Tonsil stones without tonsils

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  • Tonsil Stones (Tonsillolith)

    Your tonsils are gland-like structures in the back of your throat made of tissue that contains lymphocytes — cells in your body that prevent and fight infections. It is believed that the tonsils play a role in the immune system and are meant to function like nets, trapping incoming bacteria and virus particles that are passing through your throat.

    Sometimes the crevices and pockets in your tonsils get filled with bacteria, food debris, dead cells, mucus, and other materials that can get trapped. These materials can eventually build up and calcify.

    Tonsil stones, or tonsoliths, are formed when this trapped debris hardens, or calcifies. This tends to occur most often in people who suffer from chronic inflammation in their tonsils or repeated bouts of tonsillitis

    What Are the Symptoms of Tonsil Stones?

    Many small tonsil stones do not cause any noticeable symptoms. Even when they are large, some tonsil stones are only discovered incidentally on X-rays or CT scans. Some larger tonsoliths, however, may have multiple symptoms:

    • Bad breath . One of the prime indicators of a tonsil stone is exceedingly bad breath, or halitosis, that accompanies a tonsil infection. One study of patients with a form of chronic tonsillitis used a special test to see if volatile sulfur compounds were contained in the subjects’ breath. The presence of these foul-smelling compounds provides objective evidence of bad breath. The researchers found that 75% of the people who had abnormally high concentrations of these compounds also had tonsil stones. Other researchers have suggested that tonsil stones be considered in situations when the cause of bad breath is in question.
    • Sore throat . When a tonsil stone and tonsillitis occur together, it can be difficult to determine whether the pain in your throat is caused by your infection or the tonsil stone. The presence of a tonsil stone itself, though, may cause you to feel pain or discomfort in the area where it is lodged.
    • White debris. Some tonsil stones are visible in the back of the throat as a lump of solid white material. This is not always the case. Often they are hidden in the folds of the tonsils. In these instances, they may only be detectable with the help of non-invasive scanning techniques, such as CT scans or magnetic resonance imaging.
    • Difficulty swallowing. Depending on the location or size of the tonsil stone, it may be difficult or painful to swallow foods or liquids.
    • Ear pain. Tonsil stones can develop anywhere in the tonsil. Because of shared nerve pathways, they may cause a person to feel referred pain in the ear, even though the stone itself is not touching the ear.
    • Tonsil swelling. When collected debris hardens and a tonsil stone forms, inflammation from infection (if present) and the tonsil stone itself may cause a tonsil to swell or become larger.

    How Are Tonsil Stones Treated?

    The appropriate treatment for a tonsil stone depends on the size of the tonsoliths and its potential to cause discomfort or harm. Various options include:

    • No treatment. Many tonsil stones, especially ones that have no symptoms, require no special treatment.
    • At-home removal. Some people choose to dislodge tonsil stones at home with the use of picks or swabs.
    • Salt water gargles. Gargling with warm, salty water may help alleviate the discomfort of tonsillitis, which often accompanies tonsil stones.
    • Antibiotics. Various antibiotics can be used to treat tonsil stones. While they may be helpful for some people, they cannot correct the basic problem that is causing tonsoliths. Also, antibiotics can have side effects.
    • Surgical removal. When tonsil stones are exceedingly large and symptomatic, it may be necessary for a surgeon to remove them.

    Can Tonsil Stones Be Prevented?

    There are certain things you can do to prevent tonsil stones from developing in the first place or coming back once they get removed. Some of these things include:

    • Removing bacteria that builds up at the back of your tongue once you get done brushing your teeth. The best way to do this is to utilize a tongue scraper each night before you go to bed each night.
    • Brush your teeth regularly so that you can get rid of food debris that get trapped in between your teeth. Brush your teeth and tongue at least 2 times everyday.
    • Combine 1 tablespoons of salt and 1 cup of water and gargle it. Gargling salt water will help disinfect your mouth and help remove bacteria that could cause tonsil stones. Do this a few times everyday.
    • Increasing your water intake is a good way to prevent this problem, as it will help keep your mouth moisturized. Stay away from sugared drinks, likes sodas, and a diet high in simple sugars because they are known to contribute to the development of tonsil stones.
    • Try to stop smoking and drinking alcohol as much. Drinks with alcohol in it can leave your mouth dry, which isn’t good if you often experience tonsil stones. Smoking won’t help your situation either.

