Tonsil stones – formation, causes, prevention and treatment

Tonsil stones

In medicine, tonsils are colloquially referred to as the palatine tonsils. These are located on either side of the back of the palate, behind the palatal arch.

The tonsils, also known as the tonsils, are an important part of the immune system. Their job is to match the body’s defenses to pathogens that enter the body with food.

What are tonsil stones?

Tonsil stones are also called tonsil stones or tonsilloliths and are white to yellowish, small deposits on the upper side of the palatine tonsil. They consist of very different substances.

Visually, these deposits appear as small stones. The size of almond stones is quite different, usually the diameter is about 5 – 6 mm, the consistency of almond stones ranges from soft and crumbly to rock hard.

How are tonsil stones formed?

The palatine tonsils have a rough surface with countless small depressions, also known as crypts. These crypts reach deep inside the tonsil and serve to increase the surface area.

A mixture of food pulp, mucous membrane cells, white blood cells and various bacteria constantly collects in these depressions.

When chewing, the palatine muscles tense, the crypts are compressed and emptied, but also refill almost immediately.

Next to the palatine tonsils there are salivary glands, which rinse the surface of the tonsils and also help to empty the crypts regularly.

When lime salts from food and saliva mix into the pulpy mixture in the crypts, it can harden. The consistency changes from soft and slimy to soft and crumbly to a stone-like surface.

Doctors suspect that the formation of tonsil stones is mainly due to the deposition of white blood cells in the crypts.

These then mix with certain bacteria. Normally, tonsil stones are located deep in the crypts, but sometimes the tonsilloliths reach the surface and become visible as small, stone-like „stipples“ on the tonsil.

What symptoms can be caused by tonsilloliths?

As a rule, tonsil stones do not cause any discomfort at all. They are usually very small and are swallowed, coughed up or even sneezed out completely unnoticed. However, the components of the food and cell mixture has a very unpleasant odor, reminiscent of rotten eggs.

Larger tonsil stones can cause bad breath, sometimes tonsil stones also cause a foreign body sensation at the back of the palate. Swallowing can then be perceived as unpleasant, in rare cases swellings occur, which are accompanied by more severe pain.

In contrast to a purulent angina, i.e. a tonsillitis, the tonsils are swollen but not reddened when tonsil stones appear, the pressure or the unpleasant feeling when swallowing occurs less quickly and is also significantly less painful than swallowing in the case of a tonsillitis.

What are the causes of tonsilloliths?

Basically, tonsil stones occur in every person. Normally, tonsil stones are so small that they are not noticeable.

It is believed that the size of the tonsils themselves plays a role in the formation of large, stubborn tonsil stones. The larger the palatine tonsil is, the more and deeper the crypts are, so the formation of tonsil stones could be favored by this.

A disturbed emptying of the crypts can also lead to tonsil stones. After frequent tonsillitis, usually in the course of a single year, the surface of the tonsils may scar and make it difficult or impossible to remove the tonsil stones.

How tonsil stones can be treated or removed?

In a first attempt, no doctor is needed to remove tonsil stones. One way to remove troublesome tonsilloliths is to tense the palatal muscles.

To do this, the head is stretched back and the mouth is opened wide several times and then closed again. This causes tension in the palate muscles, which can help to remove the tonsil stones from the crypts.

Alternatively, the underside of the tonsil can be pressed with a cotton swab or the back of a toothbrush in order to manually press the tonsil stones out of the crypts.

This method has the disadvantage that sufferers often feel a gag reflex and therefore cannot build up enough pressure.

With practice, the underside of the tonsil can also be massaged with the tip of the tongue. The gag reflex is much less frequent, but this movement cannot be performed by every patient.

The palatine tonsils can be cleaned under light pressure with the oral irrigator. The water jet often loosens tonsil stones from the crypts. Rinsing with sage or chamomile tea and gargling with aseptic mouthwashes can also be helpful.

Tonsilloliths should never be scraped out with sharp or pointed objects. If tonsilloliths have become stubbornly lodged in the palatine tonsil, an ENT specialist is the best person to contact.

With special tools the doctor can squeeze or suck out the tonsil stones. In the Roeder treatment, the ENT places cupping glasses on the tonsils, the tonsilloliths are sucked into the cupping glass by the negative pressure and thus out of the crypts of the tonsils.

How to prevent the formation of tonsil stones?

If stuck tonsil stones form frequently, it can be helpful to rinse the tonsils regularly with gentle pressure using an oral douche.

Regular, gentle cleaning with a soft toothbrush can also help keep the crypts clean, preventing the formation of tonsil stones.

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