What are Tonsil stones or Tonsilloliths, Know its Treatment, Home Remedies, Prognosis, Causes, Symptoms, Complications

Tonsils are gland-like structures situated at the back of the throat, one on each side in the form of a pocket. Each of the two tonsils is usually composed of tissues with lymphocytic cells of the body that produce antibodies to fight against infections. Thus, the tonsils help in the prevention of respiratory illnesses mainly in the case of grown-up adults. Research suggests that the tonsils play a vital role in the immune system by functioning like nets, simply to trap or clog incoming virus particles and bacteria passing through the throat inside the tonsil crypt. The tonsils are usually filled with nooks and crannies where the microorganisms, mucus, and dead cells accumulate in the form of white debris. Unlike the kidney stones, sometimes, hard painful stones may develop inside the tonsil. Such a condition is termed as Tonsil stones or Tonsilloliths.

Tonsil stones or tonsilloliths are actually clusters or a lump of calcified material; mainly in the form of fleshy pad occurring within the crevices of the tonsils, i.e., Tonsillar Crypts at the back of the throat. Tonsil stones are most commonly formed in the palatine tonsils and in some cases, on or within the lingual tonsils. Tonsil stones or Tonsilloliths are hard white or yellowish in color, weighing between 0.4g and 40g. They are mainly composed of calcium salts like calcium carbonate apatite or hydroxyapatite, oxalates and other substances like magnesium salts, carbonate, phosphorus, and ammonium radicals.

Tonsil stones or Tonsilloliths are basically formed when the trapped debris inside the tonsils calcifies or hardens. Tonsil stones are not easily visible every time. Sometimes these stones may create a nuisance and thus, it becomes quite difficult to get rid of them; however, they are not much harmful. The tonsil stones generally cause bad breath or halitosis. They tend to occur in people suffering from chronic inflammation of the tonsils or people experiencing repeated episodes of tonsillitis.

Tonsils are typically filled with crannies and nooks where various types of debris including bacteria, dead cells, virus particles, saliva, mucus, and food start getting accumulated in the form of white patches within the tonsil crypts or crevices. Over time, these debris start calcifying or hardening to varying degrees finally to give rise to the formation of a tonsil stone.

Allergy problems or chronic sinus issues cause accumulation of mucus around the tonsil stones. This accumulated mucus causes the formation of post-nasal drip to the tonsils that ultimately results in the formation of tonsil stones.

Sometimes prescription medicines for high blood pressure, can lead to dryness of mouth as a side effect which finally leads to the growth of tonsil stones. The medicines prevent salivary secretion and leads to dryness of the mouth. Therefore, there is an absence of electrolytes, antibacterial compounds, or varieties of enzymes that prevent bacterial growth in the mouth. Thus, the bacteria that can cause the tonsil stones can reproduce at a faster rate when the mouth is dry.
Other potential causes of tonsilloliths include the following:

• Having large-sized tonsils
• Bad dental as well as mouth hygiene
• Repeated episodes of tonsillitis
• Chronic inflammation, swelling, and pain in the tonsils.

Small-sized Tonsil stones or Tonsilloliths are usually asymptomatic, i.e., do not cause any visible symptoms. However, large-sized tonsilloliths may produce multiple symptoms such as –

• Recurrent halitosis or bad breath
• Any kind of tonsil infection
• Sore throat
• Pain and difficulty while swallowing
• Development of bad taste at the back of the throat
• Pain or pressure in the ears
• White, yellow, or grey debris on the tonsil
• Inflammation and swelling within or around the tonsils
• Redness and irritation in the tonsils
• Manifestation of allergy or sinus infection symptoms
• Coughing in excessive amount.

Tonsil stones or tonsilloliths affect almost 6-10% of the population, frequently due to the repeated episodes of tonsillitis. However, small-sized concretions within the tonsils are quite common, but larger tonsilloliths or true tonsil stones are quite rare. Tonsilloliths commonly happen in young adults aged between 20 and 40 years and are usually quite rare in children.

The pathophysiology behind the formation of Tonsil stones or Tonsilloliths is the accumulation of sulfur-producing bacteria, virus particles, or fungi together with the debris like food particles, mucus, saliva, dead cells, etc. from postnasal drip. Together they become lodged within the small crevices or crypts present on the surface of the tonsils in the form of white pockets. The affected area attracts more debris and after a certain amount of accumulation, the debris calcifies and hardens resulting in the formation of yellow, white, or grey stone or calculi. A Tonsil stones or Tonsilloliths can be formed due to various reasons and doesn’t require the presence of any sorts of tonsil infection. Some people experience only one large-sized tonsil stone; whereas others may have thousands of smaller calculi.

The probable factors that enhance the risk of development of Tonsil stones or Tonsilloliths include:

• Excessive deposition of dead white blood cells including leukocytes
• Usage of post-nasal drip
• Dryness of mouth due to medication
• Intense salivary secretion
• Recurrent or chronic pus-filled tonsillitis
• Bacterial, virus, or sinus infections
• Activity of different enzymes on various food particles inside the mouth
• Genetic factors like the depth, size, or shape of the tonsil crevices
• Various lifestyle habits like extensive consumption of alcohol, too much smoking, stress, etc.
• Involvement of diet, such as consumption of refined foods, artificial sweetener etc.

