Treating Tonsil Stones

Treating Tonsil Stones
Q:
Treating Tonsil Stones

My daughter has very large tonsils with deep crevices. She has large numbers of small, hard lumps that she scrapes out. Her doctor said they were food particles that had gotten stuck. I find this hard to believe. Could there be other reasons for the lumps?
Alice Bradford – Carrollton, Texas

A:

Dr. Greene’s Answer:

The tonsils are sentinels, standing guard at the back of the throat to protect the delicate tissues of our lungs and intestines from foreign invaders. They are part of a ring of defenders, Waldeyer’s Ring (which includes the tonsils, adenoids, and other lymphoid tissue), encircling the back of the throat as an important line of defense. The tonsils and adenoids are largest during childhood; they are front-line guardians while the body’s more sophisticated internal immune system learns and develops.

The situation you describe, Alice, is a very common one. The tonsils usually appear like small, dimpled golf balls set on either side of the back of the throat. Children with large tonsils and deep crypts often do get food particles trapped in there. Because saliva contains digestive enzymes, trapped food begins to break down. Particularly, the starch or carbohydrate part of the food melts away, leaving firmer, harder remains of food in the tonsils. This does not look like the food that went into the mouth.

Tonsillectomy - series

As you suspect, however, there is more to these hard lumps than just food. The tonsils also trap other mouth debris such as bacteria and old cells from the surface of the mouth’s lining. Some of these cells contain small amounts of keratin, the same substance found in fingernails and rhinoceros horns. Whatever the nature of the debris, it is then attacked by white blood cells. The aftermath of this battle leaves the crevices of the tonsil strewn with hardened remains.

Most people swallow this material without ever noticing it, while it is still tiny. In those whose tonsils are large, however, the particles can lodge in the deep crypts, where they continue to grow. The enlarging lumps are called calculi of the tonsil, or tonsilloliths (tonsil stones). These stones are most common during adolescence.

Microscopic studies of these tonsilloliths have shown them to contain a combination of food particles, bacteria, oral debris, and white blood cells in a concentrically laminated pattern — rather like a pearl. Usually they are small gritty particles found in the center of soft, cheesy flecks. Sometimes, however, they become quite large, appearing as rough, yellow or gray, round stones. At times they reach an extraordinary size. Affected people usually have a history of repeated attacks of tonsillitis in earlier years.

Most people with calculi of the tonsils have no associated symptoms. In that case nothing need be done, except perhaps for brushing or scraping them out, as your daughter does. Gargling, refraining from eating during the 30 minutes before falling asleep, and careful oral hygiene may help minimize their formation.

For some people, however, the calculi can be quite bothersome, causing a constant foreign-body sensation, a chronic low-grade sore throat, recurrent episodes of tonsillitis persisting beyond childhood, or chronic bad breath.

Surgical treatment is almost never necessary for this condition, but when needed, treatment consists of either removing the tonsils or removing the calculi. Troublesome large calculi that are not easily dislodged may need an ear, nose, and throat doctor to remove them.

Not too long ago, tonsils were routinely removed for the sole crime of being swollen and inflamed. We didn’t understand, then, that the tonsils purposely accept the infections to prevent the organisms from traveling deeper, and to show the invaders to the developing immune system to train it for the future. The tonsils are selfless protectors. As a child becomes an adult, the tonsils usually begin to shrink; the watchful guardians of childhood are no longer much-needed.

Tonsils are a bit like parents: looming large early in life, diminishing over time, ever-protecting, ever-teaching, but sometimes with rough or hard spots when we let things build up ;^)

Did you find this article helpful? Do you still need more information? Let us know below.

Reviewed by: Khanh-Van Le-Bucklin, Liat Simkhay Snyder
Last reviewed: October 31, 2014
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • Hestia Thomas

    Thank you. A very well written article

    • http://www.facebook.com/drgreene Alan Greene

      Thanks, Hestia!

  • Chrystal @ Happy Mothering

    Great article. I had terrible tonsil stones and constant tonsillitis until I finally broke down and had my tonsils removed when I was 28. It was not a fun experience, but I don’t get sick nearly as often now.

    • Dr. Alan Greene

      Thanks! And I’m loving your posts this week over on the Perspectives blog here.

    • http://www.facebook.com/drgreene Alan Greene

      Chrystal, thanks for the comment. Sounds like you made a great call. Sometimes people do really benefit from having the tonsils out. And thanks for your great blog posts (http://www.drgreene.com/author/chrystal-johnson/)

      • Chrystal @ Happy Mothering

        Absolutely. It was an honor to write a series for your guest blog!

