Cista krajnika: simptomi, uzroci i liječenje

Introduction to Tonsil Cysts

Tonsil cysts are minor, rounded swelling or sacs filled with clear, watery fluid in or around the area of the tonsils. Even though they are not as widespread as, for example, tonsillitis, they can lead to soreness, swelling, and other manifestations that suggest a visit to the doctor. This article offers extensive information on tonsil cysts, signs, causes, diagnosis and treatment approaches.

Tonsils are two oval-shaped lymph glands located at the back of the throat. Locally, they are part of the body's immunity since they capture germs that find their way through the mouth or nose. However, cysts appear in the tonsils and need treatment if they become symptomatic or grow large enough to pose some risk to the individual's health.

Types of cysts that affect the tonsils include:

• Tonsillar retention cysts: These are very often seen and lead to dysphagia.
• Epidermoid cysts: While this type is seen in other body regions, such as the stomach, it is scarce in tonsils.
• Lymphoepithelial cysts: They often present as papillomatous lesions under the tongue or on the floor of the mouth. They very hardly develop on the tonsils.
• Hydatid cysts: These are also rarely involved in tonsillitis pathology. They develop as a result of a tapeworm known as Echinococcus granulosus.

What is the Prevalence of Tonsil Cysts?

Most tonsil cysts do not present clinical symptoms, so people with them will not seek treatment. That is why the frequency of their occurrence remains to be determined by researchers. Tonsillar retention cysts are the most prevalent tonsil cysts that can develop in people. These formations occur when mucus glands get blocked. Less than 0.01% of all cystic lesions, referred to as epidermoid cysts, are reported in the mouth and throat. 

What could be mistaken for a cyst on my tonsil?

If you have a sore throat and white or yellow spots or pus on your tonsils, you could have:

• Tonsillitis: Swollen tonsils with some yellow or white patches or coating usually characterise this inflammation of the tonsils.
• Strep throat: Ear infections can cause this type of bacterial tonsillitis, including large coated white tonsils.
• Infectious mononucleosis: Some of the signs of this virus are recorded to have included the inflammation of the tonsils.
• Tonsil stones (tonsilloliths): These are hard deposits of calcium formed from the accumulation of food deposits, bacteria and mucus.

What are the Signs and Symptoms of Tonsil Cysts?

1.  Swelling and Enlargement

 A tonsil cyst is one of the most noticeable signs, including a swollen area at the back of the throat. Although the cyst might be small, it can lead to enlarged tonsils due to the cyst formation. If the cyst is on one side of the face, the swelling is more on that side. Sometimes, the enlarged tonsil blocks the airway, making breathing or swallowing food difficult.

2.  Sore Throat

Sore throat is another sign that commonly occurs with tonsil cysts. The pain is usually caused by inflammation of the cyst. It is generally mild to moderate but can progress to severe if the cyst gets infected. The sore throat is similar to tonsillitis, but the pain is usually restricted to the area around the cyst.

3.  Difficulty Swallowing (Dysphagia)

As the cyst enlarges, it causes difficulties swallowing food, which is referred to as dysphagia. This becomes more complicated, especially when eating or drinking, as the large tonsils block the throat. In some cases, the cyst can produce pain when swallowing food, and some people feel that food is stuck in the throat.

4.  Bad Breath (Halitosis)

Tonsil cysts can capture germs and other particles, resulting in halitosis or foul breath. The bacteria accumulating in the cyst leads to an unpleasant odour, particularly if the cyst becomes infected. Mucus and dead cells will also pile up and cause this symptom even if you are not infected.

5.  Ear Pain

Although the cyst is in the throat, it can also cause referred pain in the ears. This is because there is a standard nerve supply to the throat and the ears. Most people with tonsil cysts state that they have dull or sharp pain in one or both ears even though they have no ear infection.

6.  Voice Changes

Depending on their size, tonsil cysts can cause voice alteration because they press on the vocal cords or hinder airflow. The cyst obstructs the vocal cords, and the voice sounds weak, hoarse, or nasal. This symptom is typically seen in people with more giant cysts than others.

7.  Visible Lump

Sometimes, a tonsil cyst is seen at the back of the throat as a swollen, white, or yellowing lump. This is usually detected during a general checkup by a doctor or the person themselves when they check their throat with a mirror. 

What are the Causes of Tonsil Cysts?

There are several causes which lead to the formation of tonsil cysts. Knowing the causes can assist in the prevention of cyst formation as well as proper care for patients with cysts.

1.  Chronic Infections

Recurring infections in the tonsils cause cysts to form. Inflammation and obstruction of tonsil crypts, which are small spaces in the tonsils, result from recurrent tonsillitis or other infections. Such blockages progress and form cysts because fluid begins to collect in them. 

2.  Tonsilloliths (Tonsil Stones)

Tonsil stones, commonly known as tonsilloliths, are small concretions that develop in the crypts of tonsils. These stones are typically benign but can create cysts if they grow or cause obstruction problems. Tonsilloliths are formed when food debris and dead cells accumulate, leading to cyst formation.

