Thursday, May 17, 2012

How do You Get Tonsil Stones (Cryptolysis)

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Tonsil stones also known as tonsillolith are small white calcareous clusters that accumulate in the crypts of your tonsils. Tonsil stones can commonly be identified by the volatile sulfuric gasses that the bacteria in these whitish yellow particles produce. Individuals commonly discover tonsil stones when they experience discomfort in the back of their throat and unexpectedly cough up what appears to be a squishy white mass. Most people readily identify tonsil stones by the smell and up until the last 2 -3 years have been unable to identify what they are.''-

With the proliferation of the Internet individuals have become increasingly aware of what these white stuff on their tonsils are and how they can get rid of them. The largest roadblock in treating tonsil stones has been the lack of general knowledge by the medical community, specifically Ear Nose and Throat doctors. Most tonsil stone suffers who present these tonsil rocks to an ENT specialist commonly experience a lack of an explanation as to what causes tonsil stones. Within the last three years communities and products have developed around the growing curiosity of tonsil stones. Many digital e-books have been produced that attempt to alleviate the problems by promising cures and natural remedies made from household items. The effectiveness of information contained in these digital-books has been largely shunned by the tonsil stone community and are considered to be “scammish”. Most such books offer temporary remedies and require time consuming fixes. Only recently has cryptolysis become a viable option for permanently getting rid of tonsil stone induced pain and bad breathe. Cryptolysis utilizes lasers or radiofrequency to reduce the amount of crypts located on the tonsils which in turn reduces the amount of food that is able to collect in the crypts. The reduction of debris in the crypts leads to a reduction of sulfur producing bacteria which eliminates tonsil stone related sore throats and bad breath. The reason why cryptolysis has gained such popularity over the last two years is because up until now the only option for individuals suffering from severe tonsil stones was to undergo a tonsillectomy. Compared to cryptolysis a tonsillectomy is more time intensive, painful and can lead to further complications. Patients who undergo a tonsillectomy are placed under general anesthesia, require 2 -4 weeks of recovery time and experience severe pain. In contrast, cryptolysis is a 30 -45 minute procedure that utilizes local anesthesia, has zero recovery time and causes minimal discomfort. Patients who have undergone cryptolysis have compared the experience to a routine dental appointment. For the majority of the patients cryptolysis is generally performed in the doctor’s office rather than an Operating Room, where a tonsillectomy is performed. One of the major benefits of cryptolysis over a tonsillectomy is the price difference. Cryptolysis is literally a fraction of the cost and that is without factoring in the time lost from work while recovering from a tonsillectomy. For information about a doctor in your area that performs cryptolysis fill out the form on the right of the screen and our staff will manually match you with a ENT in your area. First of all... NO... we do not offer laser cryptolysis. However, we do offer what we feel is a better alternative which is coblation cryptolysis. This innovative procedure developed by Dr. Chang is performed awake and using only local anesthesia (in most patients) in order to cure patients of tonsil stones (also known as tonsiloliths). Rather than using laser, we use a technology called coblation (watch movie; requires Quicktime) that in effect does the same thing, but in a much safer way for the patient (see below). Although there is no guarantee that this method will cure folks of tonsil stones (no more or less than laser cryptolysis), it is a less painful alternative method to consider and try before tonsillectomy which is the only known near 100% cure for tonsil stones (ie, as long as tonsils exist, there's always the potential for tonsil stones).''

Advantages over tonsillectomy:

A ) Can be done awake (without general anesthesia and intubation) in adult patients as long as there is:
minimal gag reflex (if you have a bad gag reflex, this will require general anesthesia and intubation), tongue is not large ,tonsil can be visualized easily when opening the mouth

B ) Much less pain than traditional tonsillectomy
C ) Faster recovery than traditional tonsillectomy

Advantages of Coblation Cryptolysis over Laser Cryptolysis:

A) No risk of airway fire (if a spark occurs due to laser use, it can ignite the air)
B) No risk of blindness (laser can bounce off shiny surfaces like metal and reflect out and burn the retina)
C) No risk of oral and facial burns (lasers do not burn just the tonsil, it can burn anything that gets in the way... in other words, do NOT turn your head, sneeze, cough, or gag if the laser is turned on!!!)
D) No risk of inhaling the plume of vaporized tissue (which can cause airway burns as well as spread infection)
E) There's some question whether there is an increased risk of life-threatening bleeding with laser use, mainly because the laser can pierce tissue like an arrow potentially. 

