Tonsil stones have to be removed

Tonsil stones

TABLE OF CONTENTS

What does medicine mean by almond stones?
In technical terms, tonsil stones are also known as tonsil stones, tonsillolites or tonsillar plugs. They consist of a mixture of food residues, dead mucous membrane cells and white blood cells, which are deposited in the indentations of the tonsils, also called crypts. The yellowish-white structures only become visible when they reach the surface of the almonds.

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How are almond stones formed?
The surface of the tonsils is fissured and forms so-called crypts. When eating, food residues, dead cells, white blood cells as well as bacteria and stored calcium salts get into these furrows. Normally, the crypts are emptied when chewing by tensing the palate muscles. If this mechanism is disturbed, however, these deposits can calcify and tonsil stones develop.

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What are the symptoms of tonsils?
In most cases, tonsil stones cause no discomfort and are swallowed, coughed up or sneezed out unnoticed while eating. A typical sign is an unpleasant halitosis. Rarely, there may be difficulty swallowing, a foreign body sensation, a dry cough, ear pain or a foul taste in the mouth.

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What are the causes of tonsil stones?
The size of the tonsils and their crypts themselves are decisive for the development of the tonsils. The more pronounced and deeper these are, the more likely it is to create crusty and granular structures. A disturbed natural emptying of the indentations due to recurring tonsillitis can also promote the formation of tonsil stones, as the surface of the tonsils scarred and the removal of the detritus, i.e. the cellular breakdown products, is made difficult or prevented due to a narrowing of the crypts.

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What are the risk factors for the small lumps in the throat?
The two most common risk factors are large tonsils with very deep and wide crypts, in which the detritus can be deposited more easily, and a disturbed emptying mechanism of the indentations, which can arise as a result of repeated tonsillitis, as the tissue gradually scars . As a result, the crypts narrow and can be emptied with difficulty or not at all through the normal chewing and swallowing movement.

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Who Is Most Commonly Affected by Almond Stones?
Especially people with frequent tonsillitis have an increased risk of getting tonsil stones, as the tissue in them becomes more and more scarred and the entrances to the crypts are blocked. People with large tonsils and many deep and wide crypts are also more likely to have problems with tonsil stones. Almond stones are rare in children.

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Are Almond Stones Dangerous?
Almond stones are usually not dangerous. They do not cause acute or chronic inflammation, nor do they require special treatment. Only very rarely do complications such as sore throat or abscesses occur. Rather, the problem with tonsil stones is that they keep coming back and can only be completely eliminated through surgical removal of the tonsils.

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What other clinical pictures can be distinguished from almond stones?
There are some diseases that have symptoms similar to tonsil stones. Almond stones are often mistaken for tonsillitis. In contrast to the yellowish-white almond stones, this shows up in the form of reddened and swollen almonds. In addition, the infection is usually accompanied by fever and severe pain when swallowing. Other diseases that must be differentiated from tonsil stones are salivary stones, pus sticks, tongue cancer, abscesses, and almond cysts.

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When should I see a doctor if I have tonsil stones?
In most cases, tonsil stones are discovered by chance during examinations by the dentist or ENT specialist. Basically, you can then try to remove the stones yourself using simple methods. However, if these attempts are unsuccessful, you should consult an ear, nose and throat doctor. This can squeeze out or suck out the tonsil stones.

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How can tonsil stones be removed?
There are numerous non-surgical methods of removing tonsil stones, such as squeezing the stones out with your tongue or toothbrush, using an oral irrigator or mouth rinse, and gargling with salt water or tea. The ear, nose and throat doctor removes the stones using other methods, such as Roeder treatment, curettage or laser cryptolysis. Unfortunately, antibiotics do not help against tonsil stones, as the bacteria hide behind a kind of protective wall in the mucous membrane and therefore cannot be reached by the antibiotic.

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When does a tonsil stone have to be surgically removed?
If tonsil stones are the result of recurring tonsillitis, the doctor can make a recommendation to completely eliminate the tonsils. However, this should always be considered as a last resort, as the procedure involves an approximately one-week hospital stay and poses possible risks.

