Generality
Cryptic tonsils are the manifestation of repeated inflammation of these lymphatic organs ( chronic tonsillitis ).
More in detail, the term is used to indicate the occupation of the space of the crypts (or cavities) present on the surface of the tonsillar glands, by infectious debris, deposits of calcific material or food residues.
Cryptic tonsils are associated with the appearance of whitish and foul- smelling plaques, bad breath ( halitosis ), ear pain, sore throat, swallowing problems and hypertrophic tonsils.
When food or other sediments occupy the space of tonsil crypts and settle permanently, they can give rise to a series of annoyances that must be corrected promptly with the appropriate treatment.
In this regard, a careful clinical evaluation by the otolaryngologist allows to identify the exact causes of the disorder and establish the most appropriate therapeutic strategies. If the cryptic tonsils cause serious recurrent infections and are resistant to drug treatment, an indication is given to their removal ( tonsillectomy ).
Tonsils: short introduction
- The tonsils are organs formed by lymphoid tissue, located on the sides of the throat, immediately behind and above the base of the tongue. When they are normal, these glands are barely visible and have a uniform rosy color. Their ovoid shape is reminiscent of an almond.
- Being in a strategic position, the tonsils have the function of forming a first barrier against infections of the upper airways, especially important during childhood, when the immune system is still not mature. These structures also favor immunization against external micro-organisms, which penetrate through the nose and mouth: when they become inflamed, the tonsils force the body to produce antibodies that can neutralize viruses and bacteria. Pharyngeal tonsils, more commonly known as adenoids, also participate in this defense against respiratory infections.
- In some cases, however, the task of the tonsils is less: after repeated bacterial or viral aggressions, these can excessively increase in volume (hypertrophy), become chronically inflamed and turn, in turn, into an outbreak of infection for other organs or tissues (heart, kidneys, etc.).
What are
Cryptic tonsils are a disorder that tends to occur over the years, when the lymphatic tissue that forms them tends to shrink, leaving the crypts partially empty and thus allowing the accumulation of infectious debris, deposits of calcific material (tonsil stones) or food residues.
Cryptic tonsons: what are they?
Present from birth, the tonsils develop progressively and reach their maximum size at the age of 3-5 years. At the age of about 7, these organs undergo an involution process, reducing their size due to the physiological atrophy, which makes them barely visible during adolescence. In adulthood, the tonsils become practically inactive from the functional point of view.
Over time, therefore, the tonsil tissues begin to shrink.
During this process, tonsillar crypts can be affected by pathological processes, also due to their particular conformation.
In particular, inside these spaces food or other residues are deposited, which, over time, undergo putrefactive processes, causing the repeated appearance of whitish and foul-smelling plaques on the tonsils and predisposing them to other unpleasant problems.
To favor cryptic tonsils are, in most cases, repeated inflammatory processes against them ( tonsillitis ) and, possibly, surrounding tissues (adenotonsillitis or pharyngotonsillitis).
What are tonsil crypts?
The tonsils are structured as a sort of hive, in which a fibrous scaffold contains lymphatic tissue; the latter component undergoes a progressive reduction, during adolescence, due to the physiological process of tonsillar involution. In some people, however, the marked volume reduction of the connective part is not supported by the fibrous scaffolding.
It follows the appearance of empty crypts, that is more or less deep cavities, which are naturally found in the tissue that makes up the tonsils; in the adult, these pockets or folds are on average 10-20 and generally have small dimensions.
Inside the tonsillar crypts, in some cases, food or other residues can be deposited that, over time, not being digested, undergo putrefactive processes. The detritus is thus formed, also called whitish caseum, which fills the cavities and causes halitosis characteristic of cryptic tonsils.
Causes
Cryptic tonsils are related to the physiological process of atrophy of tonsillar tissue .
As anticipated, the cryptic tonsils present a conformation such that they manage to trap food residues, bacteria, mucus and various kinds of debris. This predisposes to the activation of the immune system, which reacts against what has accumulated in the crypts, to eliminate it. The main factor predisposing cryptic tonsils are the chronic forms of tonsillitis (chronic inflammation of the tonsils): the relapsing episodes, causing a thickening of the epithelium, reduce the immunogenic activity of these lymphoid glands.
