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Tonsillitis, tonsil stones and cancer: Causes, symptoms and treatments

Tonsils are placed on both sides of throat and act as a first line of defense of the immune system against diseases. The most commonly seen tonsil disorder is tonsillitis, and it is especially common in children during winter. The common symptoms include sore throat, fever, swollen and red tonsils. Inflammations due to common cold can easily be recovered from by at-home treatment or medical treatment. However, if the inflammation becomes chronic, tonsils may need to be surgically removed as a last resort. Other disorders include tonsil stones and tonsil cancer. Tonsil stones can also usually be treated by at-home care. However, tonsil cancer may require radiotherapy, chemotherapy and surgical intervention. 

What are tonsils?

Tonsils are oval-shaped, pea-like lymph nodes placed on both sides of the cavity in the back of the throat. Tonsils are a part of the lymphatic system which helps combat infections and have an important role in health. They are larger in childhood and become smaller with age. Other than these, there is also pharynx tonsil (adenoid) in the back of nasal cavity over roof of the mouth and lingual tonsils which are the lymphatic tissues on the base of the tongue.

What do tonsils do?

Tonsils act as a first line defense of the immune system against diseases. They help the body combat with infection by producing white blood cells and antibodies. They also filter foreign bodies like bacteria or virus and prevent them migrate to lungs.

Since in the past, they were thought to be useless as they lost their function due to evolution, they were being surgically removed in a breeze in case of an infection, however, their importance was understood over time.

Tonsil disorders

  • Tonsillitis
  • Tonsil stones
  • Tonsil cancer

What is tonsillitis?

Tonsillitis develops as a result of infection in the tonsils by microbes. It differs based on the type of the virus or bacterium, or the site of infection.

  • Peritonsillar cellulitis and abscess: Peritonsillar cellulitis is the inflammation of the soft tissue between tonsil membrane and throat tissue, and it is more common in adults. Peritonsillar abscess is the accumulation of pus in this soft tissue.
  • Mononucleosis: It is an acute inflammatory tonsil disorder caused by Epstein-Barr virus, and mostly seen in children.
  • Strep throat infection: It is the infection of tonsils and throat by streptococcus bacteria, and most commonly seen in children.
  • Tonsil enlargement: As antibody production is increased in children during immune system development, palatine tonsils and adenoid are larger compared to adults.

In case of an infection, especially adenoid may get even larger and block the airway, thereby, cause snoring or sleep apnea. Moreover, tonsillitis can be acute or chronic. Acute tonsillitis is mainly seen in children, and termed as chronic tonsillitis in case of frequent recurrence.

Tonsillitis symptoms

  • Sore throat
  • Fever and Chills
  • Redness, or yellow or white spots on tonsils
  • Sometimes painful swallowing difficulty
  • Voice changes
  • Bad breath and loss of appetite
  • Ear- or headache
  • Neck stiffness
  • Jaw-neck tenderness and pain associated with swollen lymph nodes
  • Weakness, malaise, body aches and especially joint pain
  • In very young children, nausea, vomiting, tummy ache and crankiness may also be seen in addition to the above symptoms.

Symptoms may vary based on causal agent and patient’s body resistance. As in rare conditions, tonsillitis may cause swelling in the throat, thereby, breathing difficulty, immediate medical help might be necessary. Furthermore, in case of fever higher than 39.5oC, muscle weakness, neck stiffness and sore throat longer than two days, medical help should be sought without delay.

Tonsillitis diagnosis

The diagnosis of tonsillitis is based on physical examination. Also, further tests may be requested from pathology to determine the cause of the inflammation. Main tests include:

  • Throat culture test: In this test, a sterile swab is smeared onto tonsils and pharynx (the cavity between oral and nasal cavities, and larynx and esophagus) and samples are taken from this site. These samples are examined in the laboratory, and bacteria causing the illness such as streptococcus are studied.
  • Monospot test: In this test, the blood sample taken from the patient is examined in laboratory to determine whether cause of tonsillar inflammation is Epstein-Barr virus.

Tonsillitis treatment

Tosillitis home remedies

  • Tonsillitis due to common cold can easily be recovered from by at-home care.
  • Drink plenty of fluids
  • Get a good rest,
  • Gargle using hot salt water a few times a day
  • Use throat lozenges,
  • To keep the air at home wet, place a bowl of water for example on the heater cores
  • Ventilate your home frequently
  • Avoid any kind of smoke including tobacco

Medical treatment for tonsillitis

Sometimes, medical treatment may be used based on the severity of tonsillitis. Usually, antibiotics are prescribed for bacterial infection and it is important that this treatment is completed. Follow-up examinations may be performed to see whether the patient responds to the antibiotics.

