One out of ten people gets tonsil stones (also called tonsilloliths), hard white or yellow formations on the tonsils. You may have noticed a tonsil stone in the back of your throat while brushing your teeth. Or you may have coughed one up and wondered what it was.
The good news is that tonsil stones aren’t dangerous and usually don’t cause more than bad breath. They can often be treated without surgery. “While a tonsillectomy, surgery to remove the tonsils, can eliminate tonsils stones, it’s not necessary in most cases. Gargling after meals can help dislodge stones and prevent future stones from forming. Your doctor can also easily remove larger stones in the office,” says Alvin Ko, M.D., an otolaryngology (ENT) specialist at Henry Ford Health.
Here Dr. Ko explains what causes tonsils stones and how they are diagnosed and treated.
What Causes Tonsils Stones?
Your tonsils are glands on either side of the back of your throat. They are made up of crevices and tunnels called crypts. Tonsil stones form when food debris, secretions and bacteria form and harden in the tonsil crypts.
“We don’t know why tonsil stones form in some people and not in others. Some people may have larger crevices in their tonsils. Or they may eat foods that don’t easily dissolve in the mouth. Or the bacteria in their mouth may get caught more easily in the tonsils,” says Dr. Ko.
What Are The Symptoms Of Tonsil Stones?
According to Dr. Ko, most people don’t realize they have tonsil stones unless they cough one up accidentally. Your dentist may discover tonsil stones when examining your mouth. Sometimes tonsil stones appear on an imaging test like a CT scan, used to evaluate another health condition.
Most tonsil stones do not cause any symptoms. Some patients may experience bad breath with tonsil stones. “It’s uncertain whether tonsil stones cause a sore throat, coughing or swollen tonsils. Often when patients have these symptoms, other conditions are causing their discomfort.”
For example, laryngopharyngeal reflux (LPR) occurs when acid travels back up the esophagus (the tube connecting the throat and stomach). This condition can cause a sore throat or a feeling that something is stuck in your throat. “Many patients with tonsil stones who complain of a sore throat also have LPR,” says Dr. Ko. “Allergies and other sinus conditions may also be the culprit for throat pain.”
Tonsil Stone Diagnosis
An ear, nose and throat specialist will do a thorough head and neck exam, including a careful look in your mouth and throat. “Tell your doctor about your medical history and all of your symptoms,” says Dr. Ko. “Often symptoms point to other conditions in addition to or instead of tonsil stones.”
Your physician may also examine your nose and throat with an endoscope (a thin, flexible tube with a camera on the end). Before the exam, you’ll be given an anesthetic medication to numb the inside of your nose. Your doctor will carefully thread the tube into your nose to thoroughly examine your throat.
How Are Tonsil Stones Treated?
“Remember that if you do have tonsil stones, they are not harmful and do not pose a risk for any complications,” says Dr. Ko. “While some people find them annoying or unattractive, you can take steps to reduce their frequency.”
As an initial treatment, Dr. Ko recommends gargling with plain water, lightly salted water or water mixed with a splash of hydrogen peroxide after each meal. Gargling, followed by brushing your teeth, can help remove food debris and bacteria that can get caught in your tonsils.
Although unnecessary, some people may want visible tonsil stones removed. Your doctor can gently remove larger stones for you in the office, often using a cotton swab or other instruments.
The safest way to dislodge stones yourself is by using a water pick on the lowest setting. Spray the tonsil with a light stream of water. You can also use your fingertip or a cotton swab to gently loosen and remove a stone. Avoid using a sharp object, which can tear the tissue and cause bleeding.
If you continue to develop tonsil stones, talk with your doctor about surgery to remove your tonsils (tonsillectomy). “While surgery can eliminate tonsil stones, the procedure poses certain risks, often underrecognized,” says Dr. Ko. He advises patients to consider the following information before pursuing surgery:
- General anesthesia risks: You’re given general anesthesia before surgery so that you sleep during the procedure. General anesthesia is safe but can pose a risk of complications for people with other health conditions, such as high blood pressure, obesity or diabetes.
- Surgery risks: Between 2% and 9% of people require follow-up care to stop bleeding after tonsil removal.
- Painful recovery: Most people have severe throat pain for seven to 10 days after surgery. While medication can help manage some discomfort, most people miss work or school during this recovery period.
“Your doctor can help determine the best treatment option based on how often you develop tonsil stones and your other symptoms,” says Dr. Ko. “By starting with more conservative treatments like gargling, many people find the number and frequency of tonsil stones significantly decrease.”
Reviewed by Dr. Alvin Ko, an otolaryngologist who sees patients of all ages at Henry Ford Hospital in Detroit, Henry Ford West Bloomfield Hospital and Henry Ford Medical Center - Lakeside in Clinton Township.
