TONSILLAR CASEUM: SYMPTOMS, CAUSES AND TREATMENTS - MEDICINE - 2025

The caseum tonsil or tonsil stones are white or yellow hard formations found on or in the tonsils. They are benign accumulations of bacteria and debris in the crypts of the tonsils. Although this problem can cause discomfort, it does not pose a greater risk and is generally easily treatable.

However, they can sometimes develop into large formations causing swollen tonsils and an unpleasant odor. When they present with fever and sore throat, they can be the manifestation of an acute bacterial infection of the tonsils, also known as tonsillitis, which can have important medical implications.

The tonsils are gland-like structures located in the back of the throat; They are located on each side of the throat. They are part of a protection system that serves to prevent foreign objects from seeping into the lungs. They are made of tissue that contains lymphocytes, cells that prevent and fight infection.

In many cases, the tonsils become more of a problem than a help. Tonsils are believed to have evolved for an environment where humans weren't exposed to as many germs from pollution as we find today from living in areas with relatively high populations.

It is common for people with tonsil stones to not even know they have them. Tonsil stones are not always easy to see and can range from the size of a grain of rice to the size of a large grape.

Symptoms

Some people have no visible symptoms when they suffer from tonsil stones. Even when they are large, some tonsil stones are only discovered incidentally on X-rays or CT scans. Those who do have symptoms often suffer from the following conditions:

Bad breath

One of the main indicators of tonsil caseum is bad breath or halitosis, which accompanies an infection of the tonsil.

Sore throat

When tonsil stones and tonsillitis occur simultaneously, it can be difficult to determine if the pain in the throat is caused by the infection or the tonsil stone.

However, the presence of a tonsil stone can cause pain or discomfort in the area where it is lodged.

White rubble

Typically, tonsil stones can be seen as white, yellow, or gray nodules on the tonsils.

This is not always the case; they are often hidden in the folds of the tonsils. In these cases they can only be detected with the help of non-invasive exploration techniques.

Difficulty to swallow

Depending on where it is located and the magnitude of the tonsil stone, it can become difficult or painful to swallow food or liquids. People with stones in their throats may also feel like they have something stuck in their throat.

Earache

Due to the shared nerve pathways, the stones can cause the sensation of pain in the ear, even though the stone itself does not touch the ear.

Swollen tonsils

Inflammation from the infection and the stones themselves can cause the tonsil to swell or enlarge.

Causes

The tonsils are full of crevices, tunnels, and pits called tonsil crypts, where bacteria and other materials - such as dead cells, mucus, saliva, and food - can become trapped and accumulate. Bacteria and fungi feed on this buildup and cause a distinctive odor.

When this happens the waste can concentrate in white formations that occur in the pockets. This tends to occur more often in people who have chronic inflammation of the tonsils or repeated episodes of tonsillitis.

Tonsil stones are more common in teens and in larger tonsils. Those with poor dental hygiene can also suffer from tonsil stones. Common causes of tonsillar caseum are:

- Poor dental hygiene.

- Large tonsils.

- Chronic sinus problems.

- Chronic tonsillitis (inflamed tonsils).

When the tonsillar caseum appears suddenly, it can be a manifestation of tonsillitis. Tonsillitis usually tends to be caused by viruses (70% of cases) such as influenza or rhinovirus.

However, when it manifests with caseum, it is usually of bacterial origin, especially due to the action of Streptococcus pyogenes, also known as “the meat-eating bacteria”, because it has a toxin capable of destroying the skin (although this is not the case in this case).

The problem with tonsillitis when it is caused by this bacterium is that it can be complicated late with heart diseases (such as rheumatic fever) and kidney diseases (nephritis), which significantly increase the mortality of the patient.

Treatments

The ideal treatment for a tonsil stone usually depends on its size and its potential to cause discomfort or damage.

Salt water gargle

Gargling with salt water (1 teaspoon of salt in 8 ounces of warm water) a few times a day can help ease the discomfort of tonsillitis, which often accompanies tonsil stones.

Disposal at home

Some people choose to dislodge the tonsil stones at home with the use of picks or swabs.

Surgical removal

Sometimes tonsil stones are so deeply embedded that they cannot be removed at home. In this case, a tonsillectomy may be warranted.

Tonsillectomy is a definitive treatment for tonsil stones, as without tonsils the stones cannot form. It is generally recommended to try all conservative measures before considering a tonsillectomy.

A tonsillectomy is safe, but it can cause a sore throat for several days after surgery. Like all surgeries, tonsillectomy carries some risks. These include bleeding, infection, breathing difficulties related to swelling and, very rarely, life-threatening reactions to anesthesia.

Antibiotics

In some cases antibiotics can be used to control tonsil stones. They can be used to reduce the counts of bacteria that play a crucial role in the development and growth of tonsil stones.

Prevention

Preventing the formation of tonsillar caseum is not complicated, it is enough to have good dental hygiene. It is suggested to brush your teeth and tongue after meals, at bedtime, and first thing in the morning.

However, people who tend to suffer from chronic tonsillitis are much more likely to develop tonsil stones, with surgical removal of the tonsils being the only surefire way to prevent them. Also recommended:

- Give up smoking.

- Gargling with salt water.

- Drink plenty of water to stay hydrated.

References

1. Tonsil Stones, sf, northern Illinois ent specialists LTD: northernillinoisent.com
2. Judith Marcin, (2017), Tonsil Stones: What They Are and How to Get Rid of Them, healthline: healthline.com
3. Tonsil Stones (Tonsilloliths), sf, WebMD: www.webmd.com
4. Alina Bradford, (2017), Tonsil Stones: Causes, Removal & Prevention, livescience: livescience.com
5. Zawn Villines, (2017), What you should know about tonsil stones, MedicalNewsToday: medicalnewstoday.com