Tonsil Stones (Tonsilloliths)

What Causes Tonsil Stones?

Your tonsils are filled with nooks and crannies where bacteria and other materials, including dead cells and mucous, can become trapped. When this happens, the debris can become concentrated in white formations that occur in the pockets.

Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies. This tends to happen most often in people who have chronic inflammation in their tonsils or repeated bouts of tonsillitis.

While many people have small tonsilloliths that develop in their tonsils, it is quite rare to have a large and solidified tonsil stone.

What Are the Symptoms of Tonsil Stones?

Many small tonsil stones do not cause any noticeable symptoms. Even when they are large, some tonsil stones are only discovered incidentally on X-rays or CT scans. Some larger tonsilloliths, however, may have multiple symptoms:

  • Bad breath . One of the prime indicators of a tonsil stone is exceedingly bad breath, or halitosis, that accompanies a tonsil infection. One study of patients with a form of chronic tonsillitis used a special test to see if volatile sulfur compounds were contained in the subjects’ breath. The presence of these foul-smelling compounds provides evidence of bad breath. The researchers found that 75% of the people who had abnormally high concentrations of these compounds also had tonsil stones. Other researchers have suggested that tonsil stones be considered in situations when the cause of bad breath is in question.
  • Sore throat . When a tonsil stone and tonsillitis occur together, it can be difficult to determine whether the pain in your throat is caused by your infection or the tonsil stone. The presence of a tonsil stone itself, though, may cause you to feel pain or discomfort in the area where it is lodged.
  • White debris. Some tonsil stones are visible in the back of the throat as a lump of solid white material. This is not always the case. Often they are hidden in the folds of the tonsils. In these instances, they may only be detectable with the help of non-invasive scanning techniques, such as CT scans or magnetic resonance imaging.
  • Difficulty swallowing. Depending on the location or size of the tonsil stone, it may be difficult or painful to swallow foods or liquids.
  • Ear pain . Tonsil stones can develop anywhere in the tonsil. Because of shared nerve pathways, they may cause a person to feel pain in the ear, even though the stone itself is not touching the ear.
  • Tonsil swelling. When collected debris hardens and a tonsil stone forms, inflammation from infection (if present) and the tonsil stone itself may cause a tonsil to swell or become larger.

How Are Tonsil Stones Treated?

The appropriate treatment for a tonsil stone depends on the size of the tonsillolith and its potential to cause discomfort or harm. Options include:

  • No treatment. Many tonsil stones, especially ones that have no symptoms, require no special treatment.
  • At-home removal. Some people choose to dislodge tonsil stones at home with the use of picks or swabs.
  • Salt water gargles. Gargling with warm, salty water may help ease the discomfort of tonsillitis, which often accompanies tonsil stones.
  • Antibiotics. Various antibiotics can be used to treat tonsil stones. While they may be helpful for some people, they cannot correct the basic problem that is causing tonsilloliths. Also, antibiotics can have side effects.
  • Surgical removal. When tonsil stones are exceedingly large and symptomatic, it may be necessary for a surgeon to remove them. In certain instances, a doctor will be able to perform this relatively simple procedure using a local numbing agent. Then the patient will not need general anesthesia.

Can Tonsil Stones Be Prevented?

Since tonsil stones are more common in people who have chronic tonsillitis, the only surefire way to prevent them is with surgical removal of the tonsils. This procedure, known as a tonsillectomy, removes the tissues of the tonsils entirely, thereby eliminating the possibility of tonsillolith formation.

Unlike tonsil stone extraction, tonsillectomies are typically performed under general anesthesia. Patients who undergo the surgery have difficulty swallowing and a sore throat for at least a few days after the procedure.

  • Dr. Carlo Oller (emergency physician with www.DrER.tv) has put together more than 1800 patient education videos which can be found at www.patienteducation.video
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Last updated 3/2/19

Last updatedL 3/2/19

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