Tonsil Stones

This month’s blog deals with the common and often embarrassing problem of tonsil stones. Tonsils stones (or tonsilliths) are small clumps of whitish, odorous debris that collect in the surface crevices (crypts) of the tonsils. Many people think they are food particles, but they are primarily made up of shedded epithelium. The epithelium or surface lining of the tonsil will shed, much like skin sheds, and collect in the crypts of the tonsils. This epithelial debris may then mix with bacteria, resulting in a low grade sore throat and/or chronic bad breath. When the tonsilliths fill the crypt they may be coughed out or sometimes removed with pressure from a Qtip or the patient’s finger. After removal, they will generally recollect within weeks to months. They can be extremely annoying but are not dangerous, so if they are noticed infrequently and are only mildly symptomatic, they do not require treatment. However, for some patients, tonsilliths can be a weekly or even daily annoyance, and these patients often seek remedies.


The only permanent solution for tonsilliths is removal of the tonsils (tonsillectomy). Tonsillectomy is generally performed as an outpatient procedure under general anesthesia and the postoperative course is often quite painful. Usually the patient requires a week out of work or school. One alternative to complete tonsillectomy is cryptolysis or laser ablation of the tonsils. At Raleigh ENT this procedure is performed in the office under local anesthesia with the use of the carbon dioxide laser. The laser is used to remove enough of the tonsil to open up the crypts and therefore prevent reaccumulation of the tonsilliths. Generally, there is less pain than that associated with complete tonsillectomy and some patients may be able to return to work the next day. Not all patients may be appropriate for this procedure based on their anatomy as well as the activity of their gag reflex. A video demonstrating this procedure is available for review at www.thedoctorstv.com/main/procedure_list/279. Please call 787-7171 if you would like to schedule an appointment and discuss options of treatment with one of our physicians.


Stephen E. Boyce, MD, FACS