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Despite having a complicated name and not always known by the population, tonsil caseum are the popular “balls in the throat”, at the back of the mouth. They are easily identified when the individual looks into the mouth with the help of a mirror and sees a whitish or yellow pasty substance in the tonsils.

These are bacterial plaques that form inside small cavities in the tonsils. They are also called “caseum”, which comes from Latin and means cheese, in addition to “stones in the tonsils”.

Tonsil caseum generally poses no health risk. It is common for many people to not even realize they have the problem. That’s because they are quite small, similar to a grain of rice. But there are cases where the size gets in the way, causing swelling in the tonsils and the odor is usually unpleasant, causing bad breath.

Below, see details of the causes of tonsil stones, symptoms and treatment options.

Tonsillar caseum: what they are and symptoms

What are tonsillar caseum?

You caseous tonsils are small bumps that appear on the surface of the tonsils – which are structures that help the immune system and filter viruses and bacteria that enter through the mouth. This mass is the densest and most viscous bacterial plaque, formed by the mixture of microorganisms, mouth cells, food residues and salivary proteins.

Generally, the tone of caseous tonsils varies from whitish to yellowish and can appear in both tonsils and have different sizes, being usually quite small. Most of the time, they have a strong and unpleasant odor and are released from the tonsils when the individual sneezes, coughs, swallows saliva or compresses the region. The person can still swallow without feeling it.

What are the symptoms of tonsillar caseum?

It is common that the caseous tonsils do not cause symptoms. However, some people have:

  • Bad breath (halitosis);
  • Cough;
  • Ear or throat pain;
  • Unpleasant taste in the mouth;
  • Difficulty swallowing;
  • Swelling in the tonsils;
  • Feeling that something is stuck in the throat;
  • White or yellow spots on the tonsils;
  • Throat infections that are difficult to treat.

In the presence of caseous it can still be associated with the appearance of tongue coating, periodontal disease, and even infections such as pharyngitis and tonsillitis.

What are the causes of tonsillar caseum?

To understand the causes of caseous tonsils It is important to know that the tonsils have crypts (holes), which contribute to the accumulation of food and bacteria in the place. These debris are trapped in the region and form “balls” in the throat.

Why do tonsil caseum cause bad breath?

One of the main symptoms of caseous tonsils is bad breath, which is also known as halitosis. An estimated 3% of unpleasant odor cases are linked to the problem, according to a survey.

You caseous tonsils cause halitosis due to the accumulation of food debris, formation of bacteria and dead cells in the tonsils. However, it is worth noting that several conditions lead to bad breath and it is worth seeking a medical evaluation to check the cause of the symptom.

Who is more likely to have the problem?

All people who still have tonsils can have them. caseous tonsils. However, some people’s tonsils are known to have larger crypts, making them more likely to develop the problem.

In addition, those who have a lower flow of saliva and perform oral hygiene inappropriately also facilitate the formation of caseous and are more likely to have the condition.

It also occurs more frequently in situations that involve increased cell desquamation, including dryness caused by mouth breathing, snoring, frequent ingestion of alcoholic beverages or use of mouthwash with alcohol, orthodontic device and in those who are accustomed to nibble lips and cheeks or fingers.

People with chronic respiratory diseases, salivary gland dysfunction, gastroesophageal reflux and smokers have local changes in pH and consistency of mucus and saliva, making them more susceptible. The formation of caseous.

How is the diagnosis performed?

The diagnosis is made through a simple examination of the tonsils. Generally, the caseous tonsils are easily visible, therefore, in most cases, they do not require specific examinations.

There are rare cases in which imaging tests such as computed tomography or magnetic resonance imaging are requested to identify them and rule out other health problems.

What is the treatment for tonsillar caseum?

Most of the time, the caseous tonsils do not require treatment, only when there is great discomfort or bad breath. There are no medications to treat the problem and antibiotics are rarely given to fight laryngitis or bacterial pharyngitis, which can occur in those who have the condition.

In some cases, the specialist indicates a laser procedure. In this way, the crypts are eliminated, in which the caseous form. However, it does not guarantee that they will not appear again. There is also the possibility of mechanically removing the caseous by understanding the tonsils or with a spatula, always with medical help.

Gargling with warm water usually relieves symptoms, but using cotton swabs (or other objects) to eliminate the symptoms caseous tonsils at home is not recommended. And in some cases, they can even make the situation worse. Therefore, when in doubt, it is essential to seek the help of an expert to receive the correct guidance.

How to prevent?

It is common that the caseous tonsils appear regularly where you are predisposed to having the problem. One way to prevent it is to keep your oral health up to date, brush your teeth and tongue well regularly.

The recommendation is to brush your teeth right after meals, at bedtime and in the morning. Flossing daily also removes the risk of the problem. It is important to avoid smoking and it is recommended to drink plenty of water during the day.

When is surgery necessary?

When the caseous tonsils are causing a lot of discomfort or other problems, there is the possibility of performing a tonsillectomy, that is, the surgical removal of the tonsils. However, this procedure is rarely recommended and is considered a last resort.

Surgery is only indicated when the caseous they cause frequent tonsillitis (inflammation of the tonsils) and compromise the individual’s quality of life. That’s because, like any surgery, it offers some risks, pain and bleeding.

Which doctor to look for?

You caseous tonsils are not considered serious health problems and generally do not need medical help. However, some people experience great discomfort and frequent bad breath.

In these situations, it is worth looking for an otolaryngologist, who is the specialist responsible for treating diseases that affect the nose, sinuses, throat and ears. The dentist also advises on how to alleviate the symptoms of caseous tonsils and indicates ways of prevention.


Sandro Coelhootorhinolaryngologist at the UFC Hospital Complex (Federal University of Ceará), which is part of the Ebserh network; Adriano Fonsecaotorhinolaryngologist and head and neck surgeon at Hospital Aliança Rede D’Or, in Bahia; Marcelo Mello, otorhinolaryngologist at Hospital Cema; and Eduardo Bogazotorhinolaryngologist at the São Camilo Hospital Network (SP).

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