A cyst is a fluid-filled cavity with an epithelial lining. When this sac-like pocket forms inside the tonsils, it is termed a tonsil cyst. A tonsil cyst, like most cysts, is usually benign and non-cancerous.
Epidermoid cysts in the head and neck region are very rare. Tonsillar cysts are extremely rare, having an incidence of less than 0.01%.
The most common symptoms of a tonsil cyst are pain and difficulty in swallowing along with severe bad breath. Swollen glands, earache, headache, and fever may also be present. Several patients with tonsil cysts present to the clinics/hospitals with chronic headaches only.
Some people try to remove the cysts by squeezing them or pushing on them with a cotton swab. This should not be done as it can lead to infection and can cause the cysts to spread.
How Is a Tonsil Cyst Diagnosed?
A tonsil cyst can be of any type, i.e., epidermoid, tonsillar retention cyst, lymphoepithelial, or hydatid cyst. However, the most commonly occurring type is an epidermoid cyst.
An MRI scan reveals the cyst's contents and is used to diagnose a tonsil cyst.
MRI scans vary depending upon the protein density and fluid contents of the cyst. In most cases, hypertrophy of the involved tonsil is observed. Protrusion of the tonsil into the nasopharynx is seen in severe cases.
The treatment for tonsil cysts, or tonsil stones, usually begins with a round of antibiotics and may be all that is needed to clear them up. If these pus-filled lumps are thought to be cancerous, more serious treatments are required. In some cases, they may be chronic, and this also requires further treatment beyond antibiotics alone.
Sometimes tonsil cysts will clear up on their own without any medical treatment. If they persist, oral antibiotics are generally prescribed. It may be necessary to complete more than one cycle of antibiotics before the cysts are eliminated. They can be resistant to treatment and quite challenging to get rid of.
Penicillin and amoxicillin are commonly prescribed antibiotics for tonsil cysts that do not resolve independently. Antibiotic therapy is necessary if the adult patient also suffers from associated bacterial tonsillitis.
When tonsil cysts remain or recur after antibiotics have been tried, surgical removal may be required. A tonsillectomy is often performed by an otorhinolaryngologist, i.e., an ear, nose, and throat doctor. This type of surgery removes the tonsil tissues, which prevents the cysts from being able to form in the throat. Surgery is the only way to ensure that they do not return.
Surgical excision of a tonsil cyst is a delicate procedure. The surgeon must be conscious while removing the tonsil to prevent the cyst's rupturing. The tonsil cyst should be excised without opening because the contents of the cyst can get released into the surrounding fibrovascular tissues. That can cause an irritating effect on the surrounding structures.
Tonsillectomy procedures are generally safe, but there may be post-operative complications. Hemorrhage and pain are common complaints among patients after tonsillectomy surgery.
Studies show that patients undergoing intracapsular tonsillectomy procedures have reduced post-operative pain and hemorrhage incidence.
Tonsil Cancer Management
Most of these painful nodules are benign, but they can occasionally become cancerous. Cervical cysts tend to get converted into cancer. So, surgeons must be careful and should not invoke the condition lightly.
If a physician suspects cancer, a portion of the cyst is cut out and tested for malignancy.This is a biopsy. Malignant cysts are then completely removed, and further action may be required, such as chemotherapy or other medications.
If conversion of a tonsil cyst into cancer is suspected, the doctor can opt for any of the following therapies:
Induction chemotherapy (therapy before surgery) is now being used to manage tonsil cancer. In several cases, malignant tonsil cysts are surgically excised, followed by chemotherapy sessions.
In this therapy, the doctors combine different treatments to target cancer cells (tonsil cysts).
This type of therapy is used to strengthen the body’s immune system so that it can fight the uncontrolled, rapidly dividing cancer cells.
How to Prevent Formation of Tonsil Cysts?
Smoking and drinking alcohol can lead to tonsil cysts by increasing the amount of acid within the mouth and throat. Studies reveal that the smoking status of the patient plays a vital role in treatment prognosis.
Preventative measures should be taken to prevent tonsil cysts from recurring. Nasal irrigation is helpful in some cases, especially those that occur from frequent sinus infections. This habit can help remove debris from the sinuses and has been of utmost benefit to patients having thick mucus.
To do this, a saline solution is inhaled through the nose. The solution is then spit out and should not be swallowed. A saltwater gargle can also be helpful when done regularly because this loosens the calcium deposits that can lead to cysts.
When Should I Consult a Doctor for Tonsil Cyst?
In most cases, a tonsil cyst resolves on its own and does not require medical intervention. Smokers have a high chance of non-healing cysts. People with comorbidities that weaken the immune system may also need medical attention for a tonsil cyst.
You must visit the doctor if you experience a high fever with a tonsil cyst. A tonsillar swelling that interferes with breathing must not be neglected. If the tonsil cyst hinders breathing, you must immediately go to a doctor and get it removed.
Muscle weakness due to a tonsil cyst is a rare phenomenon, but if you feel weakness in your oropharyngeal muscles, you must visit a doctor at the earliest.
Similar Conditions That Mimic Tonsil Cyst
Treating a tonsil cyst is difficult not because of the condition itself but because of conditions similar to a tonsil cyst. Before starting treatment for a tonsil cyst, physicians carefully rule out conditions similar to a tonsil cyst. These include:
Tonsilloliths or tonsil stones can form inside the tonsils and present similarly to a tonsil cyst. These stones are frequently mistaken for tonsil cysts. People with tonsilloliths also face the problem of bad breath.
Bacterial infection can cause the tonsils to swell, i.e., tonsillitis. The condition is common in children and is contagious. Yellow-white pus draining from the tonsils can be mistaken for cyst contents.
Other conditions that mimic tonsil cyst are peritonsillar abscess, infectious mononucleosis, and strep throat.
Tonsil cysts are very rare, and they’re usually benign. This condition is more commonly seen among smokers and drinkers of alcohol. Treatment will depend on the severity of the problem; it could be solved with just antibiotics or it may require chemotherapy in the case of cancer.