Cryptic tonsils: who is most affected?
Cryptic tonsils most frequently affect adolescents and young adults, as their manifestation is related to the natural process of tonsillar involution. In children, this condition is, however, very rare.
Symptoms and Complications
The clinical picture of cryptic tonsils is characterized by the repeated appearance, with variable frequency, of agglomerates of whitish and malodorous material, at the level of the areas concerned. The patient mostly feels a sense of foreign body .
On observation, the cryptic tonsils appear as enlarged masses, of cavernous appearance. One of the most characteristic manifestations of this disorder is halitosis (or bad breath) accompanied by a bitter and unpleasant taste in the mouth .
Other symptoms of cryptic tonsils include:
- Sore throat (slight pain, discomfort or tingling);
- Radiated ear pain (reflex otalgia supported by the common innervation);
- Swallowing pain (odinophagy);
- Dysphagia (difficulty swallowing food).
If there is a concomitant inflammation, the cryptic tonsils may appear red. Unlike tonsillitis, fever is absent. In some cases, the material that accumulates in the crypts is more difficult to eliminate, so it tends to remain on the training site. The calcification of these residues predisposes to the formation of tonsillolites (or tonsil stones) or to chronic caseous (or cryptic-caseosa) tonsillitis .
Diagnosis
The evaluation of cryptic tonsils can be performed by your primary care physician or otolaryngologist.
To formulate the correct diagnosis, the procedure provides:
- Anamnesis : the doctor asks the patient to describe the symptoms, report any throat pathologies and previous inflammatory episodes.
- Physical examination : consists in the complete inspection of the upper air and digestive tract (oral cavity and throat). Cryptic tonsils cause signs similar to those of infective tonsillitis: the glands are covered with white-yellowish plaques, but the fever is absent.
- Laboratory tests : if your doctor suspects that chronic tonsillitis at the base of cryptic tonsils is supported by mononucleosis or other viral agents, it will require specific blood chemistry analysis . The patient may be subjected to an oropharyngeal swab which usually attests to the presence of Streptococcus bacterial infection. This exam consists in taking a small amount of throat secretion with a sterile cotton coated stick: the liquid is then analyzed in the laboratory to identify the etiological agent in a few days. The request of the antistreptolysinic titre (TAS) is fundamental, instead, to exclude the infection with group A beta hemolytic Streptococcus and can be an indicator of phlogosis of the tonsils even after some time.
- Imaging examinations (X-rays or CT scans) : in the case of diagnostic doubt, diagnostic imaging clarifies the position, extent and nature of the formations present at the tonsillar level (foreign bodies, tonsil stones, calcified granulomas, tumors, etc.) .
In the absence of a marked symptomatology, the diagnosis of cryptic tonsils can occur after performing tests prescribed for other reasons.
Treatment
The treatment of cryptic tonsils depends on the severity of the symptoms and the triggering causes. Often, the disease resolves itself over time, when the progressive collapse of the fibrous scaffolding no longer allows the crypts to fill with caseous material.
To alleviate disorders associated with cryptic tonsils, it may be helpful to rinse the throat with gargling using an antiseptic mouthwash or saline solution .
If the basic problem is chronic tonsillitis sustained by a bacterial infection, the doctor may indicate the intake of antibiotics aimed at selectively eradicating the pathogen responsible for the disorder. The doctor may also indicate the intake of antipyretics and analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
If the tonsillar crypts are large, it is possible to remove the caseous material from the tonsil crypts with the so-called " squeezing "; this maneuver is performed by the otolaryngologist specialist generally with a tongue depressor exerting a slight pressure below the crypt, sufficient to make the contents come out.
In the most stubborn cases of cryptic tonsils, a tonsillectomy is performed (ie the tonsils surgical procedure). This frees the patient from the persistent discomfort caused by halitosis and the sense of foreign body in the throat.
