Saturday, December 31, 2005

Stones where?

I am currently doing a project for my anatomy class on tonsilloliths and I was wondering if i could ask you some questions about it. If you are able to answer these questions, it would be greatly appreciated since I need an expert contact. My questions are listed below. Thank you very much and I hope to hear from you soon.

Q: What are some symptoms of tonsilloliths?

Just so everyone is on the same page, tonsilloliths are also known as TONSIL STONES. Symptoms include:

A recurring foreign body sensation in the throat which is relieved when the stone is expressed (removed, that is).

Bad breath.

Sore throat.


The stone itself is the most common symptom. Folks with this problem have figured out ways to pick out the stone. It's not a stone, by the way; it's a ball of dead squamous epithelial cells, combined with bacteria and bacterial waste products -- hence the foul smell.

Q: What is a possible cause?

We see this most commonly as a symptom of chronic tonsillitis. Chronic tonsillitis is a condition in which the tonsils stay inflamed despite recurrent treatment with oral antibiotics. The sore throat is typically not as severe as it is in acute tonsillitis, but it is (as the name would suggest) far more stubborn.

On a more mechanistic level, you may be asking how these things are formed. Do a bit of reading on tonsil anatomy, and you'll learn about tonsillar crypts (yes, as in 'where dead things are buried'). These are epithelium-lined invaginations which seem to be a good deal deeper in patients with chronic tonsillitis. As you know, epithelium is in a constant state of turnover: we make new skin, oral lining, and digestive tract lining on a continuous basis.

My hunch: when the crypts become too deep, the sloughed epithelium has a hard time getting out. It builds up until it becomes macroscopic and so bothersome that the host pushes it out by one means or another.

Q: Is there any way to prevent the formation of tonsil stones?

I have had limited success -- very limited success -- treating this condition with antibiotics. Some folks use a specially designed water pik device to blast out the stones, but that's not a preventive treatment.

I have seen a few of these get better without any treatment except TOT: tincture of time.

Most folks either learn to live with it, or decide to have the tonsils removed.

For more information on tonsil stones, follow this link.



At 1:55 PM, Blogger ~Tori~ said...

Thank you VERY much for the reply. This information will definitely help my paper and me dealing with the tonsil stones.

At 10:27 PM, Blogger Douglas Hoffman said...

You're welcome, Tori. So, what's up? Are you a blogger, or not?

If not, try it -- it's addictive.

At 10:37 PM, Anonymous gmostek said...

Thank you for labeling something I had for years but never was able to identify. I had tonsil stones as a teenager when I had chronic tonsillitis. They always seemed to coincide with an episode of tonsillitis. I would reach to the back of my throat with a Q-tip and excavate the tonsil stones. (Obviously I had a low gag reflex. I believe I acquired it by having to clean out my tonsils so often.) Excavating them was pretty disgusting in itself, but seemed better than having them resident in my throat. It also seemed to ease my throat pain. I had my tonisils removed shortly before I turned 17 and have had significantly lower incidence of viral infections, etc. since then. The surgery wasn't particularly fun at the age of 17, however.

I enjoy your medical blog and look forward to more informative entries.

At 3:33 PM, Blogger Elisabeth said...

I excavated my first stones in 2001 (right side) and 2005 (left side). Here are a few of my observations followed by a question.

1. I'm pregnant (19 weeks) which has worsened my stuffy nose and post-nasal drip. After one week of only sleeping on my left side (recommended position during later pregnancy), irrigation of my left crypt produced two large stones (between pea and lentil sized) and about a dozen smaller ones. The larger ones were pink, the smaller ones white with brown streaks. I think that because I was sleeping on my left side, my mucous pooled into the crypt on the left side, providing abundant bacterial fodder. I think the stones were red because of blood: (irritated nasal passages from dry air, irritated crypts from stone removal). The crypt on the right side of my throat was empty.

2. I squirt water into the crypts with a syringe, about once per week. I spit out the water with the stones. Gross yet fascinating. This removes a lot more stones with less discomfort than a bobby pin.

3. Stone production increases dramatically when I have a cold.

4. I have less morning breath after cleaning out the crypts.

5. The crypts seem to be getting deeper. Is this because I irrigate them with water (it's a little 10cc syringe)? Does it matter if they are indeed deepening (besides providing more habitat for stone production)?


At 8:00 AM, Blogger Brian said...