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Tonsil Stone Treatment: Home Remedies, When Surgery Is Needed, and More

There Are a Few Surgical Options to Get Rid of Tonsil Stones, but They’re Usually Only Recommended for Very Severe Cases

If your doctor does recommend a medical procedure to get rid of (and help prevent future) tonsil stones, here are some of the options he or she may discuss.

Tonsillectomy

A tonsillectomy is the complete removal of the tonsils. Like any surgical procedure, there are risks of complications such as bleeding and infection. It’s also a painful procedure that can involve two or more weeks of moderate to severe pain, says Thatcher.

The tonsils also play an important role in keeping harmful bacteria and viruses out of your body by acting as sentinels and preventing them from entering through your mouth, and should only be removed when absolutely necessary. (1,2,3) “They are part of the immune system,” says Setlur.

The bottom line: Your doctor may recommend this surgery if the tonsil stones are severely affecting your quality of life, and other methods to keep your tonsil stones in check are not working. (1,2) “It’s a high-risk solution for a low-risk problem,” Setlur adds.

Laser Tonsil Cryptolysis

In this surgery, a surgeon uses a laser to remove the tonsil crypts by resurfacing those areas (but not removing the full tonsils). A review published in 2013 in the American Journal of Otolaryngology of 500 cases involving this procedure found that the advantages of this surgery over tonsillectomy included no need for general anesthesia (a lower, local dose is all that is required), not having to remove the tonsils, enabling doctors to target only the areas where cryptic pockets are, reduced risk of bleeding, less pain after surgery, and shorter recovery time. (4)

Coblation Tonsil Cryptolysis

For this procedure doctors use radio-frequency energy and salt water to remove the crypts and crevices in the tonsils where tonsil stones have formed. (5) It has all the aforementioned advantages of laser tonsil cryptolysis over tonsillectomy. Additionally, it allows the doctor to operate at a lower temperature than a laser requires, so there are fewer risks than with the laser procedure (such as potential airway fire, retinal damage, and facial burns).

Your tonsils are covered with the same mucous membrane, or mucosa, that lines your mouth, nose and throat. It’s the crevices, or crypts, in your tonsils’ mucosa that may lead to problems.

RELATED: How to Tell If Your Sore Throat Needs a Doc Visit

Signs of tonsil stones

When food or debris get caught in the crevices of your tonsils, they sometimes harden or calcify, forming temporary calcium deposits.

These deposits are often small, invisible to the naked eye and harmless. “Some people may not have any symptoms,” says Dr. Osborne. “There’s no medical concern if the tonsil stones aren’t causing problems.”

For others, however, tonsil stones cause noticeable problems. The most common signs and symptoms are:

  • Bad breath
  • Throat irritation
  • A whitish node or bump on your tonsil

Bad breath and throat irritation can also be signs of tonsillitis. But tonsillitis is caused by viruses or bacteria and generally causes red, inflamed tonsils, as well as fever, headache and other symptoms.

“Some people can develop tonsil stones once or twice, while others can get them several times a week,” says Dr. Osborne.

People with lots of crevices, or crypts, in their tonsils are more susceptible to tonsil stones. Although they are more common in teens, anyone with tonsils can get them.

RELATED: Strep Throat or Sore Throat? Best Ways You Can Tell

Tips for prevention and treatment

Tonsils stones develop from food and other substances that get stuck in the tonsils. The best way to prevent them is to keep your tonsils free of debris.

Dr. Osborne recommends brushing your teeth and tongue thoroughly, and gargling after eating to help prevent any buildup. Water picks help to flush out the mouth as well, which may help dislodge tonsil stones near the surface.

Many people self-treat tonsil stones at home, removing them with a toothbrush or cotton swab. If the deposits dislodge easily, removing them yourself generally won’t present a problem.

