Palatine Tonsilloliths and Actinomyces: A Multi‐institutional Study of Adult Patients Undergoing Tonsillectomy

Abstract

Objective To better characterize associations between Actinomyces and tonsillolith versus nontonsillolith tonsillectomy specimens. Study Design Bi-institutional retrospective case-case study. Setting University and county hospital. Subjects and Methods Adult patients with a clinical history of tonsilloliths who underwent tonsillectomy from January 2006 to December 2018 were included. Patients undergoing tonsillectomy for tonsillar hypertrophy and chronic tonsillitis were identified as comparative cases. Similarly, patients with ipsilateral oropharyngeal cancer (OPC) who underwent contralateral tonsillectomy of a normal-appearing tonsil for prophylaxis against a second primary cancer were also included as comparative cases. Results The study population comprised 134 patients who underwent tonsillectomy: 62 tonsillolith and 72 nontonsillolith (tonsillar hypertrophy, n = 30; chronic tonsillitis, n = 30; normal-appearing contralateral tonsil in patients with ipsilateral OPC, n = 12). Actinomyces was reported in 11% of the patients with tonsilloliths on initial pathology reports but in 95% after re-evaluation (n = 54 of 57). Actinomyces prevalence was significantly higher in patients with tonsilloliths as compared with patients with recurrent tonsillitis (73%, n = 22 of 30, P < .001) and normal-appearing contralateral tonsils in patients with ipsilateral OPC (58%, n = 7 of 12, P < .001). Actinomyces prevalence was not significantly different between patients with tonsilloliths and tonsillar hypertrophy (83%, n = 25 of 30, P = .11). Conclusion The prevalence of Actinomyces in tonsillolith tonsil specimens is high; however, Actinomyces routinely colonizes nontonsillolith tonsil specimens. Therefore, Actinomyces is unlikely to be the primary driver of tonsillolith pathogenesis, and Actinomyces-targeted treatment of tonsilloliths may not be effective. Treatment strategies addressing tonsilloliths should be further investigated.

The Clinical Significance of Tonsillar Actinomyces in Histopathological Samples after Tonsillectomy

“…In our study, Actinomyces was found in 31.4% of patients. In the literature, the prevalence of Actinomyces colonies in palatine tonsils removed due to recurrent tonsilitis and OSAS ranges from 0.8% to 61.6% [2,14,16,[29][30][31][32]. In their study on a large cohort of patients, Aydin et al found that this percentage was 6.7% for the entire study population, including children (n = 1252) and adults (n = 568) [31].…”

“…Therefore, they questioned whether Actinomyces played an important role in the pathogenesis of this condition. They also reported that Actinomyces-targeted treatment of tonsilloliths failed to be effective [16].…”

“…Actinomyces israeli is the most commonly isolated species of Actinomyces [2,5,6,1 In the oral cavity, Actinomyces has been found in carious dentin, dental plaque, o gingival surface, and in tonsillar crypts [5,[16][17][18]. The presence of tonsillar Actinomy confirmed by the assessment of histopathological samples of filamentous clusters of philic microorganisms arranged in a radial pattern ("ray-fungus") or bacterial cul [4,5,19].…”

Correlation between the presence of tonsilloliths and the bone defects by periodontitis on imaging analysis: a pilot study

“…Some of the bacteria as a foreign nidus are periodontal disease-related bacteria, such as Actinomyces, Eubacterium, Fusobacterium, Megasphaera, Porphyromonas, Prevotella, Selenomonas, and Tannerella spp. [ 16 , 17 ]. Oral bacteria in secretions in contact with tonsillar epithelium may adhere to the mucosal surface and may stimulate cytokine production by mucosal epithelium [ 22 ].…”

Radiographic Detection of the Relationship between Tonsilloliths and Dental Plaque-Related Pathologies in a Series of Digital Panoramic Radiographs

“…Cooper et al [2] reported that Actinomyces is a common resident of an abnormal tonsil and forms a nidus for calcification. However, a recent study reported that while a strong association was identified between Actinomyces and tonsilloliths, this pathological calcification is not based on solely one microorganism because of its polymicrobial nature [6]. A limited number of studies, investigating the bacterial composition of tonsilloliths, focused on heterogeneous microbial composition [7, 8].…”