I would like to add to your explanation of the stones. I agree that deep grooves any place in the body always make it easier for problems to occur. But why does it occur on some more than others, this is almost always diet related, anything with flavor will create a film in the mouth and throat. Now under this film anerobic bacteria will thrive if they get a contstant food source, remember anything with flavor will feed bacteria, and they in turn make the holes deeper and produce the sulfar stink that you smell. Because bacteria reproduce so quickly, some as fast as 20 minutes, the only way to control their population is through not feeding them, this means that you need to wait 3 hours between meals, and I suggest sipping on water in between the meals. This does two things 1. It allows the saliva to do its job and dissolve this slime layer and remove the protective layer that the anerobes are using to their advantage. 2. Because these bacteria are anerobes they can't live in the presence of liquid oxygen, which your saliva contains, so anything that has flavor (acid) that dries the mouth will only make your breath worse eventually. This is why water is so healthy for you because it is a great source of liquid oxygen. I believe holding any kind of flavor in the mouth, or repetitive eating or drinking, creates a state of chronic infection. The body is under constant attack by acid produced by the bacteria which can not only eat holes in your teeth and jaw bone and the skin in your mouth and throat, not to mention the rest of the body.

At 8:26 AM, Blogger Brian said...

Just as in the mouth I find that the holes deepen at a faster pace if the hygiene is increased but the diet is not controlled. Hygiene will only make up for a normal diet, nothing will make up for a repetitive diet, it may slow down the damage but it may also drive the bacteria deeper and cause deeper problems because if they have a food source they will survive. Now I'm not telling you to lessen your hygiene, some hard headed patients hear it this way, get your diet in check first and sip on water between meals and the problem will go away in a week or two. Remember to eat a balenced meal, it is not a balenced meal unless it has carbs, fat, and protein, this will keep your blood sugar level and make it easier to go the full three hours between your meals. Also remember you are feeding bacteria and anything with flavor will cause a benificial enviorment for the bacteria to grow and produce the problems.

At 3:55 PM, Anonymous Anonymous said...

I had these for a while, still do on rare occasions.
It seemed to be related to consuming roasted red bell peppers, also green tea.

was a pity about the peppers.

At 8:02 AM, Anonymous dave said...

hi there, i have a throat problem, in the back of my throat. I get calcifications deposits that, might come out from the slits in the insides of my throat. Are these harmful? and would taking my tonsels out help or should i leave them out of this problem, thanks dave

At 11:27 AM, Anonymous CF said...

Mine seem to be getting bigger and bigger, but only occur on one side of my mouth. Someone suggested regulating meals (I eat alot of small meals, having IBS), and drinking lots and lots of water. I'll try this and see if it doesn't work.

At 5:46 AM, Anonymous Lisa said...

I noticed in mid 2005 that the right side of my throat was sore/achy. This came and went over a few weeks or so then I noticed that with the latest occurence there was also a very small looking blister on the right side of the roof of my mouth which was irritating. While opening my mouth as wide as I could to look at the small blister like spot and tilting my head back to look into the mirror I must have compressed my right tonsil slightly which then began oozing out these small stones that you have all described. I mentioned them to my mum who said that she had them aswell. After looking for a while longer and pressing my tonsils regularly for the next few months they eventually stopped. Now, in April 2006 I noticed my throat was sore/achy again and when I examined my throat, there again was a tiny blister on the roof of my mouth again (I use the term blister because if I scrape it it disapears - just full of clear liquid). I examined my right tonsil, and sure enough I had more stones. I've never had them in my left tonsil, but I do sleep on both sides regularly so I'm not sure why I only get them on the one side.

They are not a nice thing to have, but I would not fancy having my tonsils removed to stop the problem either.

At 2:44 PM, Anonymous Anonymous said...

I battled tonsil stones since I was 14 years old. The crypts started small on one side than spread to the other side eventually becoming into two or more crypts on both sides that eventually became one great big one on each side about a centimeter long. I had my tonsils removed in December of 2006 at the age of 22. I've fully healed but now on my right side of my mouth where my tonsil used to be I get very small reaccuring blisters. They pop up every now and then when I eat food or drink something, will they go away eventually? Has anyone else experienced this problem? Any info would help because I can't find this problem as being a side-affect of the procedure anywhere on the net.

At 8:59 PM, Anonymous Christina said...

Hi Tori... I was looking for information about my throat and came across your site. For many months now I have been coughing up these green, smelly little chunks. I cant figure out what they are. My doctor thought I was weird when I was explaining it to her so she just gave me some antibiotics. I havent taken them yet but what is wrong with my throat? I can always taste the nasty smell in my throat. I sat there trying to cough them up, and noticed they were green, had a nasty smell, and came from my left tonsil. (ur tonsil is that hole thing right in the back of your throat?) anyway, I also noticed that if it is left out like to dry, they get hard, dont smell, and turn into a redish dark color... is this okay? I smoke newports so I always figured it was from them but Im not sure if it is something more serious or if the antibiotics will work? Do you have an answer or any advise I can tell my doctor?

At 5:19 AM, Anonymous Anonymous said...

I always get the white lumps (tonsil stones) after I have eaten potato. They then create a sore throat & it becomes swollen. So I have decided it's time to stay away from them! I seem to only be able to remve them by gagging and have to often wait until they are fairly large before they will budge. I am glad to read that I am not the only one who has had them.

At 11:35 AM, Anonymous brillsec said...