        • http://www.facebook.com/drgreene Alan Greene

          The honor was mutual! :)

  • Nic

    I have had tonsil stones for a few months now. I have heard if you remove the stones promptly, the holes get smaller gradually and get back to normal. I found this true but then life caught up with me and I forgot to irrigate. Now one of my tonsils feels really full, I can see the stone in a crevice but it just won’t come out. It’s not terribly painful but I do feel something in the back of my throat. A few months ago when I went to the doctor, he used a metal tool and stretched, poked, and prodded the holes to get stuff out. Now I feel like I have little caves in my tonsils. I would rather not have them removed but I’m at a loss for what to do. I’ve tried pushing them out with my fingers but it hasn’t worked. Suggestions? Help? If I figure out how to irrigate this bugger out, is it still possible that this problem can be resolved without surgery?

    • Alan Greene

      Nic, the holes do usually get smaller gradually over time once the stones are out, and promptly removing any new stones can help keep the openings smaller. Even with ‘little caves’ in the tonsils there is hope for this getting better without surgery.

  • Morgan Musel

    Thank you so much for writing this, someone sited it on yahoo. I looked it up because it freaked me out that I routinely spat out little white stones. I’m glad it’s nothing serious, I do have one question though. How am I supposed to get them out other than gagging them up like I usually do?

    • Alan Greene

      Morgan, I’m a fan of using an irrigator to wash the tonsils and/or a scraper to gently scrape them to get small stones out or to keep new stones from forming or getting too large.

      Manual irrigators may be more comfortable and less irritating for washing than electric ones, because the electric irrigators sometimes use too much pressure. Having said that, I do love my WaterPik.

      • gina

        is it harmful when thy are swallowed???
        I cant remove them myself what else can I do and is their any medications that I can use??

  • Guest

    Thank you so much for this post. Like many who have posted here, I too have been experiencing problems with halitosis. For over a decade, I have been going to dental hygenist, dentists and even seeing a specialist at a dental school. Suffice to say my teeth are probably cleaner than most and the periodental pockets which were thought to be the root of the cause have all but dissapeared.
    The problem still remained. Foul smelling breath! During this time I became less outgoing, more introverted. When I spoke I could see people recoil (but all were too polite to say what I knew). I spoke less, became depressed because I was unable to communicate effectively face to face. The psycological impact was definetly the hardest thing to deal with. Stagnated in the same job (although quailified and experienced enough to be doing more), no close friends (too self concious to relax and be around folks) and no intimate parteners.
    After stumbling upon this article perchance and reading tips on how to remove tosil stones, I had a go that same day. To my suprise, there were two large (0.8 and 1.0cm long) white / yellowish stones on the right hand side of my tonsil. Once removed using a teaspoon, I was curious to find what they smelled like. My word!! At that moment I understood why folks kept away. The next day I decided to test the waters at work by standing closer to people when I spoke and to my suprise no one backed off!
    I have mixed feelings at the moment, one of elation that I may finally have found what the problem is and how to deal with it and one of anger. During this time none of the professionals I paid good money to see mentioned the possibility that this may be the problem. Hell, 6 months prior to this, I called my dentist and broke down but was told there is more to life.
    Anyway I am probably venting in the wrong place. I have made and appointment with my dentist. The purpose? To ask why such a simple examination was never performed.
    Thank you all and wish you well.

    • Alan Greene

      I’m sorry for what you’ve been through, but very glad you posted. I hope your story helps many others.

  • Savanna

    I have tonsil stones in both tonsils. I have a hard time swallowing and can constantly feel then. They are at a point where I can no longer remove them. My neck and ears are constantly sore and my tonsils keep getting bigger. I tried everything and nothing seems to work. Is removing my tonsils realistic?

    • Alan Greene

      Savanna, removing the tonsils may happen too often, but sometimes removing troublesome tonsils is the best answer. It’s worth considering. Difficulty swallowing (and breathing while asleep) can be very good reasons to get this done.

      An Ear, Nose and Throat surgeon (ENT) would be the person to do the job. I’m a fan of getting evaluated and asking for the pros and cons of both courses of action.

  • Carli Anderson

    I’ve always had a problem with low grade sore throats, but I’d only recently been noticing the stones in my throat. I’ve been coughing them up more and more lately and it leaves me a little concerned.
    Also it makes eating popcorn annoying because I end up having the little kernel shells stuck and scratching up my throat.

  • pooja joshi

    dear doctor,
    my kids, a son 8yrs old n a daughter 3 1/2 yrs old,r very prone to throat infections..they get sore throat in every three mnths. wht precautions shld i take to prevent this recurrence….they get swollen tonsils n this condition of tonsil pearls also..it leads to high grade fever..i m a bit worried…my doc says it is due to low immunity…is that so…kindly guide! thanks!

