Tonsil Stones

Tonsil stones can form when food, mucus, and bacteria get stuck in the craters of the tonsils.

The tonsils are lymph nodes located at the back of the throat. Tonsil stones (also called tonsilloliths or tonsil calculi) are small clusters of calcifications or stones that form in the craters (crypts) of the tonsils. Tonsil stones are hard and appear as white or yellowish formations on the tonsils. They usually smell bad (and make your breath smell bad) due to bacteria.

Several factors can cause or contribute to the formation of tonsil stones, such as the following:

• Substances such as food, dead cells, mucus, and bacteria may get stuck in the nooks and crannies of the tonsils.
• The body's immune system, which sees these as foreign invaders, sends white blood cells to the area to fight infection. When the white blood cells are done, they leave small calcifications behind.
• Usually, these small stones are swallowed but sometimes they get stuck in the tonsillar crypts and continue to grow into tonsil stones. Small stones are common; large stones are rare.

Risk factors for developing tonsil stones include people with:

• Chronic or recurring tonsillitis (inflammation of the tonsils)
• Large tonsils
• Chronic sinus problems
• Poor dental hygiene
• Smoking
• Certain medications that make your mouth dry (antihistamines, decongestants, and others)

In many cases, tonsil stones do not cause any symptoms. When symptoms do occur, they may include:

• Persistent bad breath (halitosis)
• White or yellow formations on the tonsil
• Sore throat
• Difficulty swallowing
• Ear pain
• Swollen tonsils
• The sensation of a foreign object lodged in the back of the throat/choking feeling
• Cough
• Chronic tonsil inflammation/infection

Most of the time your primary care provider will be able to diagnose and treat the condition. If symptoms of tonsil stones are severe, you may see an ear, nose, and throat (ENT) specialist, also called an otolaryngologist.

Tonsil stones can frequently be seen in the back of the throat. They typically appear as white or yellowish spots on or around the tonsils that may range in size from a grain of rice to a pea.

For stones that cannot be visualized, an MRI or CT scan can help make a definitive diagnosis.

Tonsil stone treatment is not always needed. Stones frequently either dissolve on their own or are coughed up.

For stones that do not go away on their own, there are several types of treatments:

• Medications:
  • Antibiotics to help reduce bacteria
  • Antihistamines to reduce mucus from sinus problems or allergies
• Laser treatment (laser tonsil cryptolysis): a noninvasive treatment that helps minimize or remove the tonsil pockets (crypts) where the tonsil stones are lodged
• Coblation cryptolysis: radio waves are used to change a salt solution into charged ions that can cut through the tissue to reduce crypts on the tonsils and eliminate tonsil stones
• Tonsillectomy: removal of the tonsils, usually the last resort but the only way to eliminate tonsil stones and prevent new ones from forming

Manual tonsil stone removal at home is generally not recommended. Tonsils are delicate tissues, and removing them on your own may cause bleeding and infection.

Home remedies to get rid of tonsil stones include:

• Salt-water gargle: This may help dislodge tonsil stones and get rid of the odor and bad breath they cause.
• Coughing: Tonsil stones are often coughed up inadvertently. In some cases, a hard cough may help dislodge them.
• Oral irrigation: Oral irrigators can sometimes be used to gently shoot water into the back of the mouth in an attempt to dislodge the tonsil stones. Follow instructions and use caution because it is possible to injure the tonsils if it is not done gently.

Tonsil stones, also known as tonsilloliths, often go away on their own. If they are causing pain, bothering you, or keep coming back, there are several noninvasive and invasive methods to remove them (see above paragraph).

How long do tonsil stones last?

The length of time tonsil stones last varies and depends on several factors.

• Tonsil stones may dislodge or dissolve on their own in a short time.
• Tonsil stones may last for weeks if bacteria continue to grow on the tonsils due to tonsil stones deep in the throat.
• If tonsil stones are ignored and left in place without lifestyle changes, they may last for years.
• The only surefire way to cure tonsil stones and prevent any recurrence is to have the tonsils removed (tonsillectomy).

Most tonsil stones are not serious, but sometimes they can affect your quality of life including causing bad breath. If they are continually painful or bothersome, you should reach out to your medical professional.

There are several ways to prevent tonsil stones, such as the following:

• Maintain good oral hygiene: Brush and floss regularly; consider using a tongue scraper to remove bacteria.
• Gargle regularly with mouthwash or saltwater solution.
• Drink plenty of water.
• Quit smoking.
• Avoid excess alcohol.
• Reduce consumption of carbonated beverages such as sodas.
• Treat sinus infections or allergy symptoms promptly.
• Limit dairy products.