Tonsil Stones

Tonsil Stones: Overview

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.

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The tonsils (specifically, the 'palatine tonsils') are lymph nodes located on both sides of the back of the throat, on either side of the uvula.  The uvula is a fleshy piece of tissue hanging down over the tongue, a little bit forward from the back of the mouth.

The tonsils, located on both sides at the back of the mouth
The two black arrows indicate the location of the tonsils at the back of the mouth. Above and between the arrows is the uvula.

The surface of the tonsils is not smooth but instead consists of approximately 10 to 30 'crypts', which give them a large internal surface.  It is inside these deep and branching crypts that tonsil stones can form.

Tonsil stones can become as large as a pea, but are normally a lot smaller.  In very rare cases, giant tonsilloliths may form, and be mistaken for a tumor or abscess.

Tonsil stones 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

Tonsil stones are very common and occur more frequently in adults than in children.

Tonsilloliths are caused by an accumulation of sulfur-producing bacteria, dead cells, mucus, and debris that form in the tonsil crypts and become lodged in the tonsils.

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, and even larger stones may go unnoticed.  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.

Removing a tonsil stone from the right tonsil using a Q-tip
Removing a tonsil stone (pale yellow) from right tonsil using a Q-tip. The tongue can be seen bottom-left and uvula top-right.

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.

Signs, symptoms & indicators of Tonsil Stones:

Symptoms - Head - Mouth/Oral

Coughing up foul-smelling lumps

Tonsil stones (tonsilloliths) are irregularly-shaped, whitish-yellow, foul-smelling lumps that form in the back of the throat.

(Heavily) coated tongue

A white coated tongue can be due to an accumulation of volatile sulfur compounds on the back of the tongue and throat.  These compounds are created by anaerobic bacteria living under the surface of the tongue and are the same sulfur compounds that cause bad breath and the foul smell experienced when you break open a tonsil stone.

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Tonsil Stones can lead to:


Bad Breath (Halitosis)

A medical study conducted in 2007 found a strong association between tonsilloliths and bad breath.  Among those with bad breath, 75% of the subjects had tonsilloliths while only 6% of subjects with normal breath had tonsilloliths.

Preventive measures against Tonsil Stones:


Increased Water Consumption

Drinking plenty of water hydrates the throat and prevents the formation of tonsil stones.  Carbonated drinks, preferably seltzer water, tonic water or club soda, have been known to help dislodge tonsil stones.

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