Tonsil Stones

This month’s blog deals with the common and often embarrassing problem of tonsil stones. Tonsils stones (or tonsilliths) are small clumps of whitish, odorous debris that collect in the surface crevices (crypts) of the tonsils. Many people think they are food particles, but they are primarily made up of shedded epithelium. The epithelium or surface lining of the tonsil will shed, much like skin sheds, and collect in the crypts of the tonsils. This epithelial debris may then mix with bacteria, resulting in a low grade sore throat and/or chronic bad breath. When the tonsilliths fill the crypt they may be coughed out or sometimes removed with pressure from a Qtip or the patient’s finger. After removal, they will generally recollect within weeks to months. They can be extremely annoying but are not dangerous, so if they are noticed infrequently and are only mildly symptomatic, they do not require treatment. However, for some patients, tonsilliths can be a weekly or even daily annoyance, and these patients often seek remedies.


The only permanent solution for tonsilliths is removal of the tonsils (tonsillectomy). Tonsillectomy is generally performed as an outpatient procedure under general anesthesia and the postoperative course is often quite painful. Usually the patient requires a week out of work or school. One alternative to complete tonsillectomy is cryptolysis or laser ablation of the tonsils. At Raleigh ENT this procedure is performed in the office under local anesthesia with the use of the carbon dioxide laser. The laser is used to remove enough of the tonsil to open up the crypts and therefore prevent reaccumulation of the tonsilliths. Generally, there is less pain than that associated with complete tonsillectomy and some patients may be able to return to work the next day. Not all patients may be appropriate for this procedure based on their anatomy as well as the activity of their gag reflex. A video demonstrating this procedure is available for review at www.thedoctorstv.com/main/procedure_list/279. Please call 787-7171 if you would like to schedule an appointment and discuss options of treatment with one of our physicians.


Stephen E. Boyce, MD, FACS

Sublingual Immunotherapy

As spring has arrived in the Triangle, we thought that sublingual immunotherapy (SLIT) would be a timely topic for our second blog post.  As opposed to allergy shots, SLIT consists of allergy drops placed under the tongue.  SLIT has been popular in Europe for years and is becoming increasingly popular in the United States.  SLIT has an excellent safety profile so patients can do the treatment at home.  The advantage for needle phobic patients is obvious.

While SLIT is an attractive option for some patients, there are also some disadvantages.  SLIT is not yet FDA approved in the United States and most insurance companies consider SLIT an alternative treatment for allergies and asthma.  Patients are responsible for the cost of the serum.  Optimal dosing in SLIT is an area of controversy.  At Raleigh ENT, we follow dosing protocols advocated by the American Academy of Otolargngic Allergy.  Finally, while many studies show that SLIT is an effective treatment, there is still some question whether SLIT is equally as effective as allergy shots. 

At Raleigh Ear, Nose, and Throat we offer allergy testing and treatment that ranges from medical treatment to immunotherapy (SLIT or allergy shots).  We feel that SLIT is a nice option for some of our allergy patients.

First Blog Post

Welcome to Raleigh ENT’s first blog post. We want to use this space to provide updates about our practice. Mostly I anticipate this will be in the form of clinical information. We are excited about the new additions to our website and want to be able to connect to our patients through a variety of ways.

The first topic is balloon sinuplasty. This is a relatively new tool we have to deal with chronic sinus infections. Through the years there have been important advances in the surgical treatment of sinus infections. In the 1980’s endoscopic surgery provided an enhanced view of the sinus passages and improved the accuracy of the procedure. In the 1990’s image guided techniques provided an intraoperative road map of the sinuses. This gives us anatomical detail on the order of several millimeters during a procedure and helps us to safely dissect within the sinus passages.

Balloon sinuplasty is another important advancement. The goal of sinus surgery is to improve the natural drainage pathways. A balloon is advanced over a guide wire into the offending sinus. The balloon is then inflated which safely and relatively atraumatically enlarges the natural opening. This is a similar concept to angioplasty to help relieve clogged arteries.

Our goal is to continually evaluate how we practice medicine. We are constantly learning new techniques and evaluating their role in treating disease. We look forward to passing along what we learn.