Say ahhh for the doctor! They are checking out your tonsils, an organ that is vital for your systemic immunity. Chronic inflammation of the tonsils can cause the development of tonsil stones, and large tonsil stones can lead to a variety of troublesome symptoms. People with particularly severe symptoms may even have to have their tonsils surgically removed.
Read on to learn more about what the tonsils do, why tonsil stones develop, and how you can prevent and treat them.
What are Tonsils?
The tonsils are an important organ in the immune system. They are located towards the back of the throat and are made up of connective tissue, lymphoid tissues, and blood vessels covered by epithelial cells. Running throughout the tonsils are deep, branched pockets and folds called “crypts.” If inhaled or ingested foreign substances become trapped in these pockets, they can cause an immune response [1].
Because of its role in the immune system, the tonsils tend to become inflamed when the immune system is activated by an infection. For this reason, the level of inflammation in the tonsils can be used as an indicator of the status of the immune system.
The tonsils can also become inflamed due to the activity of foreign bacteria. This becomes especially likely when the folds and pockets of the tonsils get filled up by bits of cellular “junk” from dead or dying cells. These dead remains of cells create an ideal environment for the growth of various bacteria (especially anaerobic bacteria), which can lead to further inflammation or even full-blown infection [2].
What are Tonsil Stones?
Tonsil stones (also called tonsilloliths) are calcified structures that form on the cellular debris and bacteria present in enlarged tubular glands of the tonsils. The bacteria on the surface of the tonsils can start to form biofilm. Tonsil stones progress from a gel-like structure to a hard mineral structure made up of calcium [3, 4, 5].
Small tonsil stones are common in adults, while it is rare for adults to develop large tonsil stones. People with small tonsil stones don’t usually experience symptoms. However, people with large tonsil stones often experience painful symptoms [6].
Symptoms
Tonsil stones can cause a variety of symptoms, ranging in severity from bad breath to chronic pain, and can even result in severe infections.
While the symptoms discussed here are associated with tonsil stones, they may also indicate another underlying cause. Do not attempt to self-diagnose; your doctor is best equipped to evaluate your symptoms and make an accurate diagnosis.
Some species of bacteria that can collect in and around the folds and pockets of the tonsils produce large amounts of compounds such as volatile sulfur, which can cause chronic bad breath (halitosis) [5, 7].
The build-up of bacteria that causes bad breath can sometimes also result in a lingering sensation of foul taste. This affects about 3% of tonsil stone sufferers and usually occurs alongside bad breath [3, 8].
As they grow in size, tonsil stones can also begin to cause pain throughout the mouth, jaw, and face. This can result in attacks of pain that last anywhere from a few seconds to several minutes, and which can be triggered by specific activities such as talking, coughing, or swallowing [9].
Pain can be triggered by many activities including talking, coughing and swallowing [9].
If they’re large enough, tonsil stones can also block up the throat, causing difficulties with swallowing [10, 11].
The painful symptoms of tonsil stones can also spread beyond the throat and mouth. The tonsils are connected to the ears by the glossopharyngeal nerve (also known as Jacobsen’s nerve). This connection may cause the pain from tonsil stones to spread to the ear, resulting in a chronic earache [6, 12].
Sleep-disordered breathing (dyspnea) is a very rare symptom associated with large tonsil stones and infection [13, 10].
Tonsil stone symptoms may also include:
Causes of Tonsil Stones
Chronic Tonsillitis
Chronic inflammation of the tonsils can lead to the thickening and scarring of the connective tissue within the tonsils. This scarring leads to stiff tissues where cellular debris and bacteria become trapped in the folds and pockets of the tonsils. Calcification of the trapped material forms tonsil stones. Chronic inflammation is enough to promote the formation of tonsil stones [9, 15].
Chronic inflammation of the tonsils results in rare calcium salt deposits in the soft tissue of the tonsil. This deposition occurs despite normal blood levels of calcium and phosphatase and results in the development of tonsil stones [16].
Chronic Saliva Stasis
The “chronic saliva stasis hypothesis” was first presented in 1965 when analysis of the tissue next to a tonsil stone revealed a small salivary gland surrounded by lymphoid tissue. From this observation, they concluded that scarring of the tonsils could block the salivary gland flow resulting in a build-up of saliva. Saliva stasis can give rise to the formation of tonsil stones [15].
In support of this, a recent case report of a 32 year-old-man with a large tonsil stone reported finding blocked saliva and a local accessory salivary duct during the tonsillectomy surgery. Despite the lack of tonsil inflammation, these doctors attributed the formation of the tonsil stone to saliva build-up. This accumulation of deposits from the saliva resulted in tonsil stones [15].
Other Risk Factors
Risk factors for chronic tonsillitis include:
Prevention
Good oral hygiene habits (like gargling with salt water) are important to wash out the tonsil folds and pockets [20].
Removal of the tonsils is the only known complete cure for tonsil stones [21].
Treatment
The majority of people with tonsil stones don’t have symptoms and may not know they have tonsil stones [22].
Doctors typically monitor patients with asymptomatic tonsil stones. If you are one such patient, stay in contact with your doctor and make sure to let them know about any new symptoms or developments [23].
Natural Prevention & Removal
Saltwater gargling may flush out the tonsil folds and pockets [20, 3].
In some cases, applying pressure to tonsils using a sterilized swab can release a tonsil stone. [20, 24].
Talk to your doctor about these and other options for preventing and removing tonsil stones.
Invasive Treatment
Tonsillectomy, or removal of the tonsils, is only recommended for patients who have recurrent tonsil stones. It is associated with a significant risk of illness that can last for weeks after the procedure, but it also may provide immediate relief from the pain associated with tonsil stones [21, 10, 24].
In some cases, a tonsil incision can enable the release of the tonsil stone [23].
There are some types of laser surgery for tonsil stones. It requires that the patient has small tonsils and a controllable gag reflex. Some disadvantages of this procedure include high costs, the potential of burns, and the possibility of retinal damage [25, 21].
Radio frequencies (coblation cryptolysis) may also be used to remove the tonsil stones. Pain lasts for only a few days following the procedure, and patients can return to their normal routine in one week. A single coblation cryptolysis procedure can entirely remove tonsil stones in some cases [21, 26].
As always, your doctor is best equipped to determine the best course of action in your case.