  • Donna Melton

    Thank you so much for this article and thank you to all the folks who have posted. I found it after coughing up another large gray stinky pebble. I’m 58. I am very large. I have lots of problems with allergies – having a flare now. My tonsils are huge. I tried to get my primary care doc to set me up for removal years ago after another bout of tonsillitis (never had it until I was 18). I never knew this things I hate had a real purpose. After reading the comments I’ve learned not to be ashamed (thought this was a weight issue) or embarrassed and that it is fixable. I’m out of work but between coughing up more of these and having feeling like swimmer’s ear for months I realized that despite having no insurance I need to have this looked at and get the stones removed as well as drastically improving my oral hygiene. Thank again Dr. Greene as well as folks who shared your own stories.

  • Marissa

    Hello! First of all I want to thank you so much for the article! This is awesome and superb information for those of us suffering from this annoying ailment. My issue started about a year ago and I have seen about 2 ENTs, A gastroenterologist and my family practitioners numerous times this year and I still cannot find an answer to the annoying itchy feeling in the back of my throat. The ENT did say that I have crevices in my tonsils and I have been suffering from tonsil stones for awhile now but I did not know they were. However things have gotten worse because now I am reduced to eating foods that will not accumulate inside of the crevices which in turn end up in these stones…my problem is that before I did not notice them but now they bother me so much because they seem to be forming in an area that feels close to the upper part of my tonsil that feels connected to my inner ear. When I have the stones I get this horrible itchy sensation and it unbearable and I can only find relief when the stones are out but it takes forever for the stones to come out because the pocket is too deep and I really suffer for days. I also feel like I can hear crickets on that side of my ear as I feel this things are pushing up…it has come to the point where I use a Qtip to relief the itch in my ears and I kid you not, the stones come out with the pressure of the Qtip sometimes…are they that far into my tonsil? It seems like it. Now I can no longer eat foods like breads, rice or anything that could get lodged back there because it will form a stone and I will start that cycle all over again. My ENT doesn’t seem to think it is too serious to have tonsils removed because I do not get fevers or infections just this horrible itchy sensation. I also have post nasal drip and a combination of acid reflux and we are tackling both and I will not lie my symptoms go away when I stop eating the breads, the flours, the rices, but mainly the wheat, bread starches…etc…I am trying to figure out on whether I need to get my tonsils removed, but I’d rather find a doctor that is willing to minimize the crevices through surgery, I read about certain surgeries to do that but there seems to be not many ENTS interested in doing this at all. My only hope is that by changing my diet permanently the hole might get smaller and the stones will go back to becoming irregular when I eat regular foods. The other side effect that bothers me is the feeling that my ears are stuffed, it takes several minutes but then again I also have sinus issues so I got a combination of everything and I feel like there is no ending this…after a year, it depresses me and I just want a doctor that can help me. That is all I want, and they all seem to just blow me off. I do not know what to do anymore just to suffer in pain. Thank you anyway for the helpful tips and God willing I will survive this and one day look back and realize that it wasn’t as bad as I think it is…because right now it is a nightmare!

  • PJGU

    I have dealt with this for years off and on. I am fascinated to see how common it seems to be. I thought I was an oddity to get these as an adult. Mine tend to be in one side for a while, then a year later, they will suddenly decide they like the other side. Also oddly, I can go months with never getting them at all, then they will recur out of the blue for no reason that I can yet pin down. I noticed today that I have had a huge recurrence, and my throat is very sore with blisters on the affected tonsil. I cannot tell which came first in this case. Am I sick and the inflammation puffed up the tonsil and caused inflammation to trap food particles again….or did the tonsil stone cause the symptoms?

    I would like to know where one gets a “scraper”. I have used many home made tools over the years, from an oversized bobby pin stretched open ( the knobby ends are good for not injuring the tonsils), to the flat and slightly rounded ends of a dental mirror to press the tonsil. My tips are to always sterilize your tool with alcohol before and after working on the stones, never poke or dig too far in the tonsil, and gargle with lister one or a tea tree oil/peroxide rinse for a minute after poking around. I read one time that the tonsils sit right on the blood super highway that runs directly to the brain (thus the reason for the dangers of tonsillectomy surgery). I have always been mindful of that and try not to get an infection in that area from my prodding and to never cause it to bleed if at all possible.

  • Rachel Grantham

    This is the first helpful thing I’ve seen for this. I’ve had these stones come up every so often and it goes in spells. It feels great just knowing what it is. The thing is it’s not consistent enough to really determine if I should do something about it.

  • Siobhan

    I am 20 years old and have been dealing with tonsil stones for about 2 and a half years now.

    The first one I got was rather big, about 1cm. It was on my right side. A week later I got my second one, similar in size, on my left side.

    Since then I have had a few more come, most of them have been on my right side and I haven’t had one on my left side in a long time now.

