What Are Tonsil Stones?

Occasionally, that feeling of a lump in your throat isn't caused by stress or anxiety. It could simply be tonsil stones—small, pebble-like white formations that can occasionally be found deep within the tonsils. But what exactly are these unpleasant throat intruders?

The explanation is both straightforward and complex. Tonsil stones typically appear white or yellowish and can vary in size, from microscopic particles to large chunks several centimeters across. These tonsilloliths—the technical medical term—are composed of materials that collect in the crevices of the tonsils.

Tonsils aren't just smooth lumps of tissue; they feature folds known as tonsillar crypts that create small pits in the tissue. Acting as the body's immune system defenders, the tonsils help capture foreign substances entering through the mouth, and these crypts expand their surface area, allowing for better detection of anything that may require an immune response. A healthy tonsil contains numerous crypts.

The process by which tonsil stones form within those crypts is a bit more intricate. Mytour consulted three different otolaryngologists (ear, nose, and throat specialists) on the topic, and each offered slightly varying explanations.

Like all tissues in your body, tonsils are in a constant state of regeneration. Much like your skin sheds dead cells, tonsil tissue also peels away. Normally, it travels down your throat, but sometimes it gets trapped in the crypts. There, bacteria from your mouth can begin to thrive on it, transforming it into a semi-solid stone that Dr. Erich Voigt, director of general otolaryngology at NYU Langone Health in New York City, describes as 'a cheesy ball.' (Apologies if this has now ruined cheese for you.)

Tonsillar crypts provide the ideal environment for bacteria, as they are poorly oxygenated but highly vascular. 'It becomes a prime area for bacteria to thrive and stick together, forming what's known as a biofilm structure,' explains Dr. Yosef Krespi, an otolaryngologist practicing with North Shore-LIJ Health System in New York, to Mytour. A tonsil stone, he notes, is essentially a mass of biofilm. In a 2008 study, he and his team found that tonsilloliths closely resemble dental plaque in structure, another type of biofilm found in the mouth.

However, Dr. Jay Shah, a pediatric otolaryngologist at Cleveland’s University Hospitals Rainbow Babies and Children’s Hospital, clarifies that the yellowish lump you might find in your throat isn't made up solely of bacteria. 'When researchers have analyzed tonsil stones, they found calcium, sulfur, and various other elements,' he explains.

That’s not to say bacteria are irrelevant. Scientists researching the microbial makeup of tonsil stones have discovered that the anaerobic bacteria typically found in and around tonsilloliths are responsible for producing volatile sulfur compounds. This is why individuals with severe cases of tonsil stones can experience bad breath.

While Voigt and Shah highlighted the tissue and keratin (proteins found in the mouth lining, as well as in hair and skin) from the tonsils that get trapped in these crypts as the primary source of tonsil stones, other studies have pointed out that food particles stuck in the tonsillar crypts can also contribute to tonsillolith formation. One study even suggests that trapped spit alone could be responsible for their development.

According to Krespi, the tonsil stone you see in your throat isn’t necessarily the whole stone. It might be a fragment that has broken off from the main 'mother' stone, which remains deep within a tonsillar crypt, meaning you could continue to find stones. However, Voigt states that while some patients experience recurring stones, for others, the issue is temporary and may resolve after a few weeks or months.

Everyone has tonsillar crypts, dead skin cells, and bacteria in their mouths, but not everyone develops tonsil stones. 'The big question is, why do some people get them while others don't? We don’t know,' says Shah. Some individuals have larger crypts in their tonsils, and because it’s easier for material to accumulate in larger crypts, these people seem more likely to develop tonsil stones. But large tonsil stones are very uncommon, and you are more likely to encounter a few harmless small tonsilloliths than a large stone. In general, tonsil stones are more frequent in those with a history of tonsillitis or larger tonsils that have numerous deep nooks where bacteria can get trapped.

Determining how common tonsil stones are is challenging. Some studies estimate that about 8 percent of the population is affected, while others suggest that as much as 25 percent of the population could be impacted. Both of these might actually be underestimates. Researchers Mytour consulted reported seeing tonsil stones frequently in their practice, even in patients who were unaware of having them.

The lack of concrete data on how many people are affected by tonsil stones could be due to the fact that they usually don’t require a doctor’s visit. As noted by the authors of a significant study on tonsil stones from a Japanese dental hospital in 2013, tonsilloliths are 'relatively commonly encountered in daily clinical practice, but patients rarely have complaints related to them.'

While it can be surprising (or, depending on how you see it, captivating) to peer into your throat and spot white spots at the back of your mouth, tonsil stones are generally harmless. One ear, nose, and throat specialist compares them to acne of the tonsils. They're a bit unpleasant, but for the most part, tonsil stones don’t cause any major side effects.

In more severe instances, large tonsil stones can lead to issues such as ear pain, difficulty swallowing, and other discomfort, but this is quite rare. Most people with tonsil stones are able to manage them without needing medical help, removing them with a Q-Tip, their finger, or by gargling with salt water. While doctors have specialized tools to safely remove tonsilloliths, as long as you're not using anything sharp to poke at your tonsils or push the stones deeper into the crypts, you're likely fine. If you're prone to tonsil stones, Voigt recommends gargling with a 50/50 mix of hydrogen peroxide and water to cleanse your tonsillar crypts. You could also use a water pick to do the same.

The only way to completely eliminate tonsil stones for good is by removing the tonsils entirely. However, for the majority of people, gargling or a regular Q-tip session works just fine—and even provides some pretty entertaining video.