There are numerous and divergent opinions concerning infection of the tonsil, but the majority seem to agree on the presence of cryptal plugs as a factor. Cryptal plugs are conducive to tonsillar infection because they block the passage through which the tonsil normally rids itself of cells and bacteria. They provide an environment of warmth, moisture, nutriment and varying degrees of oxygen tension, which is ideal for the growth, propagation and colonization of both aerobic and anaerobic organisms, and favor the retention and absorption of toxic metabolic products. Many of these, notably members of the Fusiformis group, are capable of causing necrosis in the deep epithelial lining of the crypt, with ensuing tonsillar infection. Aeration and circulation are interfered with, causing pressure on contiguous tissues and capillaries, a condition which may in turn produce congestion, inflammation and thrombosis.
In 1933, Dr. Otto Kahler1 published an extensive review of the tonsil
MCAULIFFE GW, LEASK M. LABORATORY ANALYSIS OF THE CONTENT OF TONSIL CRYPTS AS OBTAINED BY THE WET SUCTION TECHNIC. Arch Otolaryngol. 1941;34(4):758–770. doi:https://doi.org/10.1001/archotol.1941.00660040814008
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