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What Are Tonsil Stones?

While tonsil problems are typically considered the domain of the very young, not all health issues related to the tonsils disappear once you reach adulthood. Tonsil stones are one such problem that’s more common among adults than children.

What Are Tonsil Stones?

What Are Tonsil Stones?


What Are Tonsil Stones?

Tonsil stones, also called tonsilloliths, are not usually serious but can become annoying for some individuals, particularly if they occur frequently. These small globs of calcified debris form in the crevices and valleys of the tonsils and you can usually see them at the back of the throat.

What Are Tonsil Stones?

While tonsil stones aren’t rare, many people may have them without even knowing because they’re so small or don’t cause enough irritation to become noticeable. One 2014 study found the incidence rate to be about 8 percent for the population studied (which ranged in age from 9 to 87 years), and other studies have found that between 5 and 10 percent of people experience tonsil stones from time to time.

What Are Tonsil Stones?

Below, find answers to basic questions, including:

What Are Tonsil Stones?

  • What are the tonsils?
  • What causes tonsil stones?
  • What signs or symptoms do tonsil stones cause?
  • How are tonsil stones treated?
  • How can I prevent tonsil stones?

What Are the Tonsils?

Any discussion of tonsil stones should probably start with a review of the tonsils. Dr. Eric J. Kezirian, professor of sleep medicine at the Keck School of Medicine of USC and otolaryngologist at the USC Caruso department of otolaryngology – head and neck surgery at Keck Medicine of USS, says the tonsils are glands that sit at the back of the throat. “They’re lymph nodes that happen to be in your mouth, and they sit there on the side of your throat, forming part of your body’s first recognition of outside things like cold viruses and other infections like strep throat.” These glands help fight infectious agents that can enter the body through the mouth or nose.

Tonsils tend to be larger and more active in children, and as we age, they shrink and their immune function becomes less critical to our overall health and well-being. This is why it’s usually OK to remove tonsils in children who have repeated infections or cases of tonsillitis.

What Causes Tonsil Stones?

However, in people who keep their tonsils into adulthood, some of the changes they undergo can actually increase the chances of developing tonsil stones. “Tonsils are not smooth, round balls,” Kezirian says. “They have these folds in them,” and these nooks and crannies can provide a place for tonsil stones to develop.

“Tonsil stones are calcifications that form from debris in the tonsils themselves,” says Dr. Kyra Osborne, a general otolaryngologist at the Cleveland Clinic. “They usually form from particles of food that get caught in the crypts and valleys of the tonsils themselves.” The more crevices, or crypts, you have in your tonsils, the more prone you will be to developing tonsil stones, she says.

Kezirian explains that this debris is part of the body’s natural renewal process. As the top layer of cells dies and sloughs off to be replaced by new cells, these dead cells sometimes accumulate in the crevices in the tonsils. “These folds create pockets. The natural turnover of the lining in the mouth and the lining covering the tonsils will have cells and layers coming off, which can get trapped in these pockets. We all have bacteria in our mouth and food and other particles that can get trapped and they have the potential to form these stones. That’s all they are. They’re just a natural accumulation of stuff,” Kezirian says.

If the tonsils are irritated, that can increase your risk of developing tonsil stones. “When the tonsils get swollen, these pockets get deeper. That’s when stuff sticks around and doesn’t get out of there,” he says. Some tonsil stones may have sharp edges, too, which can further irritate the tissue, leading to pain and swelling.

What Signs or Symptoms Do Tonsil Stones Cause?

For some people, tonsil stones don’t cause any noticeable symptoms. For others, a sore throat might signal that a tonsil stone has developed. “Most of the time it’s the sensation that something is there,” in the back of the throat, Osborne says. A visual check will usually confirm that a yellow or white-ish deposit is lodged in the soft tissue at the back of throat.

A sore throat can also be a sign of tonsil stones. “Sometimes there can be some irritation from the stone being there and that can cause swelling of the tonsil itself,” Osborne says. Bad breath, also called halitosis, can also be a symptom of tonsil stones. But as Kezirian notes, “bad breath has a lot of other causes, too, so it’s not a perfect diagnosis.”

“If it’s a one-time thing (patients) don’t need to worry about being evaluated,” Osborne says. But “if the symptoms are concerning they can come in for evaluation.” She says some people get tonsil stones “multiple times a week, sometimes even daily and that can be quite bothersome for them. Or if there’s any pain or asymmetric swelling of the tonsils,” you might want to get it checked out by your primary care provider.

How Are Tonsil Stones Treated?

Most of the time, tonsil stones are not a major problem and will resolve on their own. “People figure it out themselves,” Kezirian says, and it’s usually fairly easy to dislodge a tonsil stone with your finger or a Q-tip. Stubborn tonsil stones may need the assistance of a doctor with a tongue depressor to remove. Osborne says a water pick (also called an oral irrigator or water flosser) can be used to dislodge tonsil stones.

In the most extreme cases of chronic tonsil stones, your doctor may recommend a tonsillectomy – surgery to remove the tonsils. This form of surgery is much more common among children. “It’s pretty uncommon to have to move forward with surgery purely for tonsil stones,” Kezirian says, and if you end up needing such surgery, be forewarned that such intervention can be much more challenging for adults than for kids. “Tonsillectomy is no joke. It’s super painful if you’re not 6 years old anymore,” usually causing significant pain for “a solid seven to 10 days,” and often necessitating the use of narcotic pain killers. Therefore, only in the most extreme cases would tonsillectomy be recommended.

How Can I Prevent Tonsil Stones?

Osborne recommends rinsing your mouth out after eating to help wash away debris that could develop into a tonsil stone. If debris isn’t permitted to build up, it’ll be less likely to harden into a stone.

“I recommend a gentle salt water gargle a couple times a day to people who have them occurring repeatedly,” Kezirian says. He notes that you don’t need to use a special mouthwash – many mouthwashes contain alcohol that can further irritate the tonsils. Instead, simply adding some regular old table salt to room-temperature tap water and gargling for about 30 seconds works well to flush out any detritus that’s built up and could cause problems.

While there isn’t much you can do from a dietary perspective to reduce the chances of developing tonsil stones, Kezirian notes that they’re more common among smokers. “Anything that causes inflammation in the throat including smoking will tend to make the tonsils irritated, and then you get these pockets that are deeper and that’s what sets you up for this.” So if you’re a smoker who’s having trouble with tonsil stones, that’s just one more reason to kick the habit.

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