RELATED: Boil, Soak or Pitch It? 4 Tips for a Clean Toothbrush

For those with recurring, troublesome tonsil stones, a tonsillectomy is sometimes the best option. Outpatient surgery to remove the tonsils will eliminate any problems they cause.

“It’s a quality-of-life issue,” says Dr. Osborne. “If the tonsil stones happen frequently and they’re bothersome to you, surgery may be the right treatment.”

The case of the hiding tonsil stones hits teen

This case was a little like the unfortunate customer who brings his chronically noisy car into the shop, only to have the vehicle purr like a kitten for the expectant mechanic. My patient was a teenage girl with a moderately severe sore throat as well as a complaint of a white chunk in one of her tonsils.

At the time of the exam, of course, the white spot was nowhere to be found, and after performing what turned out to be a negative strep test, I sent the teen on her way without antibiotics and with a diagnosis of viral pharyngitis.

The young lady visited again a few months later, this time for her annual physical. After discussing her progress in school and reviewing a variety of medical issues, the girl and her mother brought up the subject of recurring white spots in the tonsils. I looked closely, but once again, the tonsils were devoid of any white debris.

While throat problems rarely caused her to run fevers or miss school, the high school student felt that her tonsil spots were not only annoying, but embarrassing as well. She could often feel the little tonsil spots when she swallowed, found herself coughing up small white pebbles with some frequency, and was pretty sure that the tonsil condition was at the root of her bad breath.

Italian physician M. Mesolella and colleagues explain that these tonsil stones or tonsilloliths are hard concretions ranging in size from a few millimeters to several centimeters, though the larger stones are not very common. The cause of tonsilloliths is not well-established but might be related to unresolved tonsillitis or sluggish saliva, and tonsil stones might share a link with similar conditions such as kidney stones, gallstones and salivary gland stones.

Tonsil stone sufferers have an average age of 50 years, but stones can be seen in the pediatric population and have been reported in patients as young as 10. The Italian medical group finds that many tonsilloliths cause no symptoms, but about one quarter of patients do experience throat pain when stones are present.

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Since tonsil stones are calcified collections of sloughed skin cells, food debris and sulfur-producing bacteria, medical researchers Nicole E. Myers and her group note that the presence of tonsilloliths can lead to noticeable and distressing halitosis, or bad breath.

Patients are often tempted to pick out small tonsil stones with various common household items such as straws or cotton swabs, but Myers’ team stresses that this practice can cause irritation and bleeding. Individuals are instead advised to gargle with salt water or to use pulsating jets of water to dislodge the stones with a minimum of trauma.

If home methods do not work for bothersome tonsilloliths, an otolaryngologist can be consulted to consider curettage – scraping or spooning of the concretions out of tonsillar pockets after the application of a local anesthetic. Tonsillectomy is indicated if tonsilloliths cause severe symptoms and non-surgical methods fail to help, or if stones are associated with chronic tonsillitis.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.

Perhaps because tonsil stones are not typically considered a pathological condition, few research reports have been published about them. Nevertheless, the stones can cause an array of uncomfortable side effects, including sore throat and ear pain, not to mention the maddening sensation of a foreign body in the throat. In a 2008 case report from India, doctors described removing a giant tonsillolith that was making it painful for a young patient to swallow.

Some research suggests that tonsilloliths also have the potential to take a toll on sufferers’ social lives. In a 2007 study at the State University of Campinas in Brazil, doctors found that tonsilloliths were present in 75 percent of tonsillitis patients who had bad breath and in only 6 percent with normal breath.

But Dr. Toshihiro Ansai, an associate professor at Kyushu Dental College in Japan who has studied the link between tonsil stones and bad breath, does not think all stone sufferers need to be concerned. “Most halitosis is caused by periodontal diseases and tongue coat,” he said. “Tonsillolith would be a minor cause.”

While having tonsils surgically removed is the only solution likely to banish tonsil stones for good, Dr. Lee A. Zimmer, an otolaryngologist at the University of Cincinnati, hesitates to recommend tonsillectomy to stone sufferers right off the bat. (In some patients, tonsil removal results in complications and excess bleeding.)

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