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What is the prognosis for tonsil stones?
As a rule, tonsil stones are not even noticed by those affected and only discovered by chance. The main complaints are larger stones. There is no drug therapy for tonsil stones. The only way to permanently remove them is to have the tonsils removed by surgery. However, doctors usually advise against surgery, as it can have serious consequences for the immune system.

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Can I remove tonsil stones myself?
There are several methods you can use to remove tonsil stones yourself. You can push the stones out of the crypts with the help of your tongue or an aid such as a toothbrush or a cotton swab and a spoon handle. Stretching the throat through constant movement of the palate muscles by opening and closing the mouth can also loosen the tonsil stones from the furrows. Gargling with mouthwash, chamomile or sage tea as well as strong coughing can also lead to success. Oral irrigators or mouth rinses have proven themselves as home remedies.

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Can I prevent tonsil stones?
Regular and thorough oral hygiene is very important with tonsil stones. It is best to use an oral irrigator regularly or massage the almonds with a toothbrush. Daily brushing of teeth should be on the daily schedule anyway. You should avoid alcohol and dairy products, as these lead to increased deposits in the crypts.

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What does the removal of almond stones cost?
The cost of removing almond stones can vary widely. Surgical tonsil removal is the most expensive treatment option and costs around 2,000 to 2,500 euros, with the costs usually being covered by the health insurance company.

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The most important things in a nutshell

Almonds are yellowish-white deposits in the furrows of the tonsils Almonds are yellowish-white deposits in the furrows of the tonsils and consist of food debris, dead mucous membrane cells and white blood cells.


As a rule, tonsil stones are harmless, a few millimeters in size and mainly affect people with deep and wide crypts and people with frequent tonsillitis. These have an increased risk of disease, as the tissue in them increasingly scarred and blocked the entrances to the crypts.


Usually tonsil stones are discovered accidentally by a dentist or ENT doctor, as those affected often remain symptom-free. A typical sign, however, is, for example, bad breath. Sometimes a foreign body sensation and constant throat clearing occur. Larger stones can rarely cause swelling and pain when swallowing.


There are various non-surgical methods of removing tonsil stones yourself or with the help of a specialist. Surgical intervention is only necessary in the rarest of cases and is not advisable due to the possible complications.

What does medicine mean by almond stones?

Since the medical term for tonsils is tonsils, tonsil stones are also called tonsil stones, tonsillolites or tonsillar plugs in technical terms. They consist of food residues, dead mucous membrane cells and white blood cells and are deposited in the indentations of the tonsils, also called crypts. There they can cause difficulty swallowing, a foreign body sensation, a dry cough, earache, a putrid taste in the mouth and bad breath, but are basically harmless. The doctor can diagnose them based on their appearance or randomly in the course of a panoramic radiograph of the upper and lower jaw. Various non-surgical methods are available for removing tonsils. Surgical intervention is only necessary in rare, more severe cases.

How are almond stones formed?

The palatine tonsils, also known medically as the tonsilla palatina, are located on both sides of the back, soft palate behind the palatal arch. Their job is to report pathogens that enter the body through food to the immune system. The surface of the tonsils in the mouth is folded in a similar way to the intestine. This jagged surface forms furrows, which are called crypts in medicine. When eating, food residues, dead cells, white blood cells as well as bacteria and stored calcium salts get into these crypts. Normally they are emptied while chewing by tensing the palate muscles and swallowed unnoticed, but flaked material can settle there and develop into a crumbly, cheese-like tissue, the so-called almond plug. When these crusts and calcifications form, doctors speak of almond stones or tonsillolites.

What are the symptoms of tonsils?

In most cases, tonsil stones cause no discomfort and are swallowed, coughed up or sneezed out unnoticed while eating. Therefore, they are often discovered accidentally during a medical examination. Sometimes you can see them in the form of white and yellow lumps on your tonsils when looking at your mouth. However, what is particularly easy to recognize when it comes to large tonsillolites is the unpleasant halitosis of rotten eggs. Some patients also report a foreign body sensation or a furry feeling in the throat and constant throat clearing. Swelling and pain in the affected tonsils are also possible, although these occur very rarely. Earache has been reported in a few cases.

Are tonsil stones always visible?

