What to Do About Cryptic Tonsils

Cryptic Tonsils

Tonsil cross-section showing crypts
Tonsil cross-section showing crypts. Cultura RM/Alvin Telser, PhD/Getty Images

What Are Tonsil Crypts?

Tonsillar crypts are pockets or folds that occur naturally in the tonsils. The average adult tonsil has anywhere from 10 to 20 crypts. Crypts in the tonsils are usually small and debris free. The tonsil crypts would appear as lines in the tonsils where two edges of the folds meet.

What Can Happen With Tonsillar Crypts?

Crypts in the tonsils are normal, however they can accumulate food, mucus, and other debris which can lead to bad breath (halitosis), formation of tonsil stones, and occasionally a sore throat.

The crypts have low levels of oxygen making the environment susceptible to bacteria that do not need oxygen. When a mixture of bacteria start to accumulate in the crypt, it is possible for an infection to occur.

The infection can cause inflammation to occur, which is sometime referred to as chronic caseous tonsillitis or fetid tonsils. The "caseous" refers to a cheese-like formation in the tonsillar crypts. When the accumulated bacteria, mucus, or other debris does not dissipate, it can calcify and form tonsil stones (tonsilloliths).

What is Cryptic Tonsils?

While tonsillar crypts are normal, cryptic tonsils look like white beads on your tonsils or patches of pus. Because of this, the condition looks similar to strep throat or another throat infection. Fortunately, cryptic tonsils alone are not generally harmful to your health.

You can get cryptic tonsils because you have naturally "wrinkly" tonsils, which are more prone to trap food.

Other debris can accumulate in these holes in your tonsils as well, including pus and a bacteria that produces volatile sulfur compounds and creates halitosis (bad breath). Of all the causes of bad breath, cryptic tonsils only account or about 3% of cases, though.

Treatment for Cryptic Tonsils

There are a couple of options for treating cryptic tonsils, depending on the severity of the condition.

The standard of care for bothersome tonsil stones is to have them removed by a professional ENT or Dentist. Common methods include irrigation with saline, curettage (using a curette to scoop the stone out), or expressing the stone out manually with a sterile swab.

There are some sites that recommend using a waterpik to remove the stones in tonsil crypts. However, there isn't much research on the safety of this practice, and too forceful of water pressure could cause damage to the tonsil tissue. Other objects such as tongue depressors or sharp objects should not be used to remove the debris as it may result in damaged tissue.

Another treatment for cryptic tonsils is CO(2) laser cryptolysis. This is an in-office procedure which uses a laser beam to ablate (get rid of) the pockets in the tonsils. You will be given a local anesthetic to prevent pain during the procedure, which will generally take about 20 minutes. The use of laser removal, works much like peeling an onion. The laser exposes the crypt and allows for removal of the tonsil stone.

Following the procedure, you will be asked to use over-the-counter analgesics and gargle topical anesthetics for pain control, as well as gargle an antibiotic to prevent infection.Cryptic tonsils and bad breath may be cured the first time this procedure is performed, but some individuals may need the procedure a second time.

The last option to treat cryptic tonsils is a tonsillectomy. Removing the tonsils is effective virtually 100 percent of the time, but the surgery has risks that must be considered. Tonsillectomy is usually only recommended if you have uncontrollable bad breath that is unresponsive to treatment or other problems related to your tonsils such as chronic strep throat or sleep apnea.

Sources:

Bai, K.Y. & Kumar, B.V. (2015). Tonsillolith: A polymicrobial biofilm. Medical Journal Armed Forces India. 71(1), S95–S98. doi:10.1016/j.mjafi.2011.12.009.

Krespi, Y.P. & Kizhner, V. (2013). Laser tonsil cryptolysis: In-office 500 cases review. American Journal of Otolaryngology. 34(5), 420–424. doi:10.1016/j.amjoto.2013.03.006

Optics.org. Laser Therapy Cures Bad Breath. Accessed: October 5, 2009 from http://optics.org/cws/article/research/20867

PubMed. Relationship Between the Presence of Tonsilloliths and Halitosis in Patients With Chronic Caseous Tonsillitis. Accessed: October 5, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/18037821

Siber, S., Hat, J., Brakus, I., Biočić, J., Brajdić, Zajc, I. ... Macan, D. (2011). Tonsillolithiasis and orofacial pain. Gerodontology. 29(2). e1157-e1160. DOI: 10.1111/j.1741-2358.2011.00456.x

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