Holes in Tonsils Meaning, Pictures, Causes & How to Get Rid

What do holes in tonsils indicate? What causes them and how can you get rid of them? Read on to find out answers, pictures of how they look like and more

What do holes in tonsils/ Crypts Mean


Tonsils are an important part of our immune system and not until it was discovered that tonsils are so, doctors removed them at their own discretion. They are integral in the protection of your respiratory system preventing respiratory infections by responding to infectious agents.

When the infectious pathogen finds its way into your oral cavity and you have an intact tonsil, then its immune system will be triggered by it and it will launch an attack by mobilizing white blood cells to the site. This is why it swells.

When the white blood cells and other inflammatory markers enter the tonsils and with increased blood flow, the area becomes inflamed. The tonsils therefore assume a red color and becomes painful to swallow saliva and food. This means that this process is actually a physiological process involving your body’s own attempt to eliminate pathogens.

However important it is, some tonsils get abnormal features including formation of holes in them. While tonsils normally have crypts, holes are an abnormal feature that needs to be investigated and corrected. Many complications could arise including pre-disposing you to more infections.

Human palatine tonsils on which tonsil stones arise have a layer of epithelium with stratified squamous cells extending and partly into some branching. The branching is known as tonsillar crypt and there are several tens of this, about 10-30 (Barnes and Leon., 2000; Surgical Pathology of the Head and Neck).

The reason you have crypts is to increase the action surface area between the lymphoid tissue and antigens. Therefore, it becomes very sensitive. If you were to investigate your crypts, they would look like fissures with a lumen and walls in apposition.

From the surface of the tonsil, the crypts are simply organized and less dense while those extending close to a section known as the hemicapsule are denser. The crypts aid in concentrating the macrophages and white blood cells. Crypts are pretty normal but not tonsil holes. The term you would be using is ‘enlarged crypts’ to the extent that they look like holes. There are no holes in the tonsils.

Are the holes normal?

Tonsil holes are a pathology. Tonsil holes are a great hazard to the hygiene of your oral cavity with the hole harboring pathogens and food particles that further attract more pathogens and in turn may choose to solidify and form calcifications.

Tonsil stones result otherwise known as tonsilloliths. Bad breath or halitosis results when the food particles in the holes decompose in the presence of Halitogenic bacteria whose colonization is increased by the warmth and moisture of the oral cavity.

Tonsillar stones could fill a patch and form a hole. When dislodged deliberately or during a cough, then a hole is left on the tonsils.

normal tonsils vs abnormal tonsils apprearance
normal vs abnormal tonsils

Pictures-How do Tonsils Holes look like

Tonsil holes are hollow formations through the surface epithelium of the tonsils. Most affected are the palatine tonsils that lie on either side of the throat.

They are visible when observed but may require a medical torch light to make out the crypts and holes.

The hollow formations may be regular (round) or irregular owing to the nature of the stone that filled it. It commonly forms on an inflamed tonsil (tonsillitis) hence a red hue and swelling to its periphery.

Depending on the prevailing infection, it may be filled with pus to the sides especially if the hole is an enlarged crypt. Pus may either be white or yellow.


holes in tonsils, meaning, causes & remedies
Illustration of holes in tonsils- Wikihow

Possible Causes of holes in tonsils after tonsillitis

The most common cause of tonsillitis is an infective agent know as Streptococcus pyogenes. It is known as strep throat due to this microbe. One possible cause of holes in tonsils is a strep throat. It leads to an inflammation of the tonsils and therefore the crypts are overworking to keep the pathogen out of the throat. It also causes an irritation of the throat hence its inflammation too and therefore a severe sore throat.

Since a strep throat leads to inflammation of the tonsils, white pockets may form on them. The pockets may be white or yellow and may be accompanied by tiny red hemorrhages on the soft palate. It is also possible that since the crypts are responsible for the concentration of white blood cells, they areas with high concentrations of pus could appear as holes.

Tonsil stones are a possible complication of an inflamed tonsil. This is so due to the widening of the crevices forming spaces wide enough to accommodate food particles. The food gets decomposed by bacteria and in turn harden and solidify into a stone in the tonsils. Of course this has to happen with frequent bouts of strep throat to enable formation of the stone. The stone could further form a hole in the tonsils.

Hole in tonsil after removing tonsil stone (Tonsilloliths)

Tonsilloliths are tonsil stones and many individuals suffer from it. They appear white or yellow in colour shallowly seated on either tonsil pouches.

They are hard to touch and really painful. They are responsible, largely, for the high prevalence of halitosis and accounts for a significant percentage. These array of symptoms and signs make it a discomfort to live with and will prompt removal.

