What is Tonsil caseum?

August 08, 2020

What is Tonsil caseum?
Removal of tonsil stones, also known as tonsil caseum, with a cotton bud at home
Giant tonsil stone extracted from the tonsil crypt - tonsil caseum or tonsillolith

Tonsils are an important component of the body’s immune system because they help fight infection. They are two lumps of tissue located at the back of the mouth, one to either side. These glandular traps work like sponges to guard the inside of the body against bacteria and viruses. Tonsils have holes and crevices (crypts) and are lined with the same mucosa found in the nose, throat, and mouth. The crypts catch mucous, food particles, epithelial cells, bacteria, and viruses. They also produce white blood cells and antibodies to detect and filter bacteria.


What is Tonsil caseum?

Crypts in the tonsils are moist and have low levels of oxygen. This also makes the environment susceptible to the growth of bacteria and the formation of tonsil caseum. Caseum is a “cheese-like” substance. It is a viscous, yellowish mass that builds up when debris, mucous, and bacteria clump together in the tonsil crypts. Caseum can dislodge and be swallowed. Or it can be expelled during speech, sneezes, or coughs. If retained it can also infect the tissues of the tonsils resulting in an immune response of inflammation.


What is Chronic caseous tonsillitis?

The mechanical inflammatory process of infection is often called chronic caseous tonsillitis (CCT) or fetid tonsils. Infection most often occurs when there is epithelial shedding, salivary flow reduction, or both. It is also the body’s reaction to a bacterial or viral infection. Inflammation enlarges the pharyngeal tonsils and can increase the depth of the crypts and masses become retained. If debris, mucous, and caseum does not dissipate it can calcify or mineralize into tonsil stones (tonsilloliths). The size of tonsilloliths can range from barely visible to the size of a pea. Tonsilloliths do not pose a serious health risk, but they can cause bad breath, an unpleasant sensation in the throat, or trouble swallowing and breathing.


What are the signs and symptoms of Caseous Tonsillitis?


Some common signs and symptoms include:

• Bad breath (halitosis)

• Red or swollen tonsils

• Enlarged lymph nodes in the neck

• Sore or scratchy throat

• Pain when swallowing

• Feeling of a foreign body stuck in the throat

• Cheese like clumps in throat or mouth


Is Caseous Tonsillitis contagious?

Because tonsillitis is technically the body’s response to bacteria, it therefore, is not contagious. However, the bacteria or virus that is causing the response can be contagious.


Bacterial Tonsillitis

The cause of tonsillitis is usually bacterial in children between the ages of 5 and 15 years old and some adults. One major bacterial group that causes tonsillitis is group A beta-hemolytic streptococcal (GABHS). This is the bacteria responsible for strep throat which accounts for 5 to 15 % of sore throats in adults and 15 to 30% of sore throats in children. The bacteria usually spread when a person has direct contact with the mucus or saliva of another individual with the infection. This is also why bacteria spread more quickly in areas where people, most especially children, are in close proximity for prolonged periods of time (i.e. schools and daycare).


Viral Tonsillitis

The cause of tonsillitis is usually viral in children under the age of five and most adults. The viruses that contribute to influenza and the common cold can also cause tonsillitis, including adenoviruses, coronavirus, cytomegalovirus, and flu viruses. These viruses have a certain resilience and can live on metal and plastic surfaces for several hours.


Treatment options for tonsil caseum, tonsillitis and tonsillitis

Most cases of tonsil caseum or caseous tonsillitis will clear up on its own. There are no medications to take to get rid of caseum or tonsil stones, but physicians might recommend the use of pain relievers or antibiotics to help combat symptoms. However there are some clinical treatments for chronic caseous tonsillitis might involve the use of antiviral, antibacterial, and anti-inflammatory agents as well as some surgeries.


A basic preliminary treatment includes gargling antiseptic solutions or saline solutions to treat inflammation and dismantle the bacteria and mucosa before it can spread or harden. Another option might be using a water flosser as a noncontact method to clear away caseum and dislodge tonsil stones.


Another alternative treatment to a tonsillectomy might include laser tonsil cryptolysis. For this procedure, physicians use lasers to remove tonsilloliths from the crypts and crevices.


Where tonsil stones are too large or embedded, or there are other chronic throat conditions are present, like sleep apnea or strep throat, a medical professional may recommend the removal of tonsils (tonsillectomy). It is one of the most common surgical procedures performed on children, but fewer tonsillectomies have been performed in recent years. The procedure itself usually takes about 30 minutes and the recovery takes about a week.


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