White spots on tonsils: causes and treatment

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  • White spots typically appear as a result of a bacterial, viral, or yeast infection on tonsils.
  • Usually the best course of treatment is antibiotics to fight the infection.
  • In general, white spots on the tonsils are not dangerous and will disappear after treatment.
  • Check out the Insider Health Reference Library for more advice.

Imagine waking up with a sore throat. Maybe it hurts to swallow, or maybe your throat feels a little “off”. You go to the mirror and open it wide. There, at the very back of your throat, you will see white patches on your tonsils. They can be small and pimple-like, or they could be lumpy spots or streaks.

These tonsil marks don’t usually hurt, but they can definitely look worrisome. They are part of your body’s immune response. They often occur during an infection or in response to a foreign object lodged in your tonsils.

“White spots on tonsils will most likely go away on their own after a few days,” says Kire Stojkovski, MD, a physician and medical consultant at the Farr Institute. “Treating the underlying or primary condition will help get rid of the white spot more quickly.”

Learn about the different reasons why these white spots appear and how to deal with them.

tonsillitis

Tonsillitis occurs when your tonsils become inflamed due to an infection. White spots are a common symptom of tonsillitis along with:

  • sore throat
  • difficulties swallowing
  • Bad breath
  • Fever (over 100.4 °F)

When you see spots on your tonsils, you’re often witnessing the aftermath of a microscopic battle between your immune system’s white blood cells and the infectious germs they fight. The dead white blood cells and germs collect in a liquid called pus.

The pus can swell up under the lining of the mouth like a pimple or become a creamy spot that sits on the surface. This is called chronic cheesy tonsillitis (CCT). These white spots are generally harmless.

peritonsillar abscess

However, there are rare instances when the white spots can pose a danger. If the infection gets too severe or your body is fighting multiple pathogens at once, these spots can grow into one big lump. This is called a peritonsillar abscess (PTA).

In addition to severe tonsillitis symptoms, a peritonsillar abscess can:

  • Your airways become swollen and blocked, making it difficult to breathe
  • Spread the infection to your neck tissues and cause nerve damage
  • Rupture and cause you to breathe in pus, which can spread the infection to your lungs

Fortunately, PTAs are rare, affecting just 0.03% of Americans each year.

How to treat it: They are also very treatable. You can have the abscess drained at an outpatient center or at an ENT. After your doctor extracts the pus, they will likely prescribe corticosteroids or antibiotics to speed up the healing process.

bacterial infection

Bacteria cause 15% to 30% of cases of acute tonsillitis. The most common culprit is a type of bacteria called group A streptococci, the same bacteria that cause strep.

sore throat

Group A Streptococci thrive in the nose and throat. If the bacteria get into your tonsils, you can develop milky white spots. You may also see a grayish patch on your tonsils called a pseudomembrane.

According to the Centers for Disease Control and Prevention, other symptoms of a sore throat include:

  • Tiny red spots on the palate
  • pain when swallowing
  • sore throat
  • Swollen lymph nodes
  • fever

How to treat it: A doctor will prescribe it for you


antibiotics

and your tonsil spots and other symptoms should go away two to three days after starting the medication. It is important that you take any antibiotics that you are given. If you stop too soon, the white spots can return.

viral infection

Viruses cause up to 70% of acute tonsillitis. Here are some viral diseases that can cause spots on your tonsils.

Infectious mononucleosis

Infectious mononucleosis, or “mono” for short, is caused by the Epstein-Barr virus (EBV). Mono is most common in adolescents and young adults. EBV spreads through saliva, which is why Mono is sometimes referred to as “Kiss disease.”

Mono can look very much like a sore throat at first. Doctors often need to do an antibody test to determine which antibody is which.

Telltale signs of mono are:

    • Extreme tiredness – Fatigue is much more pronounced with mono than with strep and usually lasts a month or more
    • headache this will probably take up to two weeks
    • Red stain on the palate
    • Swollen lymph nodes that can remain swollen for over a month
    • sore throat this lasts 6-10 days, much longer than with streptococci
  • fever this usually takes a few weeks

Tonsils infected with mono look slightly different than those that fight bacteria. For mono:

  • Your tonsils may be much redder and swollen.
  • The pus may appear in extensive gray patches rather than patches.
  • The white spots can spread to the tongue.
  • Any white spots on the tonsils or tongue will likely last 6-10 days

How to treat it: Mono is caused by a virus, so antibiotics don’t work. You just have to wait it out. It usually takes four to six weeks to fully recover.

