Medical News Today: Are holes in tonsils normal?

Holes in the tonsils, or tonsillar crypts, are a normal part of a person’s anatomy. However, these holes at the back of the throat can trap bacteria and become blocked with food particles, mucus, and other debris.

Some conditions and situations that affect the holes in the tonsils can cause inflammation, a sore throat, and other bothersome symptoms. Learn more about them and what to do in this article.

What are holes in the tonsils?

Close up of the tonsils
Holes in the tonsils are normal.

Tonsils are gland-like structures at the back of the throat. They contain cells called lymphocytes that help fight off and protect the body from infections.

Tonsils help trap bacteria and viruses that enter via the throat, stopping them before they reach other parts of the body.

Holes in the tonsils can inform the immune system about what a person is ingesting through their mouth.

But, because of their role in tackling bacteria and viruses, tonsils are also susceptible to infections.

If the tonsils become swollen, then inflammation, debris, or the formation of scar tissue due to another condition may block the holes.


Causes

Several conditions can affect the holes in the tonsils and put a person at risk of infection, including:

Tonsillitis

Tonsillitis occurs when the tonsils become inflamed, usually due to a viral or bacterial infection. Both children and adults can get tonsillitis, though it is more likely to occur in children.

A person with tonsillitis may be able to feel the swollen glands in their neck. Other symptoms of tonsillitis include:

Strep throat

Strep throat is a form of tonsillitis. This infection of the throat and tonsils more commonly occurs in children. A person gets strep throat by coming into contact with group A Streptococcus bacteria.

Strep throat is infectious and passed on through the germs in coughs and sneezes. It is also possible for people to develop strep throat by coming into contact with open sores on an infected person’s skin.

Symptoms of strep throat include:

  • a painful, scratchy throat
  • pain when swallowing
  • swollen tonsils that may be red with streaks of pus
  • swollen lymph nodes in the neck
  • red spots on the roof of the mouth
  • fever

Less common symptoms include:

  • a headache
  • stomach pain
  • nausea
  • a rash

Mononucleosis

Mononucleosis, or “mono,” is another condition that can cause the holes in the tonsils to become inflamed.

Symptoms of mono include:

  • a sore throat
  • swollen tonsils with pus
  • fatigue
  • fever
  • rashes
  • a headache
  • body aches
  • swelling of the lymph nodes in the neck, armpits, or both
  • less commonly, swelling of the liver or spleen

Mono is infectious and is most common in young adults, including teenagers, and particularly college students.

The most common cause of infectious mononucleosis is the transmission of the Epstein-Barr virus (EBV) from person to person. However, some other virus types may also cause it.

Symptoms can take around 4 to 6 weeks to develop after a person is infected with EBV.

Poor oral hygiene

dental hygiene products including toothbrush floss and mouthwash
Poor oral hygiene can affect the holes in the tonsils.

If a person does not practice good oral hygiene, a buildup of bacteria could cause an infection in the tonsils.

Symptoms of poor oral hygiene include:

  • bad breath
  • recurrent cavities
  • plaque on the teeth
  • a coating on the tongue

Tonsil stones

Tonsil stones can occur when debris, such as food, dead cells, or bacteria, become trapped in the holes in the tonsils and calcify, forming hard stones.

People with chronic inflammation in their tonsils or those who experience reoccurring bouts of tonsillitis may be more likely to develop tonsil stones.

Sometimes, tonsil stones can grow, making holes in the tonsils larger and possibly prolonging an infection.

Symptoms of tonsil stones include:

  • a sore throat
  • bad breath
  • white debris visible at the back of the throat
  • trouble swallowing
  • pain in the ears
  • a persistent cough

For many people, tonsil stones cause no symptoms and they do not need to treat them.

Oral and tonsil cancer

In rare cases, people link holes in the tonsils to oral cancer that impacts a person’s tonsils.

Signs and symptoms of oral cancer include:

  • a sore that appears in the back of the mouth and does not heal
  • one tonsil that is larger than the other
  • a sore throat that does not improve
  • mouth and ear pain
  • pain when swallowing
  • a lump in the neck
  • blood in the saliva
  • bad breath

Treatment

While a doctor will not treat the holes in the tonsils, they may need to address the underlying cause of any symptoms.

Treatment will depend on the underlying problem, such as:

Tonsillitis

A person with tonsillitis does not necessarily need treatment, as the body can sometimes fight off the infection by itself.

A doctor may recommend drinking plenty of fluids, resting, and taking over-the-counter (OTC) pain relievers to minimize discomfort.

If symptoms persist beyond 3 to 4 days or get increasingly severe, a person should see a doctor. The doctor may also test for a strep infection and prescribe antibiotics or other medications, as needed.

Strep throat

strep throat br image credit james heilman md 2010 august 12 br
If a person suspects that they have strep throat, they should see a doctor.
Image credit: James Heilman MD, 2010

If a person thinks they have strep throat, they should also make an appointment to see a doctor.

A doctor will examine the throat and do a throat swab to check for group A strep bacteria.

Strep throat may need antibiotics to treat the infection, so it does not cause problems later.

Antibiotics also help reduce symptoms and prevent the spread of infection to other people.

Mononucleosis

Treatment for mono may vary depending on its severity. If a person’s organs have become inflamed, a doctor may suggest treatment to target those symptoms.

A person with mono should also:

  • stay hydrated by drinking lots of water and other clear fluids
  • rest as often as necessary
  • take OTC medications to reduce fever and manage pain

Doctors do not recommend treating mono with penicillin antibiotics, such as ampicillin or amoxicillin.

If a person’s spleen becomes enlarged due to mono, they should avoid contact sports or other intense physical activity. Taking part in strenuous exercise could cause the spleen to rupture.

Poor oral hygiene

People can improve their oral hygiene practices by:

  • brushing the teeth for 2 minutes at least twice a day
  • flossing every day
  • drinking plenty of water
  • using an antibacterial mouthwash
  • stopping smoking

Tonsil stones

Treatment for tonsil stones will depend on how large the stones are, and whether or not they are causing any symptoms.

Smaller stones can often be dislodged by gargling salt water. If this does not work, a person may want to talk to their doctor who may use lasers or sound waves to dislodge the stones.

A doctor may also suggest a simple surgical procedure if the stones are large and difficult to remove.

Occasionally, people may find it is helpful to use antibiotics to treat tonsil stones and their side effects, particularly if they cause an infection.

Oral and tonsil cancer

Treatment for oral and tonsil cancer will depend on the type of cancer, its stage at diagnosis, and whether it has spread. Treatment could include surgery, chemotherapy, or radiotherapy, or sometimes more than one of these.


When to see a doctor

While holes in the tonsils are normal, a buildup of debris or bacterial or viral infection in the tonsils can cause health problems.

The best way to reduce the risk of complications from holes in the tonsils is by maintaining good oral hygiene, not smoking, and frequently washing the hands.

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