Also, if fluid loss develops due to the illness or antibiotic use, intravenous fluid therapy can be administered. In this therapy, the fluid given to the patient via veins (IV drip) include electrolytes, sugar, or medications at necessary doses, and water. Painkillers are prescribed if tonsillitis causes sore throat.

You must consult with a physician before giving medications to children and avoid unnecessary antibiotic use.

Tonsillitis drainage

In this procedure, abscessed soft tissue is punctured using a needle and the pus is drained. It is usually used for the drainage of peritonsillar abscess.


Tonsillectomy is the procedure of complete surgical removal of tonsils which is used as a last resort for the treatment of recurrent, chronic or severe tonsillitis. The procedure is usually performed under general anesthesia using various methods. These methods vary based on the surgical instrument for tonsil removal and the procedure performed for bleeding control after removal. The most frequently used methods include hot knife-cautery, thermal welding, harmonic scalpel and plasma methods.

It is usually a short (20 min on average) surgical procedure. Blood thinning medications such as aspirin should be discontinued at least two weeks before tonsillectomy. Also, foods recommended by the physician should be consumed until the day of surgery, and fasting should be started after midnight of the evening before the operation.

The patient can usually be discharged on the same day, however, if complications occur, if patient has a complex condition or very young child, overnight or more hospitalization might be necessary. Recovery time after operation is 10 to 15 days on average.

If the patient has a personal or familial history of an adverse reaction to anesthesia, bleeding disorders, allergic reactions to medications such as antibiotics, the physician should be informed about these before the operation.

The risks of tonsillectomy

  • Reactions to anesthetics: The side effects of general anesthesia medications usually include short-term problems such as headache, nausea, vomiting or muscle pain. Prolongation of these problems or death due to anesthesia is rare.
  • Breathing problem: As the tongue and soft plate swallows after the operation, breathing problems may occur especially within the first hours after the procedure.
  • Bleeding during operation: As in rare conditions, serious bleeding may occur during operation, longer periods of hospitalization may be necessary for additional treatment.
  • Bleeding during the recovery period: If tonsillectomy scabs fall very early after the operation during the recovery period, bleeding may occur.
  • Infection: Rarely, operation may cause infection which requires additional treatment.

After tonsillectomy

After the operation, pain may be seen usually in the throat and ears, and sometimes in jaw and neck. You can do the following to relieve the pain, support your recovery period and prevent the complications:

  • Medications: Use the painkillers prescribed by your physician regularly.
  • Fluids: Drink plenty of fluids after the operation to avoid dehydration (fluid loss). Since problems may occur due to fluid loss especially in children, they should drink approximately 2 liters of cold, iced water daily. Avoid hot and fizzy drinks.
  • Foods: Soft foods which are easy to swallow such as oatmeal or gravy are the best options shortly after the operation. Also, foods like vegetable and fruit puree, dairy ice cream and pudding can be added to diet. Do not consume foods containing acid, and spicy and crispy foods. These may cause pain or bleeding.
  • Resting: A few days of bedrest after the operation is important and tiring activities such as jogging should be avoided for two weeks.

The disadvantages of tonsillectomy

Tonsillectomy is one of the most commonly performed operations in the world especially in children. It is not only used for sore, chronic and recurrent tonsillitis but also for the treatment of middle ear infection. Moreover, adenoidectomy which is the adenoids removal surgery is also a frequently performed operation in children and it is performed to improve breathing when the adenoid blocks the airways.

In the past, these organs and tissues were believed to be unnecessary, however, today it was found that both the adenoid and the tonsils have strategic importance in the nose and the throat. They act as a first line defense, help recognize airborne microbes such as bacteria and virus, and initiate the immune reaction to clear them from the body.

Studies have shown that surgical removal of these organs may lead to higher rates of allergic, respiratory and infectious diseases in the future. Therefore today, the operation is considered as a last resort.

Alternative method to tonsillectomy

In recent years, as the conventional tonsillectomy is seen as inconvenient, different surgical methods have been developed. The most common of these is intracapsular tonsillectomy in which only a part of the tonsils is removed and the rest is preserved with the sac-like cover surrounding the tonsils.

