillolith
• Gargle with hydrogen peroxide- under medical guidance and supervision – one teaspoon of hydrogen peroxide in half a glass of water can be used
• Reassurance- usually patients are worried and reassuring them and telling them about the cause helps them to cope better

Though I have read about it I would not recommend putting in buds or applicators on the tonsils in an attempt to remove the stones physically – many patients come with bleeding from the local area in such situations because the procedure is practically blind.

SURGICAL OPTIONS

1. COBLATION CRYPTOPLYSIS – Using a Coblation wand the Crypts are shaved off/ reduced so that the stones dop not form
2. TONSILLECTOMY – The final solution to persistent, painful Tonsilloliths, which cause foul odour orally and which cause the patient intense discomfort is surgical removal of the Tonsils.

DANGER SIGNS

There are certain situations in which you must visit your ENT Specialist at the earliest.

These are

• Spontaneous bleeding from the Tonsil
• Unilateral Tonsil enlargement – One Tonsil larger than the other
• Ipsilateral neck node (Jugulodigastric node) is enlarged
• Increasing dysphagia
• Change in voice

These are features of a malignant Tonsil and should be looked into immediately.