Tonsilloliths : Causes, Sympstoms, Treatment and Prevention

Tonsil Stones (Tonsilloliths)

If someone asked you where stones can form in the human body, you might think of the kidneys. But, the kidneys aren't the only place. The tonsils are another location where hard, and sometimes, painful stones may develop in certain people.

What Are Tonsils?

Your tonsils are gland-like structures in the back of your throat. You have one located in a pocket on each side. Tonsils are made of tissue that contains lymphocytes -- cells in your body that prevent and fight infections. It is believed that the tonsils play a role in the immune system and are meant to function like nets, trapping incoming bacteria and virus particles that are passing through your throat.

Most medical experts agree that the tonsils often do not perform their job well. In many instances, they become more of a hindrance than a help. It may be that tonsils evolved in an environment where humans were not exposed to as many germs as we encounter today as a result of living in areas with relatively high populations. Evidence suggests that people who have had their tonsils removed are no more likely to suffer from bacterial or viral infections than people with intact tonsils.

What Causes Tonsil Stones?

So how do you get tonsil stones? What cause tonsilloliths? Those are very good questions but unfortunately the exact causes are unknown. While tonsils play an important role in trapping harmful bacteria from entering the rest of your body, they also tend to trap food, mucus, dead cells, and other particles. There is a generally accepted notion that tonsil stones are caused by the food, particles, and bacteria that are accumulated on and in the tonsils. These particles are broken down in time by saliva and digestive enzymes and most of what remains is the hard deposits of the particle (usually calcium). The softer parts are broken down and eventually are washed away.

There have also been studies that prove a correlation between patients who have tonsilloliths and patients who suffer from post-nasaldrip, which is another cause of bad breath.

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.

Side-effects of tonsil stones

There are various signs and symptoms of tonsil stones. Below is a list of the side-effects of them. Keep in mind that tonsil stones vary greatly in size and that a lot of these symptoms only manifest themselves with patients who suffer from large or rare giant tonsilloliths.

• Bad breath (halitosis)
• Pain on swallowing
• Difficulty swallowing
• Metallic taste in mouth
• Coughing fits
• White Spots on tonsils
• Ear ache
• Swollen tonsils
• Sensation that something is stuck or lodged in the back of the throat

While the side-effects can be unpleasant and uncomfortable, they are rarely life threatening and there has not been any evidence that they negatively affect one's overall health.

How do you know if you have tonsil stones

If you suffer from the above mentioned symptoms of tonsilloliths you may have them. Keep in mind it is extremely rare to suffer from tonsil stones if you had a tonsillectomy and had your tonsils removed.

You can usually determine if you have tonsil stones through visual inspection. Grab a flashlight and face a mirror. Open your mouth in such a way that you have a clear view of your tonsils. Shine the light on the tonsils and inspect each of them thoroughly for any white spots or white objects on them.

Also you may try taking a clean Q-tip and using that to pull back the flap of the tonsils to inspect the cryptic area in the tonsils. If you do not see any white spots or objects you should be good to go. If you do see white objects they might be tonsil stones, debris from a larger tonsil stone, or a tonsil stone in development.

Tonsils stones can also be detected through X-rays and CAT scans and they are often discovered accidentally through these methods.

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.

There are various methods used to treat and remove tonsil stones. They are often removed or dislodged unintentionally by coughing or even swallowing. The simplest method of the removal of tonsil stones is take a Q-Tip (people report a bent bobby pin works well) and to gently apply pressure to the white stone until it is dislodged. If that doesn't work try to apply pressure through different angles and try a back and forth motion. 

Also if it is hard to reach you might try taking another Q-tip and using that to pull back the flap or part of the tonsil so you have better access. Remember to be very gentle. Your tonsils are very fragile and they might bleed if handled recklessly. A little bleeding is common in removing tonsil stones but do your part and be gentle and take your time to minimize the bleeding and irritation done to your tonsils.

Removal of tonsil stones is also carried out effectively by using an oral irrigator. Ideally the best irrigation tool to use is an oral irrigator that is used to irrigate the lacerations left by the removal of wisdom teeth. Other oral irrigators may be used such as a WaterPik or the SinuPulse Irrigation System but be sure to use the lowest setting at first, and if you feel even the lowest setting would be too powerful on your tonsils, then don't do it. 