    Over the past year or so I have had tonsil infections (always worse on the right side) about 5 times… And waiting them out has never helped. I would always wait until I couldn’t even swallow before going to the doctor. At that point I would end up on antibiotics and the pain would go away.

    Recently I got sick with bronchitis and was able to get better within a few days… Only to come down with a cold the very next day.

    Before getting sick with bronchitis I had a sore throat, it lasted throughout my bronchitis, throughout my cold, and even stayed after I was cleared up.

    Throughout that spurt of sickness I went to a walk in clinic 3 times (Twice complaining about my sore throats, concerned that it was staying for a long time). On the third visit my throat was swabbed for strep, and it came back negative. I even mentioned to the doctor that I knew it wasn’t strep and that leaving it alone would not solve the issue.

    Last night I was struck again with the tonsil stones, only in my left tonsil. I pushed them out, and everything else stuck inside. They were very tiny, and some weren’t even formed entirely. They were all a grayish brownish color which I have never seen before. Also inside was yellow and white mucus as well as blood. Yuck.

    I went and saw my family doctor today (she works at the walk in clinic that I go to) and she prescribed me antibiotics. Finally, relief. My tonsils are and have been infected once again. She also said they are very active. I have a follow up visit with her next week once the infection clears up. I’ve also noticed that above my tonsils, beside my uvula I have something hard under my skin, little bumps that feel like tonsil stones. Although I’m not sure they should be up there. I mentioned it to her and she is going to take a look next week.

    I know cancer and tonsil stones are in no way related, but the mucus and blood coming out of my tonsils is scaring me into believing I may have cancer as well.

    Most doctors won’t remove tonsils at my age, but I will continue to get tonsil infections, and eventually won’t notice improvement through antibiotics.

    What are the pro’s and con’s of having my tonsils removed in my situation?

  • see mun Teh

    Hi, I really have Symptoms of Tonsilitisas, especially always spit out yellow stones and bad breathe , but I don’t see yellow stones around tonsil by using torch to check myself. I really don’t know where they hide. What should I do now? Thanks.

  • Steph

    Hi. Thanks for your insight on this problem. I have read several articles which mention that tonsil typically reduce in size and issues reduce with age. Growing up I had frequent tonsils infections, typically where strep was found. I am almost 40 years old, and my tonsils are still quite large, and unfortunately, my tonsils do have crevises in them now, and I have now been getting tonsils stones consistently for the past few years in both tonsils. The stones are typically not painful, no sore throat, just annoying because it seems to be constant. My oral hygene is very good. Yesterday I worke up with my ear and tonsil quite sore on one side, and a day later, more stone pieces than usual came out of that tonsil. It is still a bit sore, and I’m wondering if there may be more in the tonsil, but also concerned about doing any potential damange. I am just wondering a couple of things.

    1) Is there any risk of putting pressure on the tonsils to extract these (e.g., can it push them back deeper and cause worse infection, or anything like that?). Do you need to be cautious about how much pressure to apply to the tonsils? Is this an effection that can spread elsewhere (e.g., lymph nodes/other)?

    2) Is there a scan or anything that can be done to check the tonsils for these stones or to check their overall health, or see if there is any concern?

    3) I really don’t want to remove my tonsils as I’ve been avoiding that for years. I saw mention that you can have laser procedure to smooth/close the crevises in the tonsils. How serious is this procedure and the recovery? Is it painful? And how effective?

    Thanks!

  • http://DrGreene.com/ Cheryl Greene

    This topic is important to so many people. You’ve asked great follow-up questions. Dr. Greene would love to answer them all, but he can’t. To try to answer the one that are most important to the most people, we’ve added a new feature — Ask Dr. Greene!

    If you have a question, just go to http://www.drgreene.com/askdrgreene/ and submit your question.

    Dr. Greene will answer one question a day and he’s going to let our readers decide which question they would most like to see answered determined by the number of votes each question receives. That means, you have a better chance of getting your question answered if you invite your friends to vote.

    Check it out — http://www.drgreene.com/askdrgreene/ — and let us know what you think.

  • Lara

    I started getting tonsil stones in November of 2013 and was put on Penicillin on February of this year and I still have these lumps today… I started removing them myself last night and I am now left with big-ish holes, is this normal for tonsil stones? Also, I am left with one large stone that I think is responsible for ny constant sore throat… how long should I leave it before consulting a doctor? :(

  • Alan Greene

    Jay, your description – including the color, shape, hardness, and smell – would fit with tonsil stones. Tonsil stones aren’t a reason to worry, but are a reason to make taking care of your mouth a priority.

  • Alan Greene

    :) Some tonsils are above average.

  • RJ

    So what happened at the appointment? Curious.