The recovery period is shorter with this method as pain occurs less, eating and drinking becomes easier and also the risk of bleeding is reduced. The only drawback is the re-enlargement of the residual tissue and the development of infection.

What are tonsil stones (tonsillolith)?

Tonsil stones are yellow or white formations developed on or inside the tonsils. Their presence may not be noticed, and they may vary in size (from rice-sized to grape-sized). They may sometimes get so big to the extent they cause tonsil enlargement. They are more frequent in adults than children.

Tonsils stones are developed due to the accumulation of different types of discharges such as dead cells, phlegm, saliva, slime and food in the crypts of tonsils which are a combination of clefts, tunnels and fossae. Potential causes include bad tooth hygiene, enlarged tonsils, chronic sinus conditions and tonsillitis.

Tonsil stone symptoms

  • Bad breath
  • Sore throat
  • Swallowing difficulty
  • Earache
  • Persistent cough
  • Swollen tonsils

Small tonsil stones are more common and may be asymptomatic.

Tonsil stone treatment

Tonsil stone surgery

Small surgical procedures may be performed especially when the stones are large or cause pain. One of these procedures, curettage is used to remove large tonsil stones under local anesthesia. Also, rinsing is performed after the operation to clean the smaller parts. Laser can also be used to remove the crypts in which the tonsils are nested under local anesthesia. Tonsillectomy which is the complete removal of tonsils is considered as a last resort.

How to remove tonsil stones without gagging?

Small stones which do not cause great discomfort can be treated using simple at-home methods. One of the most effective methods is salt water gargle. Add and dissolve one dessert spoon of rock salt to one glass of warm water and wash your mouth with this after you brush your teeth. You may be able to remove the tonsil stones and get rid of bad breath using this method.

Another way might be removing the stones by pressing the stones using your tongue or hand, however, this is not widely recommended as it may harm the tonsils if performed carelessly. Instead, you can remove the small stones by washing the tonsils using an irrigator which can be connected to the faucet. Also, a strong cough dislodge the stones.

Tonsil cancer

Being a type of oral cancer, tonsil cancer is rare. It develops as a result of abnormalization of the cells, especially the ones in the oropharynx which is the cavity in the back of the mouth. The exact cause is unclear, however, the most important triggers include using alcohol together with tobacco products including cigarettes and Human Papilloma Virus.

It may also develop in people who had tonsillectomy. As tonsils are a part of the lymphatic system, it may also develop secondary to some lymphoma types.

Tonsil cancer symptoms

  • Swallowing difficulty sometimes with pain
  • Noticeable mass on neck area
  • Discomfort in the throat
  • A dry, irritated skin patch
  • Earache
  • Voice changes
  • Tiredness and weight loss

Many patients may not be aware of the symptoms even after the diagnosis. Also, the symptoms might be associated with another condition. It is important to consult with a physician for accurate diagnosis.

Tonsil cancer treatment

  • Surgical intervention: Surgical intervention is performed to remove the tumor from tonsils, throat or lymph nodes. Based on the size and site of the mass, minimally invasive robotic surgery can be performed. Microsurgical reconstruction can be performed to improve the appearance and the function of the throat area after the removal of larger tumors or some bone structures.
  • Radiotherapy: Many radiation techniques including intensity-modulated radiotherapy (IMRT) reduce the harm to surrounding healthy tissues and shrink tumor by targeting it. Based on the stage of the disease, it is administered before or after the operation.
  • Chemotherapy: Chemotherapy can be used together with radiotherapy.

Recommendations for individuals with tonsil disorders

  • As tonsillitis is an infectious disease, avoid being in the same room and contact with infected individuals. Definitely wash your hands with soapy water when you come from outside. Similarly, try to avoid crowded areas when you have infection.
  • Do not use any medications other than the ones prescribed for you or your child by your physician and avoid unnecessary antibiotic use. Before using over-the-counter medications like painkillers, consult with your physician.
  • For sore throat, add honey and lemon juice to warm water, and drink the mixture. Honey will soften your throat, and lemon will help reduce the phlegm.
  • If your tonsils are swollen, you can prepare and drink the tea from turmeric, cinnamon or sage, and use the remaining tea to wash your mouth. For more:>>> Tonsillitis,

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