Absolutely horrific topic, but I'm so glad someone out there suffers from the same affliction and is willing to talk about it! My problem seems to be related to chronic sinusitis - I get the worst stones after a sinus infection starts subsiding, and have real trouble getting them out. Gargling, gagging, scraping: nothing seems to work. I may try the syringe trick next, because I'm going nuts with the feeling of foreign object in my throat!

At 9:01 PM, Blogger Mikala said...

DISGUSTING! Mine are getting worse and I too am going to try the syringe thing next. Gargling with salt water and Alkalol hasn't helped. The sinus irrigation did a little. As soon as I dislodge one or two, post nasal drip fills it right back up. It seems to be worse in cold, dry weather. I think I need to drink more water like I used to and quit smoking and drinking beer. I've rarely gotten these throat boogers over the past ten years or so until recently. I used to be able to see a little white in the back of my throat but now I think they are too deep down by my throat glands. Now they hurt the longer they stay in and feel hard. Sometimes I could dislodge one with a good hard sneeze but not anymore. I was told by my doctor even when I had recurring throat infections and strep as a child that I shouldn't have my tonsils removed because they were so small. Eight years ago after having one sinus infection after another a doctor told me I had vasomotor rhinitis. The only person I have ever told is my poor husband who can smell them when he kisses me! I think the slits are getting bigger. Maybe a throat booger vacuum should be invented. I had no idea how many other people were plagued with this same yucky problem until I got so fed up that I Google searched the blasted stuff. It just goes to show you that anything can be Googled!

At 7:39 PM, Blogger Mikala said...

Thought you all would like to know that I squeezed out a large, medium and small throat booger today one right after another! This is the second time I've taken a nasal decongestant and the next day--presto!

At 11:35 PM, Anonymous Anonymous said...

I had a swollen throat gland once and I figured it was mono. I remember my doctor telling me it was. As the glands stopped swelling not shortly after I would get these small stone-like (greenish/grey) clumps coming out of my throat and into my mouth. I was really confused by this and didn't know what to think, they just kept coming. I then looked in the mirror and saw in the back of my throat my glands and some of the green stuff sticking out of them slightly. I pressed against it and out came a ton of this stuff. It just kept coming and coming. I realized that it also has a very distinct and gross smell and that kind of worried me. It has been a few years and it is still there, and I still press up against it (much like you would pop a pimple) and it releases this stuff sometimes in small and other times in massive amounts. I just got fed up with it because I want to know what it is. My mother got her tonsils removed and I truly don't want that for myself seeing as she takes medication now for the rest of her life. Is that my fate?

At 5:55 PM, Anonymous Anonymous said...

I find that brushing my tongue helps to dislodge the stone from my throat then I can spit it out. I don't have sore throats or any other symptoms....just these foul smelling tiny balls that come up from my throat. I have a lot of mucus in the morning. I may start using a neti pot to see if this helps since others seem to think it's related to sinus congestion. thanks everyone for sharing your information.

At 10:54 PM, Blogger Thomas Hilboldt said...

an alergist we met with recently says that for nasal hygene, flush with sterile saline using 10cc for adults and 5cc for kids. flush until clear. this should help the top down contributor to the stones. also effective as a flush during colds or sinus infections.

regarding the stone remeval, use the diluted hydrogen peroxide gargle to penetrate the crypts and break up the boogers. dont swallow the gargle.

At 4:22 AM, Anonymous Anonymous said...


I've always been a chronic snorer since I was little. I've also, always had large tonsils. Every once in a blue moon I will get these throat boogers. They seem to come up for no apparent reason at all... Humm, it just came to me though, that I have been drinking HOT, BLACK, coffee all throughout the day, for my entire adult life. I switched to iced coffee this summer... maybe that may have something to do with it?

Mine has always been pretty far back in there, I guess. I have tried to gargle with peroxide, mouthwash, swab the back of my throat with a q-tip or toothbrush... nothing. They come out when they are good and ready.

They're like little, hard, cottage cheese curds, greenish yellow and one of the foulest smelling substances on the entire planet. One whiff of this alien like "thing" is enough to cause most people to gag uncontrollably. It's like a mix between concentrated bad breath X100, poo, fish, cheese and something that has just died... NOTHING that has come from my body has ever been that wretched smelling.

I was always curious what they were. Well, now I know...

I think that I'll go back to drinking alot of hot, unflavored beverages throughout the day. Maybe that will make them go back to where they came from for the next decade or so...

You also have my vote for the "Throat booger vacuum" idea. That would be SWEET!

At 1:13 PM, Anonymous AH said...

I'm glad that I'm not the only one out there passing tonsil stones. I've noticed that once they get dislodged, they usually come out in groups. I've usually been passing these little guys in the middle of the night and they just end up in my mouth, so I wake up and try to spit them in a kleenex. Sometimes they just come up while coughing and spontaneously, but it would be nice to be able to extract these guys regularly without them surprising my mouth in my sleep.

At 1:21 PM, Anonymous AH said...

Wow everyone has got to see this - I think she's figured out a way to get these guys out!


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