tonsilloliths

Tonsilloliths, commonly called tonsil stones, are concretions that form in the crevices (crypts) of the tonsils. They consist of bacteria, desquamated cells, mucus, and food particles that accumulate and can become calcified. The sulfur compounds produced by bacteria give many stones their characteristic foul odor.

Most tonsilloliths are asymptomatic and discovered incidentally. When symptoms occur, they may include a persistent bad taste or halitosis, a sensation of fullness or irritation in the throat, coughing, discomfort on swallowing, or visible white or yellowish clusters on the tonsils. In some cases, stones can cause throat irritation or a local infection.

Diagnosis is usually clinical, based on examination of the oropharynx by a clinician. Imaging is rarely needed. Differential diagnosis may include other calcifications in the oropharyngeal region or chronic tonsillitis with debris.

Management depends on symptoms. Asymptomatic stones require no treatment. Symptomatic stones can be removed by a clinician using gentle suction, irrigation, or curettage; patients may attempt careful removal with a cotton swab, but this carries a risk of gagging or injury. Regular mouth rinses, improved oral hygiene, and hydration help prevent recurrences; antibiotics do not dissolve stones. For recurrent or large stones, tonsillectomy or other surgical options may be considered.

Prevention focuses on reducing debris accumulation and bacterial growth in the tonsillar crypts, including good oral hygiene, regular tongue cleaning, adequate hydration, and avoiding tobacco or irritants. Most tonsilloliths are benign and can be managed without surgery when symptoms are mild.