Alternative Names: Tonsillolith, Tonsil Stone
Tonsil stones are irregularly-shaped, whitish-yellow, very foul-smelling globs of calcium, collagen, mucus and bacteria that get caught in the back of the throat. They occasionally become dislodged and may be coughed up.
Tonsil stones can in rare cases become as large as a pea, but are normally a lot smaller. They do not do any harm, nor do they mean that there is anything wrong with you. They are simply a slight nuisance, often causing bad breath.
Incidence; Causes and Development
Tonsilloliths occur more frequently in adults than in children.
Tonsil Stones are caused by an accumulation of sulfur-producing bacteria
and debris that become lodged in the tonsils. They form in the tonsil crypts
which are simply small pockets in the tonsils at the back of the throat.
The precise causes of and mechanisms behind tonsil stones are not yet fully understood.
Signs and Symptoms
Many small tonsil stones do not cause obvious symptoms. Apart from coughing up the small, soft, smelly lumps, other possible symptoms include a metallic taste, throat closing or tightening, coughing fits, or choking.
Larger stones may have multiple symptoms, including frequent bad breath, tonsil infection/swelling, sore throat, white particles, bad tastes, difficulty swallowing, a 'foreign body' sensation in the back of throat, and even ear ache.
Diagnosis and Tests
Tonsilloliths are difficult to diagnose when obvious visible signs are not present. Tonsil stones can sometimes be seen on X-rays or CAT scans and are often found by accident.
Treatment and Prevention
Treatment is not usually necessary, but is generally quite simple. Larger stones may require local excision; embedded tonsilloliths (which develop inside tonsils) are not easily removed, but will naturally erupt from the tonsils over time.
A common method that works for some people is removal by the tongue. Unlike other methods, this does not provoke the gag reflex
. While difficult to perform due to the gag reflex, a quick brushing with a toothbrush may remove surfaced tonsilloliths.
Tonsil Stones can also be removed through scraping and scooping (curettage), even at home using small implements such as Q-tips and tweezers. Another effective method is pressing a finger or Q-tip against the bottom of the tonsil and pushing upwards, helping to squeeze out the stones.
Medicine droppers (especially those with a curved tip) can be used to suck out smaller stones. First irrigating the area with saline solution may help to bring the tonsil stone(s) to the surface to make extraction easier.
Another method that works sometimes and does not stimulate the gag reflex
is simply flexing the throat, raising the tongue to the roof of the mouth and swallowing. This causes the tonsils to tense up and will sometimes result in the tonsil stone(s) popping out.
Gargling with warm salty water seems to help heal the pockets afterwards, as does a mixture of 1 or 2 drops of Grapefruit Seed Extract combined with a strong minty mouthwash to make it palatable if necessary.
A longer term cure is possible by using laser resurfacing which can be performed under local anesthetic and a laser which vaporizes and removes the surface of the tonsils. This flattens the edges of the crypts and crevices that collect the debris preventing trapped material from forming stones.
The most drastic and effective method is, of course, a tonsillectomy (removal of the tonsils.) This should be considered as a last resort, and becomes more risky the older the patient.
It should be noted that these treatments may not remove any bad breath issues; gargling with mouth wash, tongue-scraping and frequent tooth brushing will help prevent bad breath and the formation of tonsil stones.