What Causes Tonsil Stones (Tonsilloliths) and How Do You Remove Them?

Tonsil stones, also known as tonsilloliths, are clumps or lumps that form when debris becomes trapped in pockets in the tonsils—the mounds of tissue in the back of the throat. A tonsil with a tonsil stone may look like it has a crack with a small, pebble-like mass wedged inside it.

While tonsilloliths are generally harmless, they may occasionally cause discomfort such as a sore throat, feeling like there is something stuck in the throat, dry mouth, and bad breath (halitosis).

This article explains tonsil stone symptoms and causes. It offers information about how people with tonsil stones (sometimes called cryptic tonsils) are treated, some steps you can try to remove tonsil stones at home, and when it may be time to see a healthcare provider.

Tonsil Stone Symptoms

Tonsil stones range from white to yellow in color and are often (but not always) visible, sometimes looking like pus. You also may feel or see that your tonsils are swollen.

Other symptoms of tonsil stones may include:

• Bad breath
• Ear pain
• Sore throat
• Difficulty swallowing
• Pain when touching your throat

The bad breath associated with tonsil stones can be severe because a common bacteria that contributes to the formation of tonsil stones produces sulfur. Disturbing or removing a tonsil stone can sometimes release this putrid odor.

What Causes Tonsil Stones?

Tonsil stones develop when particles such as food, dead skin cells, and bacteria get trapped in tonsil tissue. Over time, this debris calcifies and hardens into rock-hard tissue that resembles stones.

Chronic inflammation can cause the formation of crypts (crack-like pockets) and tissue fibrosis (thickening and scarring), making it easier for stones to form. They're more common in older people than in teens and children.

There may be a greater risk of tonsil stones in people experiencing frequent ear, throat, and sinus infections associated with inflammation. Other contributing factors may include:

• Poor oral hygiene
• Smoking

Tonsil stones are often seen in people who experience frequent bouts of tonsillitis, which can occur due to other, potentially serious infections.

Treatment of Tonsilloliths

Tonsil stones may require professional care, though there are a few steps you can take to try to remove them yourself (and prevent them from forming).

However, if you're not sure you have tonsil stones, it's important to see a healthcare provider for your symptoms. They can determine whether you have tonsil stones or, in some cases, if a more serious condition is causing ear pain or difficulty swallowing.

Home Treatments

Tonsil stones can be removed at home in most cases. There are a few things you can try to remove tonsil stones:

• Forceful coughing to see if the tonsil stone comes loose
• A wet cotton swab, gently pressing on the stone as you try to dislodge it. Be sure not to force the stone out or rub too hard.

Once the stone is out, gargling with salt water will help to remove any bacteria. Water irrigators (water picks) have been shown to be helpful in removing a portion of the tonsil stones, but the removal is often incomplete and still results in symptoms.

Trying to remove tonsil stones on your own may lead to the stones actually becoming pushed further into the tissue, causing more discomfort and problems.

You should not try to remove tonsil stones with sharp objects, because you could accidentally damage tonsillar tissue. The tonsils are also in close proximity to major blood vessels.

When to See a Healthcare Provider

If the tonsil stone is large or you've tried to remove a tonsil stone without success, a healthcare provider can extract it. They also can accurately diagnose the problem, especially when you have symptoms of a tonsil stone but don't see the cause.

A healthcare provider may use irrigation to flush the stone out with water, or try a tool called a curette. An antibiotic also may be prescribed to treat infection associated with the tonsil stones.

Sometimes, other procedures are necessary. They include techniques called temperature-controlled radiofrequency (TC-RF) tonsil ablation and CO(2) laser cryptolysis. These treatments rely on probes inserted into the tonsil tissue, delivering energy via the radio or laser technique, while a person is under local anesthesia.

Rarely, a tonsillectomy is needed. While a tonsillectomy would subsequently remove any tonsil stones, surgical removal of the tonsils is not generally a compelling enough reason for this surgery. Your physician can review the benefits and risks associated with a tonsillectomy for tonsil stone removal.

Preventing Tonsil Stones

Tonsil stones form because of bacteria and debris that collect on the tonsils, so limiting exposure can help to prevent them.

Good oral hygiene can help. If you've had tonsil stones, you may be able to avoid recurrence through an oral hygiene routine that includes daily warm saline mouth rinses. Mouthwashes, especially alcohol-free types, may also be good for tonsil stones.

Smoking may contribute to tonsil stone formation, so quitting may reduce the risk along with boosting an overall improvement in your health.

Summary

Tonsil stones are caused by bacteria and debris in your airway that become trapped in the tonsil tissue. Over time, the debris hardens and the stones may cause symptoms, including bad breath, difficulty swallowing, and ear or throat pain.

Tonsil stones are highly treatable and may even go away on their own. While there are home remedies you can try, a healthcare provider can best diagnose and treat the condition. In rare cases, treatment may require removal of the tonsils.

Good oral hygiene can help to prevent tonsil stones from forming. If you smoke, consider quitting, as smoking may be a factor that increases your risk of tonsil stones.