Treatment of Tonsil Cysts (Tonsillar Stones)
Start with conservative management using adequate fluid intake and honey, as these simple measures can naturally flush debris from tonsillar crypts and provide antimicrobial benefits. 1
Conservative Management (First-Line Approach)
- Increase fluid intake significantly to help naturally flush debris and stones from the tonsillar crypts, which provides relief from associated discomfort 1
- Use honey as adjunctive therapy due to its antimicrobial properties and throat-soothing effects 1
- Observe for 12 months before considering any surgical intervention, as spontaneous improvement occurs in many cases 1
When to Consider Surgical Intervention
Tonsillectomy should only be considered if you meet the Paradise criteria for recurrent throat infections, which requires documentation of severe, recurrent episodes—not simply the presence of tonsil stones alone. 1
Paradise Criteria for Surgery:
- ≥7 documented episodes of clinically significant throat infection in the past year, OR 1
- ≥5 episodes per year for 2 consecutive years, OR 1
- ≥3 episodes per year for 3 consecutive years 1
Modifying Factors That Lower the Surgical Threshold:
- Multiple antibiotic allergies or intolerance 1
- History of peritonsillar abscess (especially >1 episode) 2, 1
Important Clinical Caveats
Tonsil stones (tonsilloliths) alone are NOT an indication for tonsillectomy unless accompanied by the recurrent infection criteria outlined above. The evidence provided focuses on tonsillectomy for recurrent tonsillitis and obstructive sleep-disordered breathing—not isolated tonsillar stones. 2
- Most patients with tonsil stones can be managed conservatively indefinitely 1
- Surgery carries significant risks including bleeding (potentially life-threatening), severe pain, dehydration, and rare serious complications 1, 3
- Post-tonsillectomy bleeding can occur up to 3 weeks after surgery when the wound is healing 3
Pain Management If Surgery Is Performed
- Multimodal analgesia is mandatory: scheduled acetaminophen combined with NSAIDs as baseline therapy 1
- Single intraoperative dose of IV dexamethasone to reduce pain and improve oral intake 2, 1
- Reserve opioids only as rescue medication; avoid codeine entirely in children under 12 years 1
- Monitor closely for adequate pain control to prevent poor oral intake and dehydration 1