CAUTION: You may rupture or puncture your tonsil if the water stream is too strong. Be careful and smart. Take your time while irrigating and hopefully that will get rid of your tonsil stones.

If you have tried the above mentioned methods and they did not work, consider seeing a doctor. Doctors may remove tonsil stones by curettage, laser, or even surgery if necessary. If they are really bad and keep recurring, the doctor may suggest tonsillectomy (removal of the tonsils). The doctor will let you know what the best treatment for tonsil stones would be.

Should I get my tonsils removed?

Many people consider getting their tonsils removed if they suffer from recurring tonsil stones and bad breath. It is a hard decision to make and there are many things to consider personally and with your doctor before removing them. The recovery time from a tonsillectomy increases as the patient gets older and many doctors discourage it for adults, whereas many adult patients have had them removed and stated the recovery wasn't too hard and they are loving life after having them out. 

Research the topic heavily. If tonsil stones are the only reason you want them out first try removing the tonsil stones and applying the preventive measures in your life that are outlined in the next section. If you just can't get rid of the tonsil stones and if your tonsils are causing you to have tonsillitis and sickness regularly, it might be best just to rip them out yourself. Just kidding, get a doctor to do a tonsillectomy.

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.

Prevention of Tonsil Stones

While removing tonsil stones is possible, it is important to take measures that stop them from 

returning and recurring often. We believe that the stones are caused by particles that get trapped in the tonsils, so in order to prevent tonsil stones it is important to clean your tonsils regularly to keep them free of the particles that would eventually break down and cause the tonsilloliths to develop. Here is a list of methods you can apply to prevent tonsil stones.

Brush Teeth and Gargle after meals - Brushing your teeth and gargling a germ killing oxygenating solution after meals is an excellent way to ensure that your breath is fresh and your mouth and tonsils are free from food particles that would eventually cause bad breath and tonsil stones. Before brushing after a meal it is a good idea to swish water in your mouth and spit it out until you do not see any more food particles coming out. Then drink a bit of water to wash down any particles in the back of your throat and tonsils. Now brush your teeth and be sure to gargle mouthwash thoroughly. If you do this after each meal it will help your overall oral health and help keep your mouth free of food particles. 

Irrigate your tonsils regularly - With a gentle oral irrigator wash your tonsils often, at least once a week, to insure there are no particles that have been lodged in them. Try SinuPulse Irrigation System to clean your tonsils regularly. You may also use WaterPik with the irrigator tip and on the lowest pressure setting. These irrigators will work best if you use warm water in them. 

Try Nasal Irrigation - While it is not proven that post-nasal drip is a cause of tonsil stones, it would still be prudent to clean out your nasal passages regularly as well just in case too much mucus drainage in the back of the throat is a cause of tonsil stones. Check out our article on nasal irrigation and also post-nasal drip to discover other methods on how to treat post-nasal drip. 

Use tonsil sprays and oxygenating mouthwash - Tonsil sprays and oxygenating mouthwash such as TheraBreath Oral Rinse used regularly help to break down the particles faster to hinder the development of tonsil stones. They also help neutralize sulfur-producing bacteria to freshen your breath. 

Take Oral Probiotics - Although this information is not yet backed up by studies, many people have reported that taking oral probiotics has stopped or hindered the growth of tonsil stones.

Keep in mind you will probably not see immediate results. Doing these preventive measures will hinder the growth of future tonsil stones, but do little to remove the tonsil stones you currently have.

Try to remove the tonsil stones you currently have and then carry out these preventive measures to try to keep new ones from forming. Overtime you should notice results, but don't give up after a couple of weeks. It might take months for you to see results.

Also do not neglect other oral health care while trying to get rid of tonsil stones. Basic oral care regimen that will help you have fresh breath.

If you take the protective measures above, hopefully you will be rid of tonsil stones for good and eliminate tonsil stones from your life!

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Source : WebMD, BreathMD and Wikipedia