Almond stones arise in the crypts of the almonds and are therefore only visible when they appear on their surface. That is why they usually only discover those affected by chance or as a result of complaints. As a rule, tonsil stones are a few millimeters in size.

Can white spots / points in the throat indicate tonsil stones?

Yes, white spots or dots in the throat area can indicate tonsil stones. Usually they can then be felt with the tongue. In addition, there is a bad breath.

What are the causes of tonsil stones?

Tonsil stones basically occur in everyone, but they are usually so small that they go unnoticed. The size of the tonsils and their crypts themselves are decisive for the development of the tonsils. The more pronounced and deeper these are, the more likely it is to create crusty and granular structures. A disturbed natural emptying of the indentations can also lead to the formation of tonsil stones. This can be the case after severe or recurring tonsillitis, as the surface of the tonsils becomes scarred and the removal of the detritus, i.e. the cellular breakdown products, is made difficult or impossible due to a narrowing of the crypts. Conversely, there is no evidence of an increased risk of tonsillitis due to the repeated occurrence of tonsil stones.

Why do you get almond stones?

There are no clear causes of tonsil stones, but people with deeper and wider crypts are more likely to suffer from them than others. The frequency of tonsillitis also plays a not insignificant role. The more often you suffer from such, the sooner you can get tonsils, as the self-cleaning function of the crypts is usually limited after infections. As a result, the detritus remains stored in the crypt for longer and becomes encrusted there. Conversely, tonsillolites can also be a sign of a very active immune system, which activates more white blood cells, which are then deposited in the crypts. The detritus then increases in mass and becomes more viscous. Normally, no tonsil stones can occur without tonsils.

Can tonsil stones go away on their own?

Almond stones can go away on their own, but they often reappear. Small tonsillolites in particular can easily be removed by swallowing with your mouth closed.

What are the risk factors for the small lumps in the throat?

Basically, there are two common risk factors: large tonsils with very deep and wide crypts, in which the detritus can be deposited more easily, and a disturbed emptying mechanism of the indentations, which can arise as a result of repeated tonsillitis, as the tissue gradually scars. As a result, the crypts narrow and can no longer be emptied with difficulty, if at all, due to the normal chewing and swallowing movements.

Who Is Most Commonly Affected by Almond Stones?

Especially people with frequent tonsillitis have an increased risk of getting tonsil stones, as the tissue in them becomes more and more scarred and the entrances to the crypts are blocked as a result. People with large tonsils and many deep and wide crypts are also more likely to have problems with tonsil stones. Almond stones are rare in children.

Why are some people more likely to have tonsils than others?

Doctors assume that young adults in particular, who either have larger tonsils with deeper and wider crypts or who have repeatedly suffered from tonsillitis, are more often affected by tonsil stones than children. Due to the constant irritation of the tonsils, the tissue is scarred and the natural drainage is disturbed.

Are Almond Stones Dangerous?

If you suffer from tonsil stones, you can rest assured that these are usually not dangerous and cannot bleed. They do not cause acute or chronic inflammation, nor do you have to have them specially treated. Only very rarely do complications such as sore throat or abscesses occur.

What are the consequences of tonsil stones?

The consequences of almond stones are a putrid taste in the mouth and an unpleasant bad breath. For most of those affected, this leads to a bad feeling when they are in company, as they are embarrassed by the bad breath. In addition, there is the constant appearance of new tonsillolites, which is why any treatment must be repeated continuously. Almond stones can have mental health implications for these reasons as well. In addition, there may be pain and difficulty swallowing, but these rarely occur.

Can the almonds cause bad breath?

Almond stones consist mainly of calcium carbonate, i.e. lime, magnesium and other minerals. On top of it is the so-called biofilm, a slime film with microorganisms that decompose the deposit material. This metabolism ultimately leads to the formation of sulfur gases and thus a stinky smell.

What other clinical pictures can be distinguished from almond stones?

There are some diseases that have symptoms similar to tonsil stones:

Tonsillitis (angina): In contrast to almond stones, you can recognize tonsillitis from the tonsils themselves. These are very red and swollen. In addition, the infection is usually accompanied by fever and severe pain when swallowing. Inflammation can cause scars on the surface of the tonsils, which can lead to an increased formation of tonsil stones. Another difference is the duration of the illness. For example, tonsillitis heals in a few days, mainly through the administration of antibiotics. On the other hand, tonsil stones can recur.