Not an ideal characteristic because the carotid artery is < 1 cm away from the tonsil. Read an article about a boy who died after laser tonsillectomy due to this complication. Disadvantages of Cryptolysis (regardless of method used): A) Continued problems with recurrent tonsillitis or strep throat (because with cryptolysis, there's always tonsil tissue left behind... only the crypt from which the stone develops is ablated.) B) No pathology specimen to evaluate for lymphoma or tonsil cancer C) Tonsil crypt regrowth (and therefore recurrence of stones) D) Possible need to repeat procedure multiple times for effect To address tonsil stones, most patients (60-70%) require only a single session to get treated. However, 30-40% of patients require 2 or more sessions spread out over several months to get fully treated for tonsil stones. Some patients may not respond to this method of treatment at all. Please note that if there is any concern for tonsil cancer, tonsillectomy should be pursued. Cryptolysis should not be done as there is no pathological specimen obtained. Who is the ideal patient for AWAKE coblation cryptolysis? A) Adult patient B) No or minimal gag reflex C) Entire tonsil can be visualized when patient opens the mouth D) Only a few (1-3) discrete areas where tonsil stones typically occur which can be easily seen when opening the mouth. If you have numerous areas of tonsil stone production, coblation tonsil resurfacing may need to be pursued. Tonsil stones produced at the base of the tonsil next to tongue are also difficult to address in an awake state. E) Tonsil problems dealing mainly with tonsil stones or cryptic tonsils. Not chronic tonsillitis or strep throat. 6) No tonsil cancer concern Great! I want a coblation cryptolysis performed! What do I do next? Give us a call to make an appointment to get an evaluation done to see if you are a candidate! Awake coblation cryptolysis is only performed on Friday afternoons and IS a procedure covered by insurance that we participate with. An evaluation is required first prior to scheduling the procedure. Procedure consent can be downloaded here. Post-procedure instructions can be downloaded here. Step A : Local anesthesia is applied to the oropharynx and tonsils if done awake. If not, the patient is placed under general anesthesia. cryptolysis Step B : Coblation is performed to the tonsil crypt where tonsil stones typically come from. The crypt is ablated with coblation such that the "crypt" no longer exists. cryptolysis Step C : There is a sore throat for about 1 week. However, during the healing phase, bad breath and a white plaque-like debris is seen overlying where the tonsil crypt used to be. This is NORMAL! This debris is known as eschar and it basically is a scab that's wet. (Imagine looking at a scab elsewhere on the body after you take a shower.) cryptolysis Step D : Once the area is completely healed up in about 3-4 weeks, the bad breath will resolve and the tonsil will look pretty much back to normal without the crypt (and hopefully no more tonsil stones)! Some Actual Before and After Pictures.''

These pictures were obtained with the patient under general anesthesia due to a bad gag reflex. The tonsil crypts where stones were coming out from are denoted by arrowheads. If You Live Far Away... We do not maintain a list of physicians who offer this procedure throughout the United States. Your best bet is to contact your local ENT and ask if they or anybody they know offers this locally to where you live. This website maintains a list of providers as well, but we do not vouch for or know whether it is accurate or not. TonsilAlso, please be aware that should you wish to see Dr. Chang, this procedure is generally NOT performed on the same day of the visit. The procedure (which is performed only on Friday afternoons if unsedated) will be scheduled only after Dr. Chang performs an intial evaluation. If you live far away, please email Dr. Chang your interest along with a picture of your tonsils to ensure you are a candidate for the procedure (if you are not a good candidate, we do not want to waste your time and expense to see us). When you take the picture, make sure it looks like the picture shown to the right with full exposure of the tonsils and uvula (use a tongue blade if you have to). If you have a bad gag reflex and as such, not able to take the picture as shown here, you are not a good candidate for the procedure performed without sedation (it will have to be done in the operating room under general anesthesia and intubation with correspondingly much higher costs). For patients without insurance, the cost of the procedure without sedation is $750 (which does NOT include the cost of the initial office evaluation).  keep in mind that at least for our practice, follow-up visits after the procedure is recommended. If you are not willing to commit to possible follow-up appointments, do not make an appointment with us. Why are we requiring this? After this procedure, it is not unusual that a patient may experience some problems or encounter a situation in which they are not sure what to do. In this scenario, it is very difficult if not impossible to answer questions over the phone without an examination leading to frustration and even anger (as follow-up examinations are very inconvenient especially if you live far away). As such, do NOT make an appointment with us unless you are willing to commit to follow-up visits. Although not mandatory, a routine follow-up appointment is generally made for 2 weeks after the procedure.''

This video describes a procedure to address tonsil stones using a minimally invasive technique called tonsil cryptolysis. This procedure can be done awake without sedation in patients without a bad gag reflex and takes only a few minutes to perform. This technique accomplishes the same thing as laser cryptolysis but at lower cost and increased safety. (This video was obtained with the patient under general anesthesia.)

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