symptoms and treatment of tonsil stones

Tonsil stones, or tonsilloliths, are buildups of bacteria and debris within the nooks and crannies of your tonsils. This debris hardens into small, stone-like growths.

This condition is different from tonsillitis, which occurs when the tonsils themselves become infected.

What Are Tonsil Stones?

Tonsil stones are usually harmless and nothing to worry about. They are found inside the tonsils — the gland-like tissue in the back of each side of your mouth.

The tonsils contain lymph nodes that work as a part of your immune system, filtering out viruses and other harmful particles from entering your body and making you sick.

“Small tonsil stones are fairly common, especially for people who have had repeated cases of tonsillitis,” says Jonas Johnson, MD, professor and chair of the Department of Otolaryngology at University of Pittsburgh School of Medicine and UPMC.

Dr. Johnson says stones can range in size from a few millimeters to several centimeters. “But we rarely see large, symptomatic tonsil stones that require medical treatment,” he adds.

What do tonsil stones look like?

Tonsil stones are hard white or yellow formations located within the tonsils. Tonsil stones can cause bad breath, a sore throat, and even trouble swallowing.

(Tonsil Stone image)

Never Miss a Beat!

Get Healthy Tips Sent to Your Phone!

Message and data rates may apply. Text the word STOP to opt out and HELP for help. Click here to view the privacy and terms.

What Causes Tonsil Stones?

Tonsil stones are made up of a material called biofilm which is a combination of numerous particulates from the mouth, such as:

  • Bacteria
  • Fungi
  • Particles of food
  • Dead cells
  • Mucous

All this debris collects and interacts with your mouth’s chemistry, and that debris can get caught in the crevices of your tonsils, known as the crypts.

This mixture then attaches itself to any moist surface. In the case of tonsil stones, the material becomes hardened within the tonsils. Over time, the bacteria calcifies from a soft, gel-like state to a hardened particle – a tonsil stone.

Tonsil stones appear most often in people between the ages of 20 and 60.

“Most patients who repeatedly get tonsil stones have large tonsils or repeated cases of tonsillitis,” Dr. Johnson says.

Symptoms of Tonsil Stones

The symptoms of tonsil stones can depend on how large they are. Sometimes you may experience no symptoms at all. The most commonly experienced symptom is bad breath, also known as halitosis. Research published in the British Dental Journal found that people with tonsil stones were 10 times more likely to exhibit bad breath.

Other symptoms include:

  • Chronic sore throat.
  • Cough.
  • Bad breath.
  • Foreign body sensation.
  • Painful swallowing.
  • Bad taste in the mouth.
  • Hoarseness.
  • Ear pain.
  • Upper airway obstruction.

How to Get Rid of Tonsil Stones: Treatment and Removal

Tonsilloliths are generally harmless — they’re just uncomfortable and embarrassing when they cause bad breath. Several treatments are available for tonsil stone removal, both at home and at the doctor’s office.

“Most people won’t need medical treatment for tonsil stones,” Dr. Johnson says. “But if they do, we now have several options for effective treatment.”

Some treatments include:

  • No treatment: If you’re not experiencing any symptoms, you may not need treatment at all.
  • Saltwater or mouthwash: Gargling these can help dislodge your tonsil stones.
  • Manual removal: You can scrape off the buildup using a toothbrush, Q-tip, or something similar.
  • Antibiotics: Some doctors may prescribe antibiotics to get rid of tonsil stones.
  • Surgical removal: In more severe cases, a doctor may need to surgically remove the tonsil stone. This is a simple procedure done by numbing just the area around the tonsils. · Tonsillectomy: If tonsil stones become a chronic problem, causing repeated tonsillitis, your doctor may recommend the removal of your tonsils. Tonsillectomy generally is done as an outpatient procedure, but you may need an overnight stay in the hospital. It also can result in a severe sore throat.
  • Laser Tonsil Cryptolysis (LTC): An alternative to tonsillectomy, LTC uses a CO2 or diode laser to scar the tonsil crypts. This makes it less likely for tonsil stones to form. Potential benefits include less bleeding and pain than from a tonsillectomy.
  • Coblation tonsil cryptolysis: A version of cryptolysis that uses a wand instead of a laser. This method potentially shows similar results to LTC while minimizing risks like airway fires, burns, and retinal damage.

Tonsil Stone Prevention

“Tonsil stones aren’t dangerous, but they can become uncomfortable if they are large,” Dr. Johnson says. He recommends the following steps to prevent tonsil stones:

  • Brush and floss your teeth after every meal, or at least twice per day. Make sure to brush your tongue, as well.
  • Stop smoking.
  • Gargle with saltwater or an oral rinse after eating or at least once a day.
  • Use a water flosser to clean your mouth and help dislodge any tonsil stones.
  • Stay hydrated by drinking plenty of water.

If your tonsil stones do keep coming back, a tonsillectomy might be a way to prevent them.

When Is a Tonsillectomy Needed?

Only a doctor can determine if you have an infection or need a tonsillectomy for tonsil stone removal or other treatment for chronic tonsil stones.

Talk to your health care provider if:

  • You experience severe or prolonged symptoms.
  • Your symptoms get worse.
  • You are limited by the discomfort caused by tonsil stones.

Visit the UPMC Ear, Nose, and Throat website to learn more about throat-related ailments.

Editor's Note: This article was originally published on , and was last reviewed on .

Sources
Abdulrhman Alfayez, MD, Meshal B. Albesher, MBBS, Mohammed A. Alqabasani, MD. A Giant Tonsillolith. Saudi Medical Journal. Balaji Babu B., Avinash Tejasvi M.L., C.K. Anulekha Avinash, Chittaranjan B. Tonsillolith: A Panoramic Radiograph Presentation. Journal of Clinical and Diagnostic Research. Babatunde Olamide Bamgbose, Axel Ruprecht, John Hellstein, Sherry Timmons, Fang Qian. The Prevalence of Tonsilloliths and Other Soft Tissue Calcifications in Patients Attending Oral and Maxillofacial Radiology Clinic of the University of Iowa. ISRN Dentistry. M. Dykes, S. Izzat, V. Pothula. Giant Tonsillolith – A Rare Cause of Dysphagia. Journal of Surgical Case Reports. YP Krespi, V. Kizhner. Laser Tonsil Cryptolysis: In-office 500 cases review. American Journal of Otolaryngolog.

About Ear Nose and Throat

The experts in the UPMC Department of Otolaryngology treat a variety of ear, nose, and throat (ENT) conditions in both children and adults. Our team includes board-certified physicians and highly skilled speech-language pathologists and audiologists. We provide both surgical and nonsurgical treatment options. Our research and clinical trials help to advance care for our patients. Find an ENT expert near you.