Caseous plugs on the tonsils in the throat

Such a symptom as caseous plugs on the tonsils in the throat, otolaryngologists observe quite often - both in inflammatory processes in the pharynx and in cases where there are no signs of obvious inflammation of the palatine tonsils.

Causes caseous plugs

Caseous plug in an adult, in a child, during pregnancy can appear for one reason - due to recurrent, that is, often repeated infectious inflammation of the pharynx and tonsils in the throat (glands), as well as a chronic inflammatory process in the nasopharynx or paranasal sinuses. [1]

Such plugs are an accumulation of caseous (similar to cheese, from Latin caseum - cheese) amorphous yellowish substance in the lacunae of the palatine tonsils, and risk factors for their formation include sore throat caused by a bacterial infection  (acute tonsillitis)  and chronic inflammation of the tonsils,  follicular and lacunar sore throat , herpetic or aphthous tonsillitis, monocytic sore throat (which occurs when the pharynx is affected by the Epstein-Barr virus), pharyngomycosis -  fungal sore throat ,  chronic pharyngitis , chronic  nasopharyngitis  , etc. [2]

In fact, in the presence of such plugs in the gaps of the palatine tonsils, tonsillitis can be considered caseous. And with an exacerbation of chronic inflammation with the formation of pus, purulent-caseous plugs can form.

Pathogenesis

The  tonsils (including the palatine tonsils) are immune organs that form the pharyngeal lymphoid ring and provide adaptive protection against inhaled or ingested antigens (bacteria and viruses). And the pathogenesis of the formation of caseous plugs is closely related to the immunological functions of the tonsils.

They have a branched network of depressions - lacunae (or crypts), which many times increase the area of a special reticular epithelium, dotted with nodules of lymphoid tissue, producing protective cells (macrophages, neutrophils, B and T-lymphocytes) and attracting immunoglobulins to the site of infection. And caseous plugs are formed in the gaps, where detritus gradually accumulates - cellular debris, that is, the products of phagocytosis of microorganisms and the remains of lysis of lymphocytes and macrophages.

Chronic caseous plugs can transform into so-called tonsilloliths, which are mineralized (calcified) caseous accumulations in lacunae.

Symptoms caseous plugs

With the formation of caseous plugs, symptoms are usually absent, but with the active phase of inflammation of the tonsils, general symptoms of chronic tonsillitis are observed  . 

And the first signs of the presence of such pathological accumulations in the tonsils outside the inflammatory process can be manifested by halitosis - bad breath associated with the release of volatile substances containing sulfur compounds by many anaerobic bacteria.

The presence of tonsilloliths in the lacunae can cause a foreign body sensation in the throat, an unpleasant taste in the mouth and halitosis; in addition, symptoms can manifest as pain when swallowing (sometimes radiating to the ears and neck), dysphagia (difficulty swallowing associated with swelling of the tonsils), and frequent coughing.

Complications and consequences

Why are caseous plugs dangerous? They interfere with the natural cleansing of lacunae and thereby increase the risk of infection in the tonsils - creating favorable conditions for the growth and reproduction of both pathogenic microorganisms and opportunistic bacteria and bacteroids of the obligate pharyngeal microflora, for example, of the Fusobacteriaceae family, which can cause epithelial cell necrosis.

And in the presence of Streptococcus pyogenes (beta-hemolytic streptococci), Staphylococcus aureus or Haemophilus influenzae in the lacunae, the consequences and complications typical of chronic inflammation of the tonsils, including sleep apnea and cardiac problems, are possible. 

Read more in the publication -  Chronic tonsillitis - Complications .

Diagnostics caseous plugs

The presence of caseous plugs on the tonsils in the throat is detected by otolaryngologists during a standard examination -  examination of the pharynx , as well as during a visual examination of the larynx - direct  laryngoscopy . [3]

Differential diagnosis

Differential diagnosis is carried out with purulent plugs, peritonsillar abscess, as well as a keratin cyst of the tonsils. And tonsillolitis - with foreign bodies of the pharynx, granulomatosis, venous calcifications (phlebolitis) of the soft tissues of the pharynx, as well as malignant neoplasms.

Treatment caseous plugs

Many experts believe that  treatment is  not required if caseous plugs, as well as the resulting tonsillolitis, do not bother the patient.

However, otherwise, it is necessary to rinse, or rather oral irrigation of the tonsils with a solution of common salt; it is also recommended to use a solution with the addition of an antiseptic, for example, 0.05%  Chlorhexidine bigluconate  (but it should not be used by children under 12 years of age and pregnant women).

If tonsillitis is caused by a fungal infection, the throat should be flushed with Miramistin or Hexoral solutions.

Any other medicine will not help get rid of caseous plugs. And antibiotics (Azithromycin, Augmentin, Doxycycline, Ceftriaxone, etc.) are prescribed by a doctor for exacerbation of chronic tonsillitis of bacterial etiology. Read in detail:  Antibiotics for tonsillitis .

As a rule, treatment is carried out at home, trying to remove the plugs, including calcified ones, by intensively (at least twice a day)  gargling with salt  (salt water).

Only in cases that are not amenable to conservative measures of influence - with an aggravation of the symptoms of chronic tonsillitis and significant hypertrophy of the tonsils, surgical treatment is recommended:

• cryptolysis - removal of tonsilloliths formed in lacunae using a carbon dioxide or diode laser or radio frequency radiation;
• laser ablation of the tonsils;
• removal of tonsils (tonsillectomy) . [4], [5]

Prevention

The main thing in the prevention of the formation of caseous plugs on the tonsils in the throat is the treatment of recurrent and chronic tonsillitis and infections of the nasopharynx.

Forecast

The presence of caseous plugs for the life of patients has a good prognosis, but measures that are not taken in time - given the possible complications - can significantly worsen their condition.