Tonsil stones

Tonsil stones
Other names	Tonsillolith, tonsillolithiasis, tonsillar stones, chronic caseous tonsillitis
A tonsillolith lodged in the tonsillar crypt
Specialty	Otorhinolaryngology
Symptoms	Discomfort, bad breath[1]
Risk factors	Recurrent throat infections[2]
Differential diagnosis	Calcified granulomatous disease, mycosis, syphilis[2]
Treatment	Gargling with salt water, tonsillectomy[1]
Medication	Chlorhexidine or cetylpyridinium chloride[1]
Frequency	Up to 10%[1]

Tonsil stones, also known as tonsilloliths, are mineralizations of debris within the crevices of the tonsils.^[1][3] When not mineralized, the presence of debris is known as chronic caseous tonsillitis (CCT).^[1] Symptoms may include bad breath,^[1] foreign body sensation, sore throat, pain or discomfort with swallowing, and cough.^[4] Generally there is no pain, though there may be the feeling of something present.^[1] The presence of tonsil stones may be otherwise undetectable; however, some people have reported seeing white material in the rear of their throat.

Risk factors may include recurrent throat infections.^[2] Tonsil stones contain a biofilm composed of a number of different bacteria, and calcium salts, either alone or in combination with other mineral salts.^[5][1] While they most commonly occur in the palatine tonsils, they may also occur in the adenoids, lingual tonsils and tubal tonsil.^[3][6][7] Tonsil stones have been recorded weighing from 0.3 g to 42 g,^[3] and they are typically small in size. However, there are occasional reports of large tonsilloliths. They are often discovered during medical imaging for other reasons and more recently, due to the impact and influence of social media platforms such as TikTok, medical professionals have experienced an increase in patient concern and tonsillolith evaluations.^[8][9]

They are usually benign, so if tonsil stones do not bother the patient, no treatment is needed.^[1] However in rare cases, tonsilloliths have presented patients with further complications necessitating surgical extraction. Tonsilloliths that exceed the average size are typically seen in older individuals as the likelihood of developing tonsil stones is linear. Otherwise, gargling with salt water and manual removal may be tried.^[1] Chlorhexidine or cetylpyridinium chloride may also be tried.^[1] Surgical treatment may include partial or complete tonsil removal.^[1][10] Up to 10% of people have tonsil stones.^[1] Biological sex does not influence the chance of having tonsil stones,^[1] but older people are more commonly affected.^[2] Many people opt to extract their own tonsil stones manually or with developments in dental hygiene products. Water flossers have become a more common mechanism to extract tonsilloliths and alleviate the discomfort and complications they exacerbate. Tonsil stones can become dislodged on their own while eating, drinking, gargling, and coughing. Additionally, an exhalation technique that vigorously shakes the tonsils may be performed to dislodge them. This involves loudly producing a voiceless velar fricative sound, at various pitches to shake both the palatine and lingual tonsils.