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Tonsil stones or tonsilloliths are calcified deposits of trapped cellular debris and microorganisms lodged inside the tonsils - small soft tissues positioned at the back of the throat.

There are mainly three types of tonsil in human body namely:

  • Palatine tonsils: Located on either side of the back of the throat
  • Adenoids: Located high up in your throat almost behind the nose
  • Lingual tonsils: Positioned posteriorly at the base of the tongue

Tonsil stones are most commonly seen in palatine tonsils and appear as white or yellowish patches on the back of the throat. They are usually 1 to 2 mm in size but can be as large as 1 cm in diameter. Rarely, tonsil stones occur in the deeper layers of tonsil and become difficult to remove. 

The calcified mass or tonsil stones consists of various mineral deposits like phosphorus, ammonia, magnesium along with calcium hydroxyapatite and calcium carbonate. The predisposing factor of tonsilloliths is supposed to be recurrent tonsillitis (inflammation of the tonsils) and calcification. However, tonsil stones can occur with or without a previous history of tonsillitis or any other inflammatory disorders of the body.

The size and appearance of the patch may vary as very small spot to big, hard calcifications that jut out of the tonsils. Some people also experience bad breath and/or suffer from a persistent cough. In most cases, small tonsilloliths detach themselves on gargling. However, when symptoms get severe, some prefer to get the particular tonsils removed.

  1. Tonsil stones Symptoms
  2. Tonsil stones Causes
  3. Diagnosis of Tonsil stones
  4. Tonsil stones Treatment
  5. Doctors for Tonsil stones

Tonsil stones Symptoms

A person with tonsil stones may present varied symptoms or it can remain asymptomatic. Tonsil stones most commonly occur after the age of 50, however, it can affect any person in the age group between 10 to 77 years. Both men and women are equally affected. The most common symptoms associated with tonsilloliths are:

  • Irritable cough
  • Chronic sore throat
  • Dysphagia (difficulty in swallowing)
  • Otalgia (Earache)
  • Chronic halitosis (Bad breath)
  • Foul taste
  • Abnormal sensation in throat
  • White or yellow coloured deposits on tonsil

Tonsil stones Causes

The anatomical structure of tonsil consists of folds, crypts or crevices. Regular exposure to germs like bacteria, virus and fungi sometimes widens these crypts, providing a way for calcium and other minerals to deposit. These calcified deposits trap the debris of microorganisms and stuck food particles, and appear in the form of white-yellow spots called tonsil stones. People who are prone to infection and inflammation of tonsils develop tonsil stones more easily, however, it can occur to anyone irrespective of any other pathology present in the body.

Some factors that increase the risk of developing tonsilloliths are:

  • Bad oral hygiene
  • Increased size of a tonsil
  • Inflammation of tonsil for a long period of time

Diagnosis of Tonsil stones

When you go to a doctor with suspicion of tonsil stones, he/she might recommend and carry out few evaluating tests and scans to make a definitive diagnosis of tonsilolith. These are as follows:

  • Patient history: Your doctor will ask you a few questions related to your past medical history. For example history of cold, pain in the throat, brushing frequency or oral hygiene routine. 
  • Clinical examination: After this, he/she will evaluate your tonsils clinically. You will be asked to open your mouth wide and by the help of a bright illuminating source, the doctor will examine your tonsils for the presence of tonsilloliths. Superficial stones will be clearly visible. The size of superficial stones can also be determined just by looking at stones. In many cases, clinical examination alone is enough to make the diagnosis of tonsillolith.
  • X-ray: X-ray examination is ordered when the stones are not clearly visible by a physical checkup. It is a standard diagnostic test for tonsillolith. X-rays also illustrate the position, size and shape of tonsil stones. Usually orthopantomogram (OPG) - X-ray image of the whole mouth - is done to see the tonsil stones clearly.
  • C-T scan: In certain cases, a CT scan may be ordered to get a better view of the stone and tissue damage, if any, in the surrounding area. 

Tonsil stones Treatment

Usually, tonsil stones do not have any harmful effects on human health but the associated symptoms make them unbearable. Tonsilloliths can be removed easily with treatment. Home remedies can also be used for getting rid of tonsillitis. 

  • Vigorous gargling: Saltwater gargling is one of the most common methods of removing tonsilloliths. Vigorous saltwater gargling puts force on the thin lining of tonsils, detaching the stone and providing the much-needed relief.
  • Good oral hygiene: Most of the constituents of tonsil stones come from the oral cavity itself. Maintaining good oral hygiene helps in preventing tonsil stones naturally. In addition to this, brushing regularly will help overcome bad breath, which is one of the most commonly reported symptoms of tonsil stones.
  • Extraction of tonsil stones: Another method of removing tonsil stones is by using a dental pick or dental swab. Your dentist is the best man for this job. People also try to do this by themselves at home. However, this practice should not be encouraged. Talk to your dentist to get the tonsilloliths removed.
  • Tonsillectomy: Tonsillectomy refers to the removal of tonsils through surgery. It is the only way to completely prevent recurrent tonsil stones. However, tonsils are an important part of the immune system and their removal may affect your immunity. Discuss the need for tonsillectomy with your doctor before you decide to go for it.
Dr. K. K. Handa

Dr. K. K. Handa

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

Dr. Aru Chhabra Handa

Dr. Aru Chhabra Handa

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

Dr. Yogesh Parmar

Dr. Yogesh Parmar

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

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References

  1. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How do the tonsils work?. 2011 Mar 8 [Updated 2019 Jan 17].
  2. Abdulrhman Alfayez, Meshal B. Albesher, Mohammed A. Alqabasani. A giant tonsillolith . Saudi Med J. 2018 Apr; 39(4): 412–414. PMID: 29619494
  3. Babatunde Olamide Bamgbose et al. The Prevalence of Tonsilloliths and Other Soft Tissue Calcifications in Patients Attending Oral and Maxillofacial Radiology Clinic of the University of Iowa . ISRN Dent. 2014; 2014: 839635. PMID: 24587913
  4. healthdirect Australia. Tonsil stones. Australian government: Department of Health
  5. National Health Service [Internet]. UK; Tonsillectomy: Surgery to remove your tonsils .
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