Recognize and remove tonsil stones – that’s how it works!

Recognize and remove tonsil stones - that's how it works!

Tonsil stones are small formations in the throat and pharynx that smell when crushed and can, therefore, result in bad breath. The tiny lumps are harmless and can be easily removed. In the following, you can read how tonsil stones form, what you can do about them and how to remove them yourself.

What are tonsil stones?

Tonsil stones are small white-yellowish, sometimes crumbly lumps that develop in the palatine tonsils (tonsillar palatine) or pharyngeal tonsils (tonsillar pharyngeal). They are also known as tonsil stones or tonsilloliths, as the tonsils are also called tonsils.

The tonsil stones usually consist of bard particles, oral mucosa cells and bacteria. When crushed, they give off a pungent, foul odour and can cause bad breath (technically known as foetor ex ore or halitosis). Tonsil stones are usually entirely harmless and can be easily removed.


How are tonsil stones formed?

Almost half of all people will have tonsil stones at some point in their lives. Their formation is, therefore, normal to a certain extent.

The mass that makes up tonsil stones is the remains of our chewed bard mixed with bacteria and the body’s cells. Doctors refer to this mixture as detritus. During chewing, these bard particles are pushed into the grooves of the almond surface. These are also called crypts and extend deep into the tonsils.

Tonsil tissue is home to many white blood cells, part of our body’s immune system. The first contact of the immune system with the chyme and the bacteria it contains takes place in the tonsils. After a specific time, the residue is pushed out of the tonsils again and then swallowed – a normal process.

Occasionally, however, this detritus calcifies and appears on the surface of the tonsil crypts as tonsil stones. The minerals that cause calcification come from the chewed bard. Together with them, the chyme forms a firm, crumbly consistency and then sticks to the almonds in the form of small lumps.

Causes: Why do you get tonsil stones?

Tonsil stones do not always have clear causes. However, some factors contribute to the formation of tonsil stones. Because tonsil stones form in the tonsils’ crypts, people with more profound and broader crypts have a greater tendency to develop tonsil stones. It has also been found that the likelihood of suffering from tonsil stones increases with the frequency of tonsillitis that has already been experienced.

After an infection, the self-cleaning ability of the crypts may also be restricted, leading to more extended storage of the residue and, thus, tonsil stones. However, tonsil stones can also signify a more active immune system as more white blood cells are activated and migrate to the crypts, causing the residue to bulk up and become more viscous.


Symptoms: How can you recognize tonsil stones?

Tonsil stones are discovered by the attending physician or the affected person when examining the oral cavity. They may appear as white-yellow lumps on the tonsils that are visible when the mouth is wide open.

Frequently, tonsil stones are also an incidental finding in CT images ( computed tomography ) of the skull or orthopantomograms (panoramic X-ray images of the upper and lower jaw). In this case, they must be distinguished from, among other things, calcifications of the surrounding arteries, the salivary gland or malignant tumours.

In some cases, tonsil stones are also discovered because they are causing symptoms. The following complaints  are known in connection with tonsil stones:

  • bad breath
  • Foreign body sensation in the throat
  • cough suppressant
  • earache

However, tonsil stones are usually asymptomatic, which means they do not cause any symptoms.

Are tonsil stones always visible?

Tonsil stones only become visible when they rise to the surface of the crypts. As a rule, however, they are only discovered after a thorough inspection of the oral cavity by the person concerned, so they do not usually catch the eye by accident.

In most cases, the oral cavity is only examined due to the symptoms caused by the tonsil stones. In the case of bad breath, the level of suffering is exceptionally high and is the most likely reason for those affected to see a doctor.

Tonsil stones or pus on the tonsils – how do you differentiate?

Tonsil stones and tonsillitis ( tonsillitis ) are often confused with each other. The pus deposits (spots) of tonsillitis are strongly reminiscent of tonsil stones and have a whitish-to-yellowish colour. However, tonsillitis  is usually accompanied by the following symptoms, which do not occur with tonsil stones:

Frequently occurring tonsillitis, however, promotes the formation of tonsil stones.


Are tonsil stones dangerous?

Usually, tonsil stones are not dangerous because they resolve quickly on their own and rarely cause any symptoms or complications. The most common complication is repeated pharyngitis. In rare cases, peritonsillar abscesses (abscess formation in the tonsils) and pulmonary complications from swallowing the tonsil stones can also occur.

What to do against tonsil stones?

