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The 'ins and outs' of tonsil stones: What to know and do about them

Posted by Michael Hopfenspirger, MD, Otolaryngology, Ridgeview Specialty Clinic on Jul 30, 2019 3:00:00 PM

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Although you may be unfamiliar with tonsil stones, you’ve likely had them. They generally go unnoticed for most people, but for some, they can be very troubling.

How do I get tonsil stones?

Your tonsils have numerous pits, crypts and channels along their surface. The cells of your tonsils are also constantly regenerating with old cells sloughing off. Sometimes the cells that slough off become trapped in the pits and channels. As they decay, they are a conveniently located food source for the thousands of bacteria that live in your mouth. Before you know it, we have what are commonly known as ‘tonsil stones’—balls of dead cells and bacteria.

What should I know about tonsil stones?

  • Tonsil stones are very common and essentially harmless.
  • They are not bits of food that were eaten and somehow became wedged into the tonsils.
  • They are not signs of infection. 
  • They are also not very “stony” at all. While stones that have been present for a very long time have been seen to harden, most of the time these are soft/squishy masses.

What symptoms do they cause?

Occasionally, tonsil stones may cause:
  • Bad breath
  • Foreign body sensation
  • Painful, local inflammation and infection (very rare)

How can I get rid of my tonsil stones?

The simplest and most effective option may also be nearly impossible for some people – picking them out.  Sensitive gag reflexes can make this option a non-starter for some. But manually removing them (periodically, because they will inevitably recur) is the quickest way to relief.

I typically will offer patients a disposable, blunt ear wax curette (unused, of course) as the weapon of choice. Blunt is the key word here.Tonsils will bleed if they’re stabbed. A long cotton swab might also fit the bill. 

What if you can't remove them yourself?

As I mentioned, some people’s gag reflexes make that impossible. Others may find that their stones are simply located in a part of the tonsil that is inaccessible (too deep, too low). Optional removal approaches include:

  • Warm salt water gargles, but I don’t recommend it – not because there is any potential harm, but because it’s unlikely to work (remember, the stones are somewhat stuck in there).
  • Some have found success with ‘water pick' devices, but I also feel these are in the minority.
  • Wait it out. Over time, most stones will likely come out on their own. 

When is it time to seek help?

If you can't get them out yourself, schedule an appointment with your ENT (ear, nose and throat) specialist. He or she may be able to remove a particularly pesky stone for you.

You might also be offered the option of a tonsillectomy. Tonsillectomy is an extremely successful approach to chronic tonsil stones and-for the right candidate-may be the best choice. Even so, we prefer to leave this option as a last resort. Tonsillectomies are expensive, come with a certain degree of risk and involve a painful recovery. 

So now you know the ins and outs of tonsil stones-the gifts your tonsils keep on giving.

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Topics: Specialty Care

Medical and health information presented here is intended to be general in nature, and should not be viewed as a substitute for professional advice. Please consult with a health care professional for all matters relating to personal medical and health care issues. In case of an emergency, please call 911. 

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