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What are Tonsil stones



Prof Guri Sandhu

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Tonsil stones (tonsilloliths) are white or creamy deposits in the tonsils and are formed when there is mineralisation of the material that is caught in the tonsillar crypts. This material may contain food or dead skin, together with bacterial biofilms. As well as an association with chronic bacterial or fungal colonisation, tonsil stones may be linked to recurrent acute infections.

About 10% of the population will have tonsil stones, but most people have no symptoms, and they are usually an incidental finding on examination. Sometimes patients report bad breath in connection with tonsilloliths, or if the ‘stones’ are particularly large their presence may be felt.

If you believe the tonsil stones are causing bad breath, and you wish to discuss treatment, then you should seek a referral to an ENT surgeon.
If you have a persistent pain in your throat, especially if it localises to one side, this is unlikely to be related to tonsil stones and you should see your family doctor in the first instance.

If there are no symptoms then they require no treatment. Otherwise gargling with warm salty water or manual removal could be tried.
With persistent or recurrent tonsilloliths surgery may be considered. Tonsillectomy (removal of the tonsils) is the definitive solution to this problem but the procedure is associated with post-operative pain, and a small risk of bleeding during the first two weeks following surgery.
Laser reduction of the surface of the tonsils can remove the crypts and crevices (cryptolysis) where tonsil stones form. This is most commonly performed using the Carbon Dioxide laser. This technique is associated with less pain and fewer complications. However, future ‘sore throats’ may lead to the tonsils enlarging again and the crypts reforming.