Coblation tonsil cryptolysis

What is coblation tonsil cryptolysis?

Tonsil stones (tonsilloliths) form in deep pits on the surface of the tonsils, called crypts. Food debris and bacteria collect in the crypts and harden into small white or yellow stones, which can cause bad breath, a bad taste, throat irritation, and the feeling of something stuck in the throat.

Cryptolysis treats the cause. Under a short general anaesthetic, I use a coblation wand, which uses a low-temperature plasma field, to gently resurface the tonsils, smoothing and shallowing the crypts so debris can no longer collect. This is sometimes called tonsil resurfacing.

The tonsils themselves are not removed. Because only the surface is treated, the procedure is far less painful than tonsillectomy, and recovery takes days rather than weeks. Both tonsils are usually treated in the same sitting.

The procedure code is F3440. Check with your insurer that the operation is covered.

Alternatives

Tonsil stones are harmless, so doing nothing is safe. Gargling after meals, a water flosser used gently over the tonsils, and dislodging stones as they appear all help some people manage. Tonsillectomy (removing the tonsils completely) is the definitive cure but carries a longer, more painful recovery and a higher bleeding risk. Cryptolysis sits between the two.

Asking for your consent

I involve you in all the decisions about your care. By law I must ask for your consent and will ask you to sign a consent form on the day. I will explain all the risks, benefits, and alternatives beforehand. If you are unsure about anything, please ask me again before signing.

Preparing for the operation

You will have a pre-assessment appointment with the hospital to confirm you are safe to have the operation, usually by phone. Follow the fasting instructions the hospital gives you.

Arrange an escort, a responsible adult, to take you home and stay with you overnight
Arrange transport home, by car or taxi
Bring all the medication you currently take
Tell the hospital if you have a cold, flu, or tonsillitis in the two weeks before admission, as your operation may need to be postponed
If you smoke, stop as early as you can. Smoking adversely affects healing and increases the risk of infection

What happens on the day

A short general anaesthetic. The operation is done as a day case and takes about 20 to 30 minutes.
Everything is done through the mouth. There are no cuts on the skin.
The coblation wand resurfaces each tonsil, smoothing the crypts at a relatively low temperature to protect the surrounding tissue.
Both tonsils are usually treated in the same sitting.
You go home the same day, usually three to four hours after returning from theatre.

Recovery at a glance

Recovery is much easier than after tonsillectomy. Most people are back to normal within a few days.

First 24 hours. Rest at home with your escort. A sore throat, like a bout of tonsillitis, is expected.
Days 1 to 5. The throat is sore, especially on swallowing. Regular painkillers and normal eating and drinking keep it manageable.
First week. Most people return to desk work within 2 to 4 days. Avoid strenuous exercise for a week.
Healing surface. A white or grey coating forms over the tonsils while they heal. This is normal and not an infection.
Follow-up. I review you in clinic to check the tonsil surface has healed well.

Aftercare

Take painkillers regularly as prescribed. Paracetamol and ibuprofen together work well. Do not take aspirin-based painkillers (for example Anadin) as they can make you bleed.
Use benzydamine (Difflam) spray or mouthwash. It numbs the throat and makes swallowing easier. Use it regularly, especially before meals, following the label.
Eat and drink normally from day one. Chewing and swallowing keep the throat muscles working and speed up healing.
Drink plenty of fluids. A dry throat is more painful.
Mild ear pain is common. This is referred pain from the throat, not an ear infection.
Avoid smoky places and people with coughs and colds while the throat heals.

Risks

Coblation cryptolysis is a safe procedure and serious complications are uncommon. The risks to know about are:

Pain. A sore throat for around a week is expected, though much milder than after tonsillectomy
Bleeding. Uncommon, and less likely than after tonsillectomy. Any bleeding from the mouth after you get home needs assessment in A&E
Infection. A small number of patients develop an infection of the healing surface and may need antibiotics
Incomplete relief or recurrence. Crypts can re-form over time and stones can return. Some patients need a repeat treatment, or choose tonsillectomy later
Taste disturbance. Rare and almost always temporary
Minor mouth injuries. The instrument that holds the mouth open can occasionally bruise the lips or tongue, or chip a tooth. This is rare; tell me beforehand about any loose teeth, crowns or veneers
Anaesthetic risks. The anaesthetist will discuss these with you on the day

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This page is general information and not a substitute for individual medical advice. The right treatment depends on your assessment.