Can sinus drainage cause tonsil stones?

Patient's Query

Hello doctor,

I have had sinus problems my whole life, getting sinus infections every year or sometimes twice a year, constantly having drainage in the back of my throat) and it was only annoying until a few days ago. Four days ago, I learned I had tonsil stones when I coughed up about 10 (no photos provided). I went to the doctor and she said it was because of a virus causing me to produce more mucus than normal. I was given a medicine and took it and the mucus amount went down a lot and I started feeling better and thought my tonsil stones were gone. However today, I coughed up two more. So, I decided to see if there were any I did not find on my previous visit, so I could make sure there were none left. I ended up removing 22 tonsil stones (photos provided to prove I am not exaggerating). While removing one, my tonsil started bleeding. I am not even sure if they are all out since I got the majority of those from one side of my mouth and my throat has hurt after both times I have gotten them out. Anyway, my question is, is there a possibility my sinus issues are linked to my tonsil stones, and would an ENT help me remove them since I have so many? Is there a possibility I have tonsillitis?

Answer

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)

Hello,

Welcome to icliniq.com.

I understand you want to know if your tonsil and sinus problems are related.

Yes. Recurrent post nasal drip due to sino-nasal infection or chronic sinusitis can cause local infection in the tonsils which make the tonsillar crypts produce thick and excess mucus. This mucus gets trapped in the tonsillar crypts which are small passages in the tonsillar tissue. After entrapment, they act as a nidus for the growth of bacteria and stone formation. Over time, they form stones, known as tonsilloliths.

Regarding bleeding, excessive trauma by pressing the tonsil to remove the stones could have traumatized the epithelium and caused bleeding. The tonsils could have been infected and pressing them would have released the inflammatory exudate which has blood also.

What to do:

We need to know the exact symptoms.
What are the sinus-related symptoms?
What is the duration and frequency of symptoms?
Is there nose block or smell sensation?
Is there aggravation or relief with medicines or nose drops?
Regarding tonsil related symptoms, is there any swallowing problem, pain, voice change, throat pain aggravation, relief, fever, etc.?
Have you done any tests for this such as a tonsillar swab, streptococcus, sinus scan or CT?

I would advise you to take a picture of your mouth wide open so that I can see the tonsils clearly and grade their enlargement. I would also be able to see congestion, flushing of anterior pillars, palate, posterior pharyngeal wall and lateral pharyngeal bands. If post nasal drip is there, that also can be made out in the picture.

A sinus CT scan is required to check if you have any lingering pathology in the sinuses which are contributing to the throat problem. The sinus scan should be ideally done when there is no infection because, during an infection, the scan will anyways show pathological changes in the sinuses.

Whether you have an infection now, we can say after looking at the throat. If there is, we shall institute appropriate antibiotics, decongestants, and mucolytics. Subsequently, you can go for the scan.

Until then, I would advise taking a dilute mouth rinse, the one with Benzydamine is good. Along with that, take some anti-inflammatory medicines like Trypsin-Chymotrypsin-Rutoside combination.