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Treatment protocol for Tonsillar Crypts, Tonsilloliths: Dr. Vijay Chourdia

M3 India Newsdesk Dec 23, 2018

Tonsillar crypts and Tonsilloliths are becoming more common these days with some patients repeatedly presenting with a diagnosis. In this article Dr. Vijay Chourdia, a noted ENT surgeon, details on the two conditions and advises on treatment protocol to be followed.

Dr. Vijay Chourdia is a noted ENT surgeon and specialist with more than 31 years of experience in the field. 

Tonsillar Crypts & Tonsilloliths

Tonsillar crypts (holes) are pockets or folds that occur naturally, around 10-30 in each tonsil, and extending through the full thickness of the tonsil. Normally, the openings are fissure like and the walls of the lumina are in apposition. One of the crypts is usually larger and known as crypta magna.

The other crypts serve as forward entry holes for the immune system, providing early exposure of the system cells to infectious organisms introduced into the body via food or other ingested matter. The crypts are small and debris-free, but can accumulate food, mucus, dead cells and other debris providing an inviting environment for bacterial colonies which may form solidified plugs or tonsil stones (Tonsilloliths).

Patients suffering from chronic tonsillitis/sinusitis/post-nasal drips or those with poor oral hygiene (as it favors overgrowth of bacteria) can develop Tonsilloliths. Low levels of oxygen in the crypts favors growth of anaerobic bacteria.

Cryptic tonsils look like white beads/patches of pus and fortunately, by themselves are not generally harmful, even if they cause some discomfort for patients. Patients with Tonsilloliths may remain symptom-free even if the Tonsilloliths are visible or may have symptoms even if they are not seen on the surface but are lodged in depth.

Common symptoms to look for are Bad breath (halitosis), patient feeling like something is stuck in the throat or persistent irritation, redness of tonsils, chronic sore throat, earache, difficulty swallowing, foul- smelling cheese-like clumps in the tonsil.


Doctors can try the following methods to dislodge the plugs:

  • Expressing out the plugs gently with a cotton swab or using a tool that can probe or scoop forward the plug into mouth and not into the throat can help.
  • The patient can also be made to rinse his/her mouth for 3 minutes with H2O2 or saltwater (alkaline pH- because bacteria thrive less and because salt water helps change the mouth chemistry) and also with alcohol-free antiseptic frequently to help dislodge the stones and debris.
  • Sometimes, irrigation with a dental water jet may help with removal of plugs followed by antibiotics to eliminate oral bacteria.
  • Patients should also be counselled about the condition and told not to confuse the stones or any of the symptoms with cancer.


Additionally, other common remedies and preventive measures patients can be advised to follow include:

  • Avoiding foods & drinks that could irritate the tonsils, especially alcohol, citrus and acidic fruits, vinegar, spicy, fried and coarse foods, onion, garlic, non-veg, and dairy products
  • Drinking green tea with honey for soothing the throat
  • Drinking plenty of water and avoiding dry mouth
  • Quitting smoking as chemicals can deposit in the holes and irritate tonsils again
  • Maintaining regular oral hygiene, which means brushing thrice, cleaning the tongue and gargling with water after every meal

If conventional treatments fail, Tonsillectomy could be a permanent solution.


Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

This article was originally published on 22. 8.18

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