Tonsil stones also referred to as Tonsilloliths are relatively rare conditions. Tonsil stones are calcified material which is formed within the crevasses around the tonsils. They are primarily composed of calcium, but often include other minerals like magnesium, ammonia, carbonate, etc. Tonsil stones are more frequently observed around the palatine tonsil but may also occur around the lingual tonsils.
Various reports have suggested that tonsil stones often vary in size and range between 300 mg to 42 grams in weight. Tonsil stones are not associated with any specific symptoms and usually not harmful, but the treatment of tonsil stones is often required to treat bad breath.
How Are Tonsil Stones Formed?
Tonsils are often covered by crypts or crevasses, which are the prime sites where tonsil stones are found. Food material and mucus tends to get accumulated in the crevasses which in turn get infected with bacteria or fungi. Eventually, these materials tend to be surrounded by different forms of calcium salts like carbonate, oxalate, hydroxyapatite or other salts like magnesium and phosphorous. This results in the formation of tonsil stones in the palatal and lingual tonsils.
Tonsil stones affect individuals who suffer from chronic inflammation of the tonsils or suffer from repeated bouts of acute tonsillar infection. On an average, tonsil stones are usually small, however occasionally large tonsil stones may be observed in some individuals.
Symptoms Of Tonsil Stones
Tonsil stones are a harmless condition and may often not be associated with any symptoms. However in some cases certain symptoms may be observed,
- The most frequent symptom associated with tonsil stones includes bad breath or halitosis, especially if the stone gets infected. Inflammation of the tonsils caused due to infection of the stone can be associated with pain on swallowing.
- Some patients may complain of metallic taste in the mouth with bouts of coughing and choking.
- Larger tonsil stones may be associated with other symptoms due to spread of the infection to surrounding areas. These symptoms include earache, post nasal drip, etc.
- Sensation of a foreign body may exist in the back of the throat in cases of large tonsil stones.
Treatment Of Tonsilloliths
In general no specific treatment is required for the management of tonsil stones, especially if the stones are asymptomatic. However in cases with recurrent halitosis and recurrent throat infections, treatment is required. The treatment regimen comprises of the following,
- Irrigation: This is the simplest technique of removal of tonsil stones. Irrigation involves pushing a jet of water and a low pressure to the tonsils. The pressure level of the water force should be modulated depending upon the individual’s convenience. Electrical oral irrigators are to be avoided since they are too powerful and can cause damage to the tonsils.
- Curettage: Curettage may be required for larger lesions, especially when they are infected. Curettage involves gentle scrapping of the tonsils, often under sedation.
- Laser treatment: Laser treatment is not specifically designed for removal of tonsil stones but is meant to reduce the frequency of occurrence of these stones. The procedure is performed under local anesthesia and involves resurfacing on the tonsils to reduce the crypts and crevices on the surface to prevent subsequent accumulation of derbies and formation of stones.
- Tonsillectomy: Though not recommended specifically for tonsil stones, tonsillectomy may be performed especially if there is a risk of recurrent infections and enlarged tonsils.