Removal of tonsil stones is done through a number of home remedies or by coughing. The second option is not deliberate but may still manage to dislodge the stone from its seating. Stones that are deposited not only on the tonsils but also on the soft palate of the oral cavity result in some irritation.

The irritation stimulates a reflex motion of the throat aiming at expelling the foreign substance.

Dislodgement of the stone in either way results in formation of a hole. So when you notice a hole on the tonsil when you know that you had a tonsil stone, then relax. The stone got dislodged and a hole was left, so it means there was a place for it there in the first place.

While tonsil holes caused by a dislodged tonsil stone can go away on its own, it is important to keep watch over it.  Try maintain a high level of hygiene so as to prevent it from getting infected.

With white stuff/Pus

White stuff on tonsils means that the tonsils have been infected. The white is caused by build-up of pus and pus contains white blood cells in response to an infectious agent. The tonsil may also be infected if the hole has yellow stuff which is also pus. Pus can either be white or yellow.

Infections are different and depending on the critter in it, it could be bacterial or fungal. Viral infections such as that caused by Epstein Barr Virus (EBV) that results in mononucleosis, usually don’t exhibit a white patch on the tonsils. However, according to epidemiologists, mononucleosis can manifest with white patches in a third of cases.

It is important to manage a tonsil hole that has white stuff or pus on it as this could be an infection. Upper respiratory infections could spread to the lower parts leading to lower respiratory infections which are worse off.

Enlarged tonsils with holes & Getting Bigger

When your tonsil holes are getting bigger then it could mean that:

Your tonsils are getting more inflamed:

when the inflammation gets worse, they the crypts are enlarged and so is the epithelium. The initially smaller hole has its periphery pulled outwards so that it becomes bigger. Therefore, this could mean that you are not taking care of the infection or that which resulted in the inflammation.

At times it is normal

when you are a child, the tonsils are normally larger than they will be as you grow up. The tonsils begin to shrink as they will be no longer needed as much when you are grown up.

Therefore, when you have a tonsillar stone, the hole in which it is lodged may become bigger relatively compared to the size of the tonsils.

Actually, the hole is literally occupying more space in the shrinking tonsil but not increasing in size. However, this is best noticeable between subsequent tonsilloliths during which you can notice the difference between the holes after and before the stone is dislodged.

Holes on tonsils and sore throat Indication

Not all painful sore throat infections are caused by strep. In fact, most sore throats are caused by viruses. The best way to differentiate between a sore and strep throat is to consider other symptoms. Are you experiencing other symptoms such as sneezing, runny nose or coughing? A viral cough normally when productive, produces colorless sputum.

Holes in tonsils are rarely caused by a sore throat and it is unlikely that they will result in formation of holes on the tonsils.

After Strep Throat

Strep throat is the biggest cause of tonsillitis. Tonsillitis, as detailed in the previous sections of this material, leads to inflammation of the tonsils and hence enlargement of the tonsil crypts. The tonsil crypts may appear as holes.

The crypts may be occupied by a debris of food and bacteria leading to a tonsilloliths that seats in the crypts. When the strep throat is subsiding, the crypts shrink around the debris of food that is continuously hardening and forming a stone. The hole becomes larger and when it is dislodged, it leaves an exposed hole on the tonsil.

How to get rid, clean and Treat Tonsil Holes

Since tonsil holes are not a disease of its own but a symptom or sign of a disease, treatment is symptomatic. The underling condition needs to be treated however.  Sometimes it does not require any treatment and may just go away on its own. If it is an infection, then you may need to take antibiotics to treat it.

Treatment options include:

  1. Administering antibiotics for strep infections: this infection if not treated by lead to complications such as scarlet fever, rheumatic fever, post-streptococcal glomerulonephritis or streptococcal toxic shock syndrome above exercabating the tonsillar hole.
  2. If the hole is appreciably large, then you may have to undergo a tonsillectomy. This is a surgical procedure in which the tonsils are removed.
  3. Surgical removal of tonsil stones: this may help prevent the formation of a stone as seen with home remedies. Even if the hole were to form, it would be sutured closed.
  4. Pain killers: you will need analgesics such as ibuprofen and paracetamol to alleviate the pain associated with tonsilloliths or infections that cause tonsil holes.

Tonsil stones can be infected at any time if not already infected. It is therefore important that you take care of your oral hygiene and making it optimum.

You may need a mouthwash or a gargle with chlorhexidine or Povidone iodine to augment your after-meal brushing of your teeth. The gargle or mouthwash should be a broad spectrum and fortunately the two mentioned drugs are, against bacteria, fungi and viruses.

Drink plenty of water to flush off the pathogens in your oral cavity off the area around the hole. Make sure it is clean drinking water.

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