The caseum on the tonsils results in the presence of small whitish balls visible on the tonsils. This phenomenon is not pathological, it is even frequent with age. However, it is best to clear the tonsils of this aggregate to avoid any complications.

The caseum on the tonsils or cryptic tonsil is a “normal” phenomenon (not pathological): it results in an aggregate of dead cells, food debris, bacteria or even fibrin (filamentous protein) which lodges in the cavities. tonsils called “crypts”. These crypts are furrows on the surface of the tonsils; generally the latter widen more and more with age: the cryptic amygdala is frequent around the age of 40-50 years.

The caseum takes the form of small whitish, yellowish or even grayish balls of irregular shapes and pasty consistency. It is visible to the naked eye when examining the fundus. Caseum is also often associated with foul breath. Note that the term caseum comes from the Latin “caseus” meaning cheese in reference to the compact appearance and the nauseating odor of the caseum which racall the cheese.

The main risks of complications are the formation of cysts (by occlusion of the tonsil crypts) or the installation of calcium concretions (tonsilloliths) in the tonsil crypts. Sometimes the presence of caseum on the tonsils is also symptomatic of chronic tonsillitis: if this inflammation of the tonsils is benign, it can cause complications and must be treated.

Chronic tonsillitis

The occurrence of caseum on the tonsils may indicate chronic tonsillitis. This benign pathology is nonetheless bothersome and is not without risk of local complications (intra-tonsillar abscess, per-tonsillar phlegmon, etc.) or general (headaches, digestive disorders, infection of the heart valve, etc.) etc.).

Generally, the symptoms are subtle but persistent, prompting patients to consult:

• bad breath;
• discomfort when swallowing;
• tingling;
• sensation of a foreign body in the throat;
• dysphagia (feeling of blockage felt during feeding);
• dry cough ;
• tired ;
• etc.

The origin of this affection which preferentially affects young adults is not well known, although certain contributing factors have been pointed out:

• allergy;
• poor oral hygiene;
• smoking;
• repeated nasal or sinus complaints.

Tonsillolithes

The presence of caseum can cause a condition called tonsilloliths or tonsillitis or tonsil stones.

Indeed, the caseum can calcify to form hard substances (called stones, stones or tonsilloliths). In the majority of cases, calcium concretions are located in the palatal tonsils2. Certain symptoms generally prompt the patient to consult:

• chronic bad breath (halitosis);
• irritative cough,
• dysphagia (feeling of blockage during feeding);
• earache (ear pain);
• sensations of a foreign body in the throat;
• a bad taste in the mouth (dysgeusia);
• or recurrent episodes of inflammation and ulcerations of the tonsils.

The treatment is often carried out from small local means that the patient can carry out himself:

• gargles with salt water or baking soda;
• mouthwashes ;
• cleaning the tonsils using a Q-tip soaked in solution for mouthwash, etc.

A specialist can intervene by various local means:

• Water spraying by hydropulseur ;
• Superficial CO2 laser spraying which is practiced under local anesthesia and which reduces the size of the tonsils and the depth of the crypts. Usually 2 to 3 sessions are necessary;
• Use of radiofrequencies which allow the retraction of the treated tonsils. This painless surface method usually requires several months of delay before observing the effects. This treatment consists of a deep gesture in the amygdala by means of double electrodes between which passes a radio frequency current determining an extremely precise cauterization, localized and without diffusion.

Chronic tonsillitis

Clinical examination of the tonsils (mainly by palpation of the tonsils) confirms the diagnosis.

Tonsillolithes

It is not uncommon for these stones to be asymptomatic and to be discovered incidentally during an orthopantomogram (OPT). The diagnosis can be confirmed by CT scan or MRI2.