Wondering about those nasty, smelly, whitish to yellowish chunks that often come from your throat? They are called tonsil stones. Medically known as tonsilloliths or tonsillar calcifications, tonsil stones are small deposits lodged in the tonsils. Some of these deposits are unnoticeable, while larger chunks can feel as if they are protruding from the back of the throat. They are often coughed up into the mouth, while others require intervention for complete removal.
What are Tonsil Stones? How Do They Form?
Tonsil stones are calcified deposits or chunks made of trapped food particles, remnants of dead cells, bacterial scraps, and mucus. Saliva and digestive enzymes break down these constituents until they end up calcified into small individual deposits or chunks and trapped or lodged in the tonsils.
Note that these calcified deposits usually formed in the tonsillar crypts but can also be formed in the throat and the roof of the mouth where food particles, cellular and bacterial remnants, and mucus can be trapped. The presence of tonsilloliths is called tonsillolithiasis. So how does one get tonsil stones? What causes their formation? The exact mechanism of tonsillolith formation is still debated.
Several studies have established an association between their formation, chronic purulent tonsillitis, and post-nasal drip. Others have associated t with biofilm formation. The biofilms are usually immune to antibiotic treatment due to the three-dimensional structure formed by a bacterial colony.
Why Do These Small Deposits Smell Really Bad?
Tonsil stones are also breeding ground for anaerobic bacteria. It is also worth noting that the tonsil crypts also provide an ideal environment for anaerobic bacterial activity. These bacteria essentially feast on the nourishing contents coming from the food particles, cellular and bacterial remnants, and the amino acids cysteine and methionine found in mucus.
Sulfur is produced by bacteria that feast and thrive on tonsil stones. This means that the build-up and growth of this bacterial population results in the emission of different gaseous sulfur compounds such as hydrogen sulfide and methyl mercaptan. These compounds have a distinctive putrid smell similar to a rotten egg or a decaying organic matter.
What are the Signs and Symptoms? What are The Implications?
Take note that tonsil stones are one of the notable causes of bad breath or halitosis. Hence, foul odor coming from the throat is the most common sign and symptom of having tonsillolith. Having a metallic or putrid taste in the mouth is also another common sign.
In other cases, especially when the calcified deposits are really large, otherwise known as giant tonsilloliths, an individual might experience difficulty or pain in swallowing and a discomforting sensation that feels as if something is protruding at the back of the throat. The presence of tonsil stones can become physically intrusive and create an unpleasant sensation.
Tonsil stones are not usually harmful. However, they either result from another underlying medical conditions or produce side effects such as tonsillitis, sore throat, earache, and coughing fits. Repeated infections can create an environment more prone to stone formation.
How to Prevent Tonsil Stones? How are They Treated?
The absence of a complete understanding of tonsil stone formation means no foolproof prevention method exists. However because they cause bad breath and can feel uncomfortable, some individuals seek professional help.
One of the simplest and most effective ways to prevent the formation of tonsil stones is the regular cleaning of throat and tonsils through oral irrigation. An oral irrigator produces a pulsating jet of water that can help in thoroughly removing food particles, cellular and bacterial remnants, and mucus lodging in the tonsil crypts and other parts of the throat and mouth.
It is still important to keep in mind that high-pressured irrigators can rupture the tonsils. This can result in further complications like inflammation and infection.
Surgical procedures are another way of preventing tonsil stones. Reducing the surface area of the tonsils, especially the tonsil crypts and crevices, through laser resurfacing helps in lessening the likelihood of trapping debris. This procedure is called laser cryptolysis.
The surgical procedure known as tonsillectomy directly eliminates the possibility of tonsil stone formation development. This involves the removal of the tonsils. It is often used to treat nasal airway obstruction, snoring, obstructive sleep apnea, and peritonsillar abscess. It is also sometimes recommended for chronic tonsillitis.
Most tonsil stones are easily coughed up. Stubbornly lodged ones might require curettage or cotton swabbing. Consistent home remedies like vigorous gargling with antiseptic mouthwash or warm salt water can contribute to prevention and some relief.
FURTHER READINGS AND REFERENCES
- Dykes, M., Izzat, S., & Pothula, V. 2012. “Giant tonsillolith: A rare cause of dysphagia.” Journal of Surgical Case Reports. 2012(4). DOI: 10.1093/jscr/2012.4.4
- Ferguson, M., Aydin, M, & Mickel, J. 2014. “Halitosis and the tonsils: A review of management” Otolaryngology: Head and Neck Surgery. 151(4): 567-574. DOI: 10.1177/0194599814544881