In principle, tonsil stones do not have to be treated. In the event of problems, however, they can be removed without hesitation. A distinction is made between methods for self-treatment and methods that should be reserved for medical professionals since the risk of injury with these treatment methods is very high.

Remove tonsil stones yourself.

The following methods and home remedies can be used to treat tonsil stones yourself:

  • stretching of the throat
  • direct removal, for example, with a toothbrush
  • Aspirate through pipettes
  • oral irrigator
  • Gargle


Remove tonsil stones by stretching the throat.

The throat can be stretched by simply raising the head, and the tonsil stones can be pushed out of the crypts. This procedure has the lowest risk of injury and should always be carried out first.

Even when swallowing with a closed mouth, some people can create enough negative pressure to suck the tonsil stones out of the crypts.

Get rid of tonsil stones with toothbrush & Co.

If the gag reflex is not so pronounced, tonsil stones can also be removed with a toothbrush handle, cotton swab, wooden spatula, finger, or tongue root. The tonsils are massaged upward, pushing the tonsilloliths out of the crypts.

Pipette to remove tonsil stones

Tonsil stones can also be removed from the tonsils using a curved eyedropper. The curved pipette is placed on the tonsils, and the tonsil stones are sucked out of the crypts with negative pressure. Doctors often use this method, but it can also be carried out safely as a self-treatment.


Remove tonsil stones with the oral irrigator.

Another remedy for tonsil stones is the oral irrigator. With this method, a water jet is generated using a pump. As a rule, the oral irrigator is used for oral hygiene after brushing your teeth. A low water pressure setting can also be used to remove tonsil stones. The crypts are flushed with the water jet. The use of a saltwater solution is recommended.

Gargle: Remove tonsil stones without gargling

If there is a strong urge to gag, a direct mechanical removal or a massage of the tonsils with an oral irrigator is very uncomfortable. It is a good idea to try stretching above the throat or gargle with an antibacterial solution or teaHerbal teas such as sage, chamomile, marshmallow or St. John’s wort are suitable.

Medical treatment methods for tonsil stones

The following treatment methods should be reserved for medical professionals:


Roeder treatment: Remove tonsil stones with the suction glass

The Roeder treatment, or Rödern, is an alternative medical method intended to support the self-cleaning of the tonsils. First, the existing tonsil stones are sucked out of the tonsils with a glass bell (Röder suction glass). The tonsils are then massaged with a cotton hook or a finger covered with cotton. This procedure is often combined with almond rinses or herbal teas to flush out smaller, deep-seated tonsil stones.

Homeopathy: Strengthening of the immune system

In homoeopathy, tonsil stones are treated with immune-boosting agents. Different plant extracts are used. Echinacea, honey bee venom and deadly nightshade are all good for treating tonsil stones. Treatment by a knowledgeable homoeopath is recommended, as some of the substances used can be harmful to health in higher doses.

Curettage to remove tonsil stones

ENT doctors often use curettage to remove tonsil stones. Here, the tonsil stones are carefully detached from the tonsils with a curved wire, the curette. The crypts of the tonsils are then rinsed out with water to remove the smaller stones as well.


Laser cryptanalysis under anaesthesia

Laser cryptanalysis is a procedure that vaporizes the surfaces of the tonsils and smooths the edges of the crypts. This makes accumulating detritus more difficult and facilitates the self-cleaning function of the tonsils. Laser cryptolysis is performed under local anesthesia.

Surgical removal of tonsil stones

Tonsil stones are rarely surgically removed. An operation is only necessary if the tonsilloliths cause severe symptoms or if all other treatment approaches have failed. More often, repeated tonsillitis is the reason for the removal of the tonsils (tonsillectomy), which means that no more tonsil stones can develop if the tonsils are completely removed.

Therefore, the mere diagnosis of tonsil stones does not indicate surgery.

Can tonsil stones go away on their own?

Tonsil stones can go away on their own without treatment. However, they often reappear after removal, which can be very frustrating for those affected as the treatment has to be repeated repeatedly. 


Prevention: What helps against tonsil stones?

Tonsil stones can only be avoided partially. However, the following preventive measures can be taken to prevent tonsil stones:

  • Brushing your teeth: Regular brushing of your teeth cleans the oral cavity of bacteria and thus also helps to reduce the frequency of tonsil stones.
  • Gargling: Gargling with douches and teas can also help preventively as they promote oral hygiene. Here again, the already mentioned herbal teas are suitable.


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