3.  Mucous Retention

Tonsil cysts occur when mucous accumulates in the tonsil crypts. The tonsils also secrete mucus; if the crypts are blocked, the mucus forms a cyst. This process is analogous to the formation of mucous retention cysts in other body areas, including the sinuses.

4.  Congenital Abnormalities

It is also important to note that some people are genetically predisposed to having tonsil cysts due to congenital disabilities. These defects can alter the architecture of the tonsils, resulting in blockages and fluid retention.

5.  Human Papillomavirus (HPV) Infection

HPV has been linked to the formation of cysts in the throat, including the tonsils. Some types of HPV can lead to the formation of benign tumours in the throat tissue, which forms cysts. Although it is not as frequent as other causes, this should be taken into consideration in patients with a history of HPV infection.

6.  Allergies and Irritants

Long-term contact with allergens or other agents that irritate the tonsils causes inflammation and, subsequently, the formation of cysts. People who have chronic rhinitis or postnasal drip are likely to develop tonsil cysts due to persistent inflammation. 

7.  Gastroesophageal Reflux Disease (GERD)

GERD results in the regurgitation of acids in the throat, causing inflammation of the tonsils, which leads to cyst formation. This is especially so in people who have chronic acid reflux since the tissues of the tonsils are regularly exposed to stomach acid.

What are the some of the Ways to Diagnose a Tonsil Cyst?

Tonsil cysts can be diagnosed through physical examination, medical history, and some diagnostic tests. Therefore, it is important to make the right diagnosis to determine the right treatment. 

1.  Physical Examination

First, a healthcare provider will examine the patient's throat and tonsils physically. If the cyst is large enough, one may be able to see it as a small lump on the tonsil. The healthcare provider might use a tongue depressor to better view the throat. Sometimes, a little camera called an endoscope is used to get a better look at the throat.

2.  Imaging Tests

If the cyst cannot be easily seen, further diagnostic tests, including ultrasound, CT scan, or MRI, are done to reveal and determine its size. Such tests reveal detailed images of the tonsils and adjacent tissues, which helps determine whether the cyst is benign or requires more referral. 

3.  Biopsy

If the cyst looks atypical or if there is a suspicion of cancer, a biopsy is conducted. This entails taking a small piece of tissue from the cyst to perform some tests in a laboratory. A biopsy can determine whether the cyst is benign, a neoplasm, or infected.

4.  Laboratory Tests

In case of an infection, the doctor conducts a throat or blood test to confirm the presence of bacterial or viral infection. Knowing the cause of the disease can be beneficial in managing the case, especially if antibiotics or antiviral drugs are warranted.

What are the Management and Treatment Options of Tonsil Cysts?

There are several ways through which doctors treat tonsil cysts, and these include: Most of the time, tonsil cysts do not need intervention; they heal on their own. However, if the cyst is painful or creates some disturbance, one must visit a doctor or a surgeon.

1.  Watchful Waiting

If the tonsil cyst is small and has no symptoms, the doctor advises the patient to refrain from intervention and instead monitor the cyst. This approach is usually recommended for patients with cysts revealed during routine examinations or when the patient has rather mild symptoms. The cyst is occasionally followed up with checkup examinations to see if it has grown or caused any other problems.  In many cases, the condition can be managed with watchful waiting, with no further intervention necessary unless symptoms appear.  Small tonsil cysts can be left untreated and disappear independently without medical treatment. Some studies conducted in NHS clinics have shown that 40-50% of asymptomatic cases do not progress and do not need any further intervention. It is advised to return every 3-6 months or so for a checkup on changes. A routine checkup is usually all that is required unless there are new symptoms to worry about.

2.  Antibiotics

Antibiotics are used in the treatment process if the cyst is due to a bacterial infection or has become infected. This is particularly helpful in cases of cysts that result from tonsillitis, peritonsillar abscess, or chronic tonsillitis.

Common Antibiotics: Penicillin or amoxicillin is usually taken, but doctors opt for clarithromycin for patients with penicillin allergies.

Duration of Treatment: The average period of antibiotic treatment is 7 to 10 days. For chronic infections, the treatment takes longer or has to be repeated several times.

Efficacy: Antibiotics can help reduce inflammation and pain and prevent the growth of bacteria. Nonetheless, antibiotics cannot remove the cyst unless an infection is present.

Complications: Misuse of antibiotics is one reason antibiotic resistance is a big problem in the UK. In the current world, healthcare providers do not easily prescribe antibiotics to patients since they are sure of the infection.

3.  Surgical Drainage

In other words, surgical drainage is advised if the cyst is large or painful. This entails making a small cut on the cyst and emptying the trapped fluid to help relieve symptoms like difficulty swallowing, pain, or obstruction.  It is usually a day case procedure, and the patient is usually given local anaesthesia. The cyst is cut to release the fluid enclosed within it. Recovery is relatively swift, and most people can return to their routine within a day or two. The effects of the pain relief are almost instant. Surgical drainage is not curative, and the cyst return if the root cause is not addressed. Based on the literature, it has been estimated that 20-30% of patients get a relapse after drainage, depending on the patient's condition. In UK clinics, surgical drainage is used in 15-20% of severe tonsil cyst symptoms cases.

