There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Tonsilloliths
The management of tonsilloliths, also known as tonsil stones, can be approached in several ways, including:
- Expectant management for small tonsilloliths, which are common clinical findings and may not require intervention 1
- Surgical intervention, such as tonsillectomy, for large tonsilloliths that cause symptoms such as odynophagia, dysphagia, and referred otalgia 2, 3
- Less invasive techniques, such as laser cryptolysis, which may be preferable to tonsillectomy in adults, potentially avoiding general anesthetic and the higher risk associated with tonsillectomy in this group 4, 5
Diagnostic Considerations
Diagnosis of tonsilloliths can be challenging, and a thorough history, careful inspection, and detailed characterization of the lesion through digital palpation are essential 3. Additional investigations, such as plain radiography and computer tomography, may also be useful in confirming the diagnosis.
Treatment Options
Treatment options for tonsilloliths include:
- Watchful waiting for small tonsilloliths or those that are asymptomatic 1
- Tonsillectomy for large or symptomatic tonsilloliths 2, 3
- Laser cryptolysis, which has been shown to be effective in reducing symptoms and improving patient satisfaction 4
- Medical management, such as antibiotics, for cases of recurrent tonsillitis or tonsillolithiasis 5, 1