tonsill stone and heart infection

[jem72]

my six year son is diagnosed with bicupsid aortic valve. my physician says that such type of kids are prone to get infection at valves.
my son gets tonsill stones frequently , is this really a concern for his heart or i must be worried only when he gets symptom of tonsillitis such as fever and pain.
is it really necessary to treat tonsill stones with antibiotics every time to avoid reaching infection at heart.
he is otherwise healthy .

[Marie M Gleason, M.D.]

Dear jem72: Tonsil “stones” or tonsilloliths are collections of debris and bacteria in the spaces of the tonsils (called crypts) that can harden due to calcium deposits.  Usually they occur in people who are prone to recurrent tonsillitis.  They may be completely asymptomatic if they are small, or they may cause symptoms such as bad breath, sore throat or difficulty swallowing if extremely large.

Patients with bicuspid aortic valves (unoperated) have a slightly higher chance of developing a heart valve infection (called endocarditis) than the general population.  This type of infection is serious and can destroy valve tissue to the extent that heart surgery might be necessary.   In the United States, the American Heart Association published revised guidelines for preventative antibiotic use in 2007.  In particular, patients with simple, unoperated bicuspid aortic valve do not require special antibiotic prophylaxis for procedures under these new American guidelines.  This has been considered quite controversial in both the USA and in other Western countries.  There are some physicians who feel that the risk of not treating with antibiotics is a risk they are unwilling to take.  I am not sure what the physicians in India feel about these recommendations.  The incidence of serious infections related to bacterial infections can vary across regions of the world, due to different genetic predispositions of the patient population and bacterial characteristics of the region.

Regardless, if your child gets real tonsillitis (with pain and fever), the use of antibiotics is appropriate.  If the episodes of tonsillitis are recurrent, then one needs to have a conversation regarding the pros and cons of tonsillectomy with your doctor.  Simple, small and asymptomatic tonsil “stones” without infection, probably do not strictly require antibiotic treatment.   However, you should have further discussions with your doctor (or ear, nose and throat specialist) in this regard.