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Tonsil stones are smelly white or yellow lumps of variable size that form inside the tonsils. They are usually small in size.
Tonsil stones can be quite hard and calcified, like a stone, or soft and compressible, like plasticine. Anyone, from children to the elderly, can develop this problem.
In most cases, tonsil stones are not large or harmful enough to warrant surgical intervention. (1)
Prevalence of Tonsil Stones
Tonsil stones are a quite common problem but often less talked about, making it seem rare. They are generally left untreated despite the recognizable and bothersome symptoms as people avoid talking about it due to the unwarranted embarrassment.
It is estimated that around 10% of the adult population has experienced tonsil stones. (2)
Children who suffer frequent episodes of tonsillitis often form tonsil stones. However, the tonsils shrink back on their own by the time the child reaches the age of 10 and no treatment is required.
Causes of Tonsil Stones
Tonsil stones form when food is compressed into the side of the throat when chewing and swallowing. In some people, cracks and holes appear in the tonsils, often after a bout of tonsillitis and glandular fever.
At times, bacteria, dead cells, mucous, or food particles may accumulate in the crevices and form debris, often leading to tonsil stones. Tonsil stones are often multiple and recurrent. Once you have cracks and holes in the tonsils, food is continually trapped and forms into tonsil stones.
Symptoms of Tonsil Stones
Tonsil stones cause bad breath, as the trapped food may have been swallowed weeks previously. (1) The rotting food enables putrefying bacteria to multiply and many of these emit foul smells.
Moreover, it has been observed that the successful treatment of chronic tonsil stones often leads to an improvement of other symptoms, particularly chronic bowel problems, other stomach issues, chronic fatigue syndrome, and chronic inflammatory tonsillitis.
Treatment of Tonsil Stones
Tonsil stones can disintegrate as they sit in the holes and cracks of the tonsils. They can then ooze out as a thick whitish fluid, which is usually swallowed.
The following treatment modalities are presently available for treating tonsil stones.
1. Short-term modalities and their side effects
In most cases, the primary physician will ask the patient to gargle with salt water as a remedy.
You can also use cotton buds, water jets, and purpose-made small picks for the removal of superficial stones. However, this must be done with caution as they pose a risk of damaging your tonsils.
2. Surgical interventions
For patients above 8 years of age, surgery can be performed for the removal of tonsil stones. The best way to cure tonsil stones is to remove the cracks and holes in the tonsils that cause the stones to form.
This means some form of tonsil removal, whether complete removal under general anesthesia (“traditional” tonsillectomy) or partial removal, often using carbon dioxide laser under local anesthesia. (3) However, tonsillectomy should only be performed if there is no other remedy, or there is a risk of cancer. (4)
Tonsil Stones and Tonsillitis
Tonsil stones almost certainly do trigger tonsillitis (infection of the tonsils) all on their own.
This is because the natural rotting process of the organic food that tonsil stones are made of causes local inflammation (soreness) in the cracks and holes where tonsil stones form. This, in turn, leads to swelling of the lining of the tonsils deep in the crypts.
Subsequently, the natural defensive wall of the tonsils weakens, allowing in viruses and bacteria that multiply to cause tonsillitis.
Can Tonsil Stones Be a Sign of Throat Cancer?
Tonsil stones themselves are not a sign of cancer. However, white patches in the mouth can be the first sign of mouth or throat cancer. Hence, always get your throat and mouth checked if you think you have white patches.
Tonsils stones form in the crevices of the tonsils due to the accumulation of food, bacteria, and mucus. They can either be present as soft clumps or as hard stones.
Tonsil stones cannot be avoided if you have tonsillar crypts (holes and folds) where food can get lodged in. Realistically, the only options are to either put up with them or to have them surgically treated.