White spots on the tonsils are often associated with a condition called tonsillitis, which is the inflammation of the two small glands located at the back of the throat, or the tonsils. The white spots are typically a visible indication of infection or inflammation in the tonsils and can have various causes.
Common causes of white spots on tonsils
Dr Arpit Sharma, consultant – ENT and Head Neck Surgeon at P D Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, says that the most common cause of white spots in the tonsils is acute follicular tonsillitis. This is usually accompanied by sore throat, pain while swallowing, and fever. This condition is usually bacterial or viral in nature and can lead to the formation of pus-filled pockets or follicles on the surface of the tonsils. These pockets or white spots are a result of the body’s immune response to the infection, and often contain dead cells, debris, and bacteria.
The other common causes of white spots can be infectious mononucleosis, (caused by the Epstein-Barr virus, which can make one feel very tired and sick), viral tonsillitis (EBV and herpes), tonsillitis, candidiasis, a fungal infection caused by a yeast called Candida, and aphthous ulcers (a common type of mouth ulcer). Herpes is a group of viruses that can cause various infections. Herpes is contagious and can spread through close contact, including kissing or sexual activity.
Dr Sharma says that the pain and discomfort usually depend on the severity of the infection. “It can be bearable with minimal discomfort or at times severe enough to not be able to take food orally and may require pain medications,” she points out.
Sometimes, bits of food stuck in one’s tonsils. If they stay there for a while, they turn into hard deposits known as tonsil stones, according to a 2020 study by a team led by Dr Simone Arvisais-Anhalt, director of Laboratory Medicine Informatics at University of California. When one can see these stones, they usually look like small white or yellow pebbles. They might attract bacteria, which can make one’s breath smell bad. Pus can also gather in the crevices and harden, making the stone bigger.
Dr Ravi M, senior consultant – ENT, Fortis Hospital, Bengaluru says that white spots on the tonsils can be due to infection or food particles decomposing on their surface. These white spots often appear in the form of patches. “The surface of the tonsils has small pits where food particles can stuck. Over time, bacteria and natural processes cause these trapped particles to decompose, forming small white particles known as tonsil stones or tonsilloliths,” he explains. In simple terms, these are like little stones that can develop on the tonsils.
Symptoms
There can be a variety of accompanying symptoms with white spots on tonsils, like fever, cough, sneezing, headache, difficulty in swallowing, body aches, stuffy nose, swelling in the neck, and facial pain.
Diagnosis and treatment
The diagnosis is made based on clinical examination and other factors like age, the severity of symptoms, and other accompanying symptoms. However, in some situations, a blood test may be required. Sometimes, a throat swab is also useful in diagnosis.
Dr Ravi M says that vaccination has significantly reduced the occurrence of certain infections causing white patches, like diphtheria, which are now rare.
The treatment is in the form of symptomatic management with painkillers, anti-allergy medications, gargles, and antacids. Clinical features determine the need for antibiotics. “The management algorithm also depends on presenting symptoms and their severity and, the age of the patient,” says Dr Sharma.
Takeaway
White spots on your tonsils might seem scary, but they are usually not harmful. They are just a sign that your immune system is working to protect you. These spots often appear when you have a bacterial, viral, or yeast infection. The most effective treatment is usually antibiotics to fight the infection. In general, white spots on tonsils are not a big concern and usually disappear after treatment.