Salivary stones: Salivary stones, also known medically as sialolites, consist of crystallized saliva components, which are normally flushed out of the salivary glands unnoticed and do not cause any discomfort. However, if they are to become larger and tilted, they can lead to a narrowing of the salivary gland, which is noticeable as a dry mouth. If the gland becomes completely blocked, it will cause swelling and inflammation. This can cause severe pain that can spread all over your face.

Pus: You can recognize pus as a white-yellowish, punctiform coating on the tonsils. They always indicate a bacterial infection and occur especially with sore throat and angina. The pus on the tonsils is usually associated with severe swallowing difficulties and pain and must always be treated by an ear, nose and throat doctor.

Tongue cancer: This type of cancer is very rare and is also known medically as tongue cancer. It is one of the tumors of the oral cavity and throat and can appear in different places. The base of the tongue is most often affected, but growths can also form on the edge of the tongue, at the tip or on the frenulum. These arise from degenerate cells, so-called squamous epithelial cells. Typical symptoms are white bumps on the back of the tongue, difficulty swallowing, a feeling of lump in the tongue, speech disorders and increased salivation.

Abscess: Almond abscesses are usually associated with tonsillitis, but they are rare. This is a pus-filled cavity on or next to the almond, which is formed by the immune system to prevent bacteria from spreading in the body. The captured bacteria are destroyed by phagocytes and other cells of the immune system, causing pus to form. If the abscess swells too much, there is a risk of it bursting, which is why you should always consult a doctor immediately.

Almond cyst: Cysts are fluid-filled, mostly benign cavities and can also appear on the neck. A distinction is made between central and lateral neck cysts. The lateral cervical cysts, in turn, can be associated with the tonsils. When there is inflammation, these swell significantly and harden. If left untreated, bacterial inflammation can develop, which can also result in an abscess. This leads to a sore throat, difficulty swallowing and often a fever.

When should I see a doctor if I have tonsil stones?

Basically, you can try using simple methods to remove the stones yourself. However, if these attempts are unsuccessful, you should consult an ear, nose and throat doctor. This can squeeze out or suck out the tonsil stones. You should also seek medical advice if you are afraid of harming yourself.

How can tonsil stones be diagnosed?

In most cases, tonsil stones are discovered by chance themselves or the dentist or ENT specialist. But even with complaints such as an unclear bad breath, a foreign body sensation, a throat clearing or a furry feeling in the throat, the doctor will check your tonsils for signs of tonsil stones. Depending on the size and texture of the stones and their distance to the surface, they shimmer whitish through the mucous membrane or appear as white deposits on the tonsils. Only deep stones cannot be seen with the naked eye. The doctor can identify this with the help of x-rays or computer tomography, whereby the examinations with regard to the costs and the radiation exposure are in no relation to the mildness of the symptoms.In some cases, a distinction between tonsil stones and a purulent tonsillitis is only possible with the help of a smear, with which the disease-causing bacteria can be detected.

When does it make sense to remove the white stones?

Removal of tonsil stones makes sense if they cause discomfort and are the result of frequently recurring tonsillitis, as otherwise the tissue will become increasingly scarred. The tonsils shouldn't be removed just because of the tonsil stones, as almonds are an important part of the immune system.

How can tonsil stones be removed?

There are numerous non-surgical methods that you can perform at home to remove tonsil stones. If these aren't successful, the ear, nose, and throat doctor can use other procedures to remove the stones. Be aware that in most cases none of these removal methods are sustainable, which means that you will have to repeat the removal process over and over again.

 

The only really definitive solution is surgical removal of the tonsils. You should only consider this if the psychological strain is very high. In any case, this step should be carefully considered, as it will severely weaken the immune system.

What non-surgical methods can be used to loosen tonsil stones?

In addition to the surgical removal of the tonsils, the doctor can also use other much milder methods of removing the tonsil stones. These include Roeder treatment, curettage and laser cryptolysis:

Roeder treatment: In this naturopathic procedure, first described by Heinrich Roeder around 1900, the doctor places cupping glasses on the tonsils and can