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Concept: Tonsillolith


BACKGROUND: Nanotechnology is receiving enormous funding. Very little however is known about the health dangers of this technology so far. Chronic tonsillitis is one of a number of diseases called idiopathic. Among other factors, the tonsils are exposed to suspended particles in inhaled air including nano particles. The objective of this study was to detect and evaluate metallic particles in human tonsil tissue diagnosed with chronic tonsillitis and in amniotic fluid as a comparison. METHODS: Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) was used for identification of solid particles in a total of 64 samples of routinely analyzed biopsy and cytologic material. RESULTS: Almost all samples were found to contain solid particles of various metals. The most frequent, regardless of diagnosis, were iron, chromium, nickel and aluminium. The size, determined using SEM, varied from around 500 nm to 25 µm. The majority formed aggregates of several micrometers in size but there were a significant number of smaller (sub-micrometer or nano-sized) particles present. The incidence of metallic particles was similar in child and adult tissues. The difference was in composition: the presence of several metals in adults was due to occupational exposure. CONCLUSIONS: The presence of metallic particles in pathologically altered tissues may signal an alternative causation of some diseases. The ethiopathogenic explanation of these diseases associated with the presence of nano-sized particles in the organism has emerged into a new field of pathology, nanopathology.

Concepts: Iron, Metal, Scanning electron microscope, Energy-dispersive X-ray spectroscopy, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


Recent studies suggest that tonsilloliths are clinically related to halitosis and tonsillar abscess. Based on our empirical knowledge, tonsilloliths are relatively commonly encountered in daily clinical practice. It has been reported that the detection rate of tonsilloliths was under 24% in previous reports, although experience suggests otherwise. The purpose of the study was to evaluate the prevalence and characteristics of tonsilloliths using computed tomography (CT). In addition, the possible causes of low detection rates on panoramic radiographs were evaluated based on comparisons between CT images and panoramic radiographs in order to elucidate the limitations of visualizing the area around the palatine tonsils on panoramic radiographs.

Concepts: Medical imaging, Radiography, Report, Rates, Clinical death, Tonsil, Tonsillitis, Tonsillolith


Tonsillolith is a calcified mass in the tonsil and/or its surrounding tissue considered to be caused by chronic tonsillitis. However, here we hypothesised that a tonsillolith can also be formed by chronic saliva stasis in the tonsillar tissue, without any signs of chronic inflammation. We present a case of 32-year-old male patient with large tonsillolith. We reviewed his medical files, preoperative imaging and intraoperative findings. During a standard tonsillectomy we encountered a large tonsillolith measuring 3.1 x 2.6 cm. Additionally, a careful dissection of the lower pole of the remaining tonsillar tissue revealed a large fistulous tract filled with saliva. Postoperative examination of the preoperative computerized tomography scan found a hypodense fistulous tract extending from the lower tonsillar pole toward the left submandibular gland, measuring 36 mm in length, which was diagnosed as accessory duct of the submandibular gland. To our knowledge, this is the first case of a large tonsillolith associated with the accessory duct of the ipsilateral major salivary gland. Furthermore, from the aetiopathological view, this finding supports the saliva stasis hypothesis for formation of the tonsillolith. However, larger studies including a detailed radiological analyses as in our case, are needed to further investigate this possible aetiology of tonsilloliths.

Concepts: Saliva, Salivary gland, Submandibular gland, Sublingual gland, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


Recurrent tonsillitis might reduce the immunological capability of fighting against the infection of tonsil tissue. Polypodium leucotomos (Anapsos) immunomodulating effect has been subject of research in the last years. The aim of this research is to test the in vitro immunomodulating capacity of Anapsos in a child palatine tonsil explants model.

Concepts: Immunology, In vitro fertilisation, In vitro, Tonsil, Tonsillitis, Tonsillolith


Tonsillar stones are the products of calcified accumulates of cellular debris and microorganisms, in the crypts of palatine tonsils. Tonsillar stones are common findings and the known cause of bad breath (halitosis). Development of large tonsillar stones, however, is rare with only a few cases reported in the literature. We present the case of a 45-year-old man with a history of recurrent sore throat and tonsillitis for a long period, and snoring with other unremarkable ears, nose and throat findings. A large-sized tonsillar stone detected in the left tonsil measured 3.1 × 2.3 cm. The patient underwent elective stone removal and tonsillectomy.

Concepts: Oral hygiene, Stone, Tonsil, Tonsillectomy, Halitosis, Tonsillitis, Tonsillolith, Lymphatics of the head and neck


Benign enlargement of the lingual tonsils due to various causes may cause symptoms that warrant treatment. Conventional lingual tonsillectomy remains a challenging procedure, and there is no established standard procedure. We aimed to review the patients receiving different methods of lingual tonsil surgery for various indications at our institute.

Concepts: Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


Lingual tonsilloliths are not as well-known to radiologists than palatine tonsilloliths, although they might be common in clinical practice. The aim of this investigation was to clarify the prevalence and imaging characteristics of lingual tonsilloliths using panoramic radiographs and computed tomography (CT) images.

Concepts: Clinical trial, Medical imaging, Radiography, IMAGE, Tonsillolith, Post-nasal drip


Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.

Concepts: Infection, Glands, Pus, Salivary gland, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


Retropharyngeal lesions are often associated with Kawasaki disease (KD). A 4-year-old male first presented a peritonsillar and retropharyngeal abscess-like lesion. Surgical tonsillectomy was performed to avoid a risk of mediastinal abscess, but he fulfilled the diagnostic criteria of KD after the operation. This prompted us to perform a histological study on the KD tonsils.

Concepts: Medicine, Medical terms, Inflammations, Anatomical pathology, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.

Concepts: Pathology, Statistical significance, Lymphatic system, Part, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith