Can Surgery Remove Tonsils for Chronic Tonsil Stones and Odor?

Can chronic and foul-smelling tonsil stones be treated with a tonsillectomy?

Hello Doctor, my tonsils have been developing stones every few days since high school.
A few years ago, I consulted a doctor who advised me to avoid dairy products for a while.
I have also been maintaining good oral hygiene, brushing my teeth after meals, using dental floss, getting my teeth cleaned every six months, and I regularly express my tonsils and rinse them with mouthwash.
However, there hasn't been much improvement so far.
Recently, my tonsils have become even smellier.
When I express the crypts where stones frequently form, I can only get some foul-smelling yellowish-white liquid out, and the tonsils still smell bad.
I can't seem to express the entire stone, and I'm starting to wonder if there might be stones lodged inside.
I feel like the only solution might be to remove my tonsils.
Doctor, I have a few questions: 1.
Even though my tonsils don't swell or hurt much, the bad odor is affecting my daily life.
Can I have my tonsils removed in this case? 2.
Can the long-term formation of tonsil stones be considered chronic inflammation? 3.
My tonsils have always appeared quite small; will the surgery be able to remove the deep crypts where the stones frequently form? (I feel like the crypts where stones form are quite deep.)

Ke Ke, 20~29 year old female. Ask Date: 2024/01/10

Dr. Ji Zhaoyun reply Otolaryngology

Hello, regarding the conditions for tonsillectomy that you mentioned, they are generally as follows: 1) Enlarged tonsils causing respiratory issues or conditions such as obstructive sleep apnea; 2) Presence of malignant tumors; 3) Recurrent tonsillitis (as you mentioned).
Internationally recognized criteria for recurrent tonsillitis include: a) More than 7 episodes of tonsillitis in one year; b) More than 5 episodes per year for two consecutive years; c) More than 3 episodes per year for three consecutive years.
If you meet these criteria, tonsillectomy may be recommended.
You can consult an otolaryngologist for further evaluation.

The potential complications of tonsillectomy primarily include: 1) Postoperative bleeding; 2) Wound infection, although these risks are relatively low.
You may experience pain for about three days post-surgery, and it is advisable to maintain a light, cool diet, avoiding hard and irritating foods.
If you are still undecided about whether to proceed with the tonsillectomy, it is recommended to rinse your mouth after meals to help clear any tonsil stones (located in the tonsillar crypts) and to avoid catching colds.
If you do catch a cold, seek medical attention promptly, as these measures can help reduce the likelihood of tonsillitis.
Wishing you good health and safety.

Reply Date: 2024/01/10

More Info

When it comes to chronic tonsil stones, also known as tonsilloliths, and the associated odor, surgery can indeed be a viable option for those who have not found relief through conservative measures. Tonsil stones form when debris, such as food particles, dead cells, and bacteria, accumulate in the crevices of the tonsils. This can lead to discomfort, bad breath, and in some cases, recurrent infections.
1. Surgical Consideration: If your tonsils are not inflamed but are causing significant odor and discomfort, tonsillectomy (surgical removal of the tonsils) may be considered. The decision to proceed with surgery should be based on the severity of your symptoms and their impact on your quality of life. Chronic bad breath and the inability to manage tonsil stones through hygiene practices can justify surgical intervention. It is essential to discuss your symptoms in detail with an ENT specialist, who can evaluate your condition and recommend the best course of action.

2. Chronic Inflammation: The presence of recurrent tonsil stones can indeed be indicative of chronic inflammation. While the tonsils may not always appear swollen or painful, the ongoing accumulation of debris and bacteria can lead to a state of chronic irritation. This can manifest as persistent odor and discomfort, even in the absence of acute infections. Chronic inflammation of the tonsils can also predispose individuals to further complications, including recurrent throat infections.

3. Surgical Technique: Regarding the surgical procedure, a skilled surgeon can effectively remove the tonsils, including the deep crypts where stones may form. The tonsils are composed of lymphoid tissue and can vary in size and shape among individuals. During a tonsillectomy, the surgeon will remove the entire tonsil, including the areas where stones are likely to develop. This procedure is typically performed under general anesthesia, and while there may be some risks associated with surgery, the benefits often outweigh the potential complications for patients suffering from chronic tonsil stones.

In summary, if your tonsil stones are significantly affecting your quality of life and conservative measures have not provided relief, a tonsillectomy may be a suitable option. It is crucial to have a thorough discussion with your healthcare provider about your symptoms, the potential benefits and risks of surgery, and what you can expect during the recovery process. Many patients report significant improvement in their symptoms and quality of life following the removal of their tonsils, especially those who have struggled with chronic tonsilloliths.

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