4.  Tonsillectomy

This procedure is usually done for patients who have recurrent cysts in the tonsils or chronic tonsillitis. This is a surgical procedure in which all the tonsils are removed, and it is a permanent solution to cysts and recurrent infections.

Tonsillectomy is done under general anaesthesia; the patient is usually admitted for one night in the hospital. It is a relatively common operation. However, the recovery takes from one to two weeks. Tonsillectomy is the most efficient and radical method of treating recurrent tonsil cysts with a high efficiency. Research in the United Kingdom has reported that cyst-related problems can be cured in more than 90 per cent of patients who undergo a tonsillectomy, especially those with chronic tonsillitis. The primary complications include post-surgical bleeding and infection. There are very few side effects that can occur with the use of anaesthesia, and they are scarce. It is still rare, but such complications have significantly reduced due to the developments in surgical procedures. Tonsillectomy is still prevalent in the UK, and the NHS conducts over 35,000 tonsillectomies annually. Although most surgeries are for chronic tonsillitis, many are also done for recurrent tonsil cysts and other tonsil diseases.

5.  Laser Ablation

Laser ablation is a surgical procedure that uses laser light to remove the cyst by breaking it down. It is a relatively recent approach to cyst treatment and is usually employed in place of surgery in cases of minor or shallow cysts.

Laser ablation is most often performed under local anaesthesia. The laser beams are directed at the cyst without hurting other body parts; this lessens the inflammation and the chance of scarring. Recovery is faster than surgery; most patients can return to their routine in a day or two. The significant advantages of laser ablation are high accuracy and a short rehabilitation period. It also minimises the chances of the occurrence of the same disease again. It should be noted that the recurrence rate after laser procedures is 10-15%, while that of traditional surgical drainage is higher. Laser ablation is offered in some specific ENT clinics in the UK; however, it is not as popular as tonsillectomy or conventional surgery due to the cost and necessary equipment.

6.  Home Care and Treatment of Symptoms

Several home remedies help to reduce the symptoms of tonsil cysts in people with small cysts or those who have not opted for surgery. However, these remedies can only alleviate the symptoms and do not cure the cyst.

Rinsing the throat with warm saline water also helps to reduce swelling and pain. It also assists in maintaining the cleanliness of the area and minimises the chances of getting an infection.  Ibuprofen or acetaminophen can be purchased without a prescription and help manage pain and inflammation. Healthcare providers recommend these for pain relief in the comfort of the patient's home. Take water and use a humidifier to make the throat less dry or sore and thus make it easier to cope with the symptoms.

What are the Various Complications of Tonsil Cysts?

Tonsil cysts are generally not malignant, but if they are not addressed, they can cause problems, especially if they are large or infected. 

1.  Airway Obstruction

In severe cases, the vast tonsil cysts block the airway, making breathing difficult. This medical emergency needs to be handled as soon as possible. Some symptoms include difficulty breathing, a whistling sound during breathing, or a feeling of suffocation.

2.  Infection

If the tonsil cyst gets an infection, it is termed a tonsillar abscess. This condition is called peritonsillar abscess, in which pus forms a collection around the affected tonsil. An abscess can be very painful, cause fever, and cause problems swallowing food. To this end, it is recommended that a doctor treat the affected area to drain the abscess to stop the spread of the infection.

3.  Chronic Pain

Though the cyst is infected, it causes discomfort and pain, especially when swallowing food. This can be very debilitating and can also limit one's ability to eat, talk, or even sleep properly.

4.  Recurrence

Tonsil cysts return after treatment, especially if the cause is not treated. Some conditions that make a person likely to suffer recurrent cysts include chronic infections, allergies, or tonsil stones.

What are some of the Effective Prevention Strategies to avoid Tonsil Cysts?

To prevent the formation of tonsil cysts, one has to consider the factors that cause their development. Although it is impossible to avoid the formation of cysts entirely, the following measures help in the prevention of cyst formation:

1.  Good Oral Hygiene

Tonsil care involves preventing the accumulation of bacteria and other debris that lead to cyst formation through proper oral hygiene practices. One should always brush and floss teeth and use mouthwash to ensure the mouth and throat are clean.

2.  Managing Allergies

Patients with chronic allergies should consult their doctor to find ways to deal with their conditions. Minimising contact with allergens, taking antihistamines, or using nasal sprays also helps avoid inflammation of the tonsils.

3.  Treating Acid Reflux

GERD can be controlled through diet, medication, and lifestyle alterations to prevent the formation of tonsil cysts.

4.  Regular Medical Checkups

One can get a checkup from a healthcare provider and have the tonsil cysts diagnosed before they cause many symptoms. This enables the doctor to treat the condition in the early stage and, therefore, avoid complications.