Diagnosis of Tonsil stones or Tonsilloliths is usually done upon normal inspection and manifestation of symptoms. Tonsilloliths are generally quite hard to diagnose without the presence of any proper signs or symptoms. Along with common findings, radiological studies and imaging techniques are used to identify a radiopaque mass around the tonsil. Computed tomography or CT may reveal broad-spectrum calcified images in and around the tonsillar zone. Sometimes, differential diagnoses are performed to identify chronic or acute tonsillitis along with tonsilloliths.

Most of the Tonsil stones or Tonsilloliths, especially smaller and asymptomatic ones require no treatment. However, if the Tonsil stones or Tonsilloliths cause potential harm or discomfort then the following treatment options can be included:

• Antibiotics: Different antibiotic medications are generally used to treat tonsil stones. Mostly, these antibiotics are helpful for solving basic symptoms of Tonsil stones or Tonsilloliths.
• Anti-inflammatory Medicines: NSAIDs or non-steroidal anti-inflammatory drugs like Nimesulide are often prescribed for oral mouthwash mainly to reduce pain and inflammation associated with Tonsil stones or Tonsilloliths.
• Cryptolysis for Tonsilloliths: This treatment mainly involves removal of tonsil stones from tonsil crypts using LASER therapy. In this treatment, under local anesthesia, carbon dioxide laser first smoothens and vaporizes the surface of the tonsil and finally debris is collected. This is a painless and short-term treatment and tonsilloliths may recur in future.
• Curettage to Treat Tonsil Stones: This is actually a scooping method for the removal of large-sized tonsil stones and after this treatment; irrigation is required to wash out smaller pieces much effectively.
• Coblation Cryptolysis: This treatment involves the transformation of radio waves to charged ions through a salt solution that cuts through tissue to remove stones and thus reduces tonsil crypts.
• Surgery or Tonsillectomy to Treating Tonsil Stones or Tonsilloliths: When tonsil stones become excessively large and become symptomatic, then it necessarily requires a surgical removal or tonsillectomy. The surgical procedure completely removes the tonsil stones under local anesthesia. Tonsillectomy even involves partial or complete removal of the tonsils along with stones according to the manifestation of the symptoms.

The common home remedies to get rid of tonsil stones or tonsilloliths include:

• Using Toothbrush to Manage Tonsil Stones: Generally, the toothbrush bristles are used to apply pressure on the tonsil until they becomes soft and loosen. The smaller stones come out from the inner side of mouth through mouthwash after giving little more pressure.
• Lemon Juice: Lemon juice in lukewarm water can be useful home remedy to remove tonsil stones. Gargle with lemon juice around the tonsils simply to cleanse off the affected area.
• Consumption of Raw Onions or Garlic: Due to their anti-bacterial properties, both onions and garlic are an excellent home remedy to remove any form of oral or throat infection and thus maintain proper oral health by removing tonsil stones completely.
• Gargle with Salt Water: Gargling with salted warm water may help in decomposition of tonsil stones and also ease the discomfort of tonsillitis naturally.
• Unsweetened Yogurt to Treat Tonsil Stones: Consuming natural unsweetened yogurt is a probiotic and thus always acts as a good home remedy for tonsil stones and other oral infection.
• Balanced Diet: Eating a proper balanced diet, especially a complete vegetarian diet, usually helps to remove and treat tonsil stones.

Tonsil stones or Tonsilloliths although very rare, may affect a large part of population. The prevention measures and natural removal of the tonsil stones are possible, but the condition may recur. Therefore, consultation with an ENT specialist regarding the surgical options may benefit an affected individual. However, the recovery time varies largely depending on how much of the tonsil is resurfaced or removed. The total time required to recover from a tonsillectomy is about 10-15 days.

Tonsil stones or tonsilloliths rarely cause any sort of major health complications; but the possibilities still remain. However, sometimes the tonsilloliths grow larger in size and thus can cause the tonsils to inflame or swell. The most significant complication caused by tonsilloliths is the damage of the tonsil glands. Tonsilloliths combined with tonsil infections usually require surgical treatment and may lead to excessive infection or bleeding.

Fortunately, there are a few preventive measures in order to avoid the harmfulness of tonsil stones. These include:

• Practice good oral hygiene, including cleaning of back of the tongue as well as the teeth twice daily.
• Consume adequate amount of water daily and thus stay hydrated.
• Drink water after every meal to wash down food particles
• Keep the nasal passages clean to decrease postnasal drip
• Rinsing of mouth at a regular interval using an oxygenating mouthwash
• Limit dairy products in the diet
• Weekly irrigate the tonsils with an oral irrigator to prevent accumulation of debris within the tonsil crevices
• Stay away from sugary as well as refined foods and drinks as much as possible
• Coffee should also be avoided or to be consumed in very less amount as caffeine in coffee reduce the pH of the mouth and thus makes it acidic, which is ideal growth environment for anaerobic bacteria.
• Avoid smoking and consumption of alcohol.

All the medical treatment options as mentioned in the article are much effective and safe, but only a physician will recommend the best for an individual, after diagnosing the extent of symptoms for the tonsil stones or tonsilloliths accurately. The natural treatment methods are also quite effective. However, in severe cases, it is always ideal to undergo a surgical removal procedure. The best thing is to follow different preventive measures to avoid the appearance of the tonsil stones beforehand.