Wondering about those nasty and smelly whitish to yellowish chunks that often come off from your throat? They are called tonsil stones. Medically called as tonsilloliths or tonsillar calcifications, tonsil stones are small deposits that are lodged in the tonsils. Some of these deposits are unnoticeable while bigger chunks can feel as if they are protruding at the back of the throat. They are often get coughed up into the mouth while others require intervention to be completely removed.
What are tonsil stones? How do they form?
Generally, 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. Take note that they are 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 condition of having tonsilloliths is medically referred to as 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 and chronic purulent tonsillitis, as well as post-nasal drip. Other studies have also established a linked between these deposits or chunks and biofilm. 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?
It is important to stress the fact that tonsil stones are also breeding ground for anaerobic bacteria. Furthermore, 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.
The bacteria that feast and thrive on tonsil stones produce sulfur. This means that the build-up 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?
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 another sign.
In other cases, especially when tonsil stones are really big, otherwise known as giant tonsilloliths, difficulty or pain in swallowing, and a discomforting sensation that feels as if something is protruding at the back of the throat are other symptoms.
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.
How to prevent tonsil stones? How are they treated?
There is no known foolproof way of preventing the formation of tonsil stones because of the absence of an exact understanding of their mechanism. However, due to being the cause of bad breath, 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. However, oral irrigators that are too powerful can rupture the tonsils, thus resulting in further complications such as 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, and thus, the formation of tonsilloliths. This procedure is called laser cryptolysis.
Another surgical procedure that directly results in the impossibility of developing tonsil stones is called tonsillectomy. This procedure involves the removal of the tonsils. While it is prescribed to treat obstructive sleep apnea, nasal airway obstruction, snoring, and peritonsillar abscess, it is also recommended for chronic tonsillitis.
Tonsil stones can be readily coughed up into the mouth. However, some are persistently lodged in the tonsils. In this situation, removal by curettage or scooping or through the use cotton swabbing is observed. Home remedies such as regular and vigorous gargling using an antiseptic mouthwash or a mixture of warm water and salt can help in prevention and treatment to a certain extent.
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