During recovery, it’s important to listen to your body and to rest when you’re tired. Your doctor may recommend that you avoid vigorous exercise for a month. Mono can cause your spleen to swell and there is a risk of it rupturing if you put too much strain on your body.

oral herpes

If you’ve ever had cold sores, you can probably blame herpes simplex virus type 1 (HSV-1) for them. Don’t worry, you’re not alone: ​​more than half of adults in the US have had oral herpes at some point.

Most people get oral herpes through nonsexual contact. You may have come into contact with infected saliva by sharing silverware or dunking your pretzels in a shared dip. Because the virus is so widespread, the older you are, the more likely you are to have been exposed to it.

Oral herpes rarely causes tonsillitis. But when HSV-1 reaches your tonsils, you may see white or red patches in the form of cold sores. When these sores leak fluid, they can cause shallow cavities called ulcers.

Once you’ve contracted HSV-1, the virus stays with you and usually lies dormant in your body. Some lucky people never develop symptoms. Others will have recurring outbreaks from time to time, which may look like this:

  • Itching and burning around the mouth
  • Swollen lymph nodes
  • Blisters (cold sores) on the lips, tongue and gums

You’re more likely to show symptoms during the first few outbreaks, when your body’s immune system is still adjusting to the virus.

How to treat it: Oral antiviral medications can help reduce herpes-related tonsils. Cold sores outside the body can respond well to topical ointments. For other symptoms, you can take anti-inflammatory drugs and painkillers.

yeast infections

Your body naturally houses a community of bacteria and yeast called your microbiome. Normally, these organisms live in harmony with your body and support your daily functioning. But when something disrupts the microbiome in your mouth, white patches can appear.

oral thrush

The most common yeast infection in the mouth is caused by Candida albicans. If this yeast grows too much in your mouth and throat, you can develop oral thrush (also called candidiasis).

Signs of oral thrush are:

  • tastelessness
  • Pain when eating or swallowing
  • A “cotton feeling” in the mouth
  • Cracks at the corners of the mouth
  • White or light yellow patches around the mouth and throat

With oral thrush, you’re more likely to see patches and streaks than defined patches. The patches often look creamy like cottage cheese. The spots are most likely on your tongue or the lining of your cheeks and lips, but they can also show up on your tonsils.

You are at higher risk of oral thrush if you:

  • Do you have a weakened immune system due to age or a medical condition such as uncontrolled diabetes
  • I’ve been taking antibiotics for a long time
  • Have undergone chemotherapy
  • Didn’t eat enough iron
  • Do you have dentures that don’t fit in your mouth?

How to treat it: You can treat oral thrush with antifungal medications. This can be in the form of a pill, lozenge or liquid. This treatment regimen usually lasts one to two weeks.

Non-infectious causes

Not all tonsil spots are caused by an infection. Sometimes they are caused by foreign objects.

tonsil stones

Sometimes food and dirt can get stuck in the crevices of your tonsils. If the object stays there too long, it hardens into a mineral deposit that we call a tonsil stone.

Tonsil stones are very common, affecting up to 10% of people at some point in their lives. They become more common with age, peaking between the ages of 50 and 69.

Usually, these tonsil stones are too small to see and cause no symptoms. Most people don’t realize they have tonsil stones until they get a routine X-ray or CT scan at their dentist’s office.

When tonsil stones are visible, they often look like white or yellow pebbles. They can attract bacteria that can cause your breath to smell. Pus can also collect in the gap and harden, making the stone larger.

Unlike tonsillitis, tonsil stones generally do not cause a fever. They also won’t make your tonsils red and swollen. Often they cause no pain at all.

How to treat it: If you have a tonsil stone that’s bothering you, gargling with salt water may help. You can swallow a tonsil stone without choking, but spitting one out is faster than digesting it.

You can also try removing a tonsil stone with a water pick or cotton swab. Don’t use your fingers to pick it out, as you could scratch your tonsils and cause more infection.

Insider snack

White spots on your tonsils can look scary but aren’t generally dangerous. They are simply a sign that your immune system is doing its job to protect you.

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