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Tonsil stones, tonsils

The tonsils (palatine tonsils) are a pair of soft tissue masses located at the rear of the throat (pharynx). Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa (like on the adjacent mouth lining). Running through the mucosa of each tonsil are pits, called crypts.

Picture of the Human Tonsils

The tonsils are part of the lymphatic system, which helps to fight infections. However, removal of the tonsils does not seem to increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.

What causes tonsil stones?

Your tonsils are filled with nooks and crannies where bacteria and other materials, including dead cells and mucous, can become trapped. When this occurs, the debris can become concentrated in white formations that occur in the pockets.

Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies. This tends to occur in people who suffer from chronic inflammation in their tonsils or repeated bouts of tonsillitis.

What are the symptoms of tonsil stones?

Most people have small tonsil stones and these do not cause any noticeable symptoms. Even when they are large, they may only be discovered incidentally on X-rays or CT scans. Some larger stones, however, may have multiple symptoms:

  • Bad breath. One of the prime indicators of a tonsil stone is exceedingly bad breath, or halitosis, that accompanies a tonsil infection.

One study of patients with a form of chronic tonsillitis used a special test to see if volatile sulphur compounds were contained in the subjects’ breath. The presence of these foul-smelling compounds provides evidence of bad breath. The researchers found 75% of the people who had abnormally high concentrations of these compounds also had tonsilloliths, or tonsil stones. Other researchers have suggested that tonsil stones be considered when the cause of bad breath is in question.

  • Sore throat. When a tonsil stone and tonsillitis occur together, it can be difficult to determine whether the pain in your throat is caused by infection or the tonsil stone. The latter differs in that it may cause you to feel pain or discomfort in the area where it is lodged.
  • White debris. Some tonsil stones are visible in the back of the throat as a lump of solid white material. This is not always the case. Often they are hidden in the folds of the tonsils. In these instances, they may only be detectable with the help of non-invasive scanning techniques, such as CT scans or magnetic resonance imaging.
  • Difficulty swallowing. Depending on the location or size of the tonsil stone, it may be difficult or painful to swallow foods or liquids.
  • Ear pain. Tonsil stones can develop anywhere in the tonsil. Because of shared nerve pathways, they may cause a person to feel referred pain in the ear, even though the stone itself is not touching the ear.
  • Tonsil swelling. When collected debris hardens and a tonsil stone forms, inflammation from infection (if present) and the tonsil stone itself may cause a tonsil to swell or become larger.
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