Plaques in the throat: how to recognise them

By Cristiano Antonino On Sep 15, 2022

Plaques in the throat are yellowish-white manifestations of the mucous membrane covering the tonsils and sometimes the back of the pharynx

Causes of throat plaques

Plaques in the throat may indicate 3 distinct clinical pictures that vary depending on the underlying causes:

A) acute inflammation: for adults and, above all, for children, whose immune defences are still developing, throat plaques may be the acute manifestation of one or more infections of the following types

viral: caused, for example, by adenoviruses, influenza and parainfluenza viruses, etc;
bacterial: group A beta haemolytic streptococcus, Klebsiella pneumoniae, Haemophilus influentiae etc;
mycotic: candida, thrush etc.;

B) cryptic tonsils: these are benign alterations or ruptures of certain tonsil cavities called ‘tonsil crypts’. These alterations of the crypts, originating from various factors, interfere with their capacity to clean themselves, leading to a stagnation of dead cells and debris that can appear on the outside of the tonsil in the form of plaques that are called ‘caseous scurf’, also characterised by a bad odour;

C) chronic inflammation: this is a clinical picture, mainly in adults, in which plaques are associated with frequency and recurrence with a fever, usually in the evening, due to a chronic inflammation that remains latent until imbalances such as climatic changes, physical exertion, etc. occur.

The symptoms of throat plaques

Symptomatology is an important aspect when talking about plaques in the throat as it makes it possible to identify and distinguish the 3 clinical pictures mentioned above.

A) acute inflammation: can be characterised by clinical manifestations such as:

sore throat (pharyngodynia);
pain during swallowing;
pain during swallowing in the ear area, this because the ear and tonsillar region share sensory innervation;
swelling and pain in the glands (latero-cervical adenopathy) located under the mandibular angle and in the lateral part of the neck
fever;

B) cryptic tonsils: in the case of a structural alteration of the tonsillar crypts, the clinical picture does not present inflammation and pain, but is characterised only by

presence of white-yellowish plaques;
bad breath;

C) chronic inflammation: compared to the acute form, which may present with high fever and intense pain even in the lymph glands of the neck, the chronic form manifests more nuanced symptoms with, for example

fever (slightly above 37)
general malaise;
muscle pain.

When to go to the doctor

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In the majority of acute inflammatory cases, throat plaques resolve with medical therapy within a couple of weeks.

If, however, the situation does not improve with each passing day, it is advisable to return to the doctor.

Protracted tonsillitis can often be caused by common causes such as undiagnosed mononucleosis (kissing disease).

For this reason and in order to rule out even fortunately rarer diseases, such as hidden acute leukaemias, if the clinical picture does not improve or does not resolve within a couple of weeks, it is always advisable to see a specialist for the appropriate medical assessments.

Even in the case of frequent recurrences it is advisable to consult the doctor who will prescribe investigations such as blood tests to assess the inflammatory state (blood count with leucocyte formula, c-reactive protein, ESR, TAS, etc.) and thus be able to proceed with the most suitable therapy.

How to treat throat plaques

The treatment of throat plaques again varies depending on their type and cause:

A) acute inflammation the standard therapy involves taking:

anti-inflammatories and possibly antipyretics for a period of 3 days;
antibiotics: if after 3 days the symptoms have not improved, the infection must be treated with antibiotics prescribed by the doctor for a period of 8-10 days;
further treatment/intervention: if after 8-10 days of antibiotics there is no improvement, the doctor will prescribe further investigations on the basis of which a targeted therapy can be set up, which in the case of frequent infectious recurrences can, as a last resort, also include a tonsillectomy;

B) cryptic tonsils: in this case, the symptomatology is not painful or pathological, therefore, surgery is generally performed for aesthetic reasons or because of the bad odour generated by the deposition material, which, if poorly tolerated, may lead to the option of tonsillectomy;

C) chronic inflammation: after the acute manifestation has been treated, action is taken to strengthen the immune system so as to increase the body’s defences. For example, anti-tonsillectomy vaccines can be carried out to reduce the number of infectious episodes.

Tonsillectomy

Tonsillectomy, or the surgical removal of the tonsils, is a procedure that is desirable especially for adults and children over the age of 3 years who have an indication for it, although, of course, it must be evaluated on a case-by-case basis.

Our tonsils, which are not only the ‘palatine tonsils’ that we see, but also the ‘pharyngeal’ (adenoids) and the ‘lingual’ ones, i.e., located behind and at the base of the tongue, form a complex known as Waldeyer’s lymphatic ring, which up to the age of 10 years performs an important function in the body: to recognise pathogens entering through the mouth and upper airways so as to develop protective antibodies.

If it is possible, therefore, up to that age it is preferable to preserve them; then this function of theirs is lost and the information gathered is transferred to the medulla of the long bones, where the production of antibodies also shifts.

Plaques in the throat on holiday: what to do

Of the 3 types listed, those that most frequently occur on holiday, causing discomfort and inconvenience, are obviously those attributable to acute or chronic inflammation.

To distinguish between them, it is necessary to observe the symptomatology encountered.

But can one go to the seaside with plaques in the throat?

The answer to this question, which many people ask themselves, varies depending on the type of throat plaques.

In the presence, in fact, of:

plaques of an acute inflammatory nature: it is better to stay at home and rest;
plaques of a chronic inflammatory nature: yes to the sea, but taking care to avoid climatic changes and exertion;
cryptic tonsils: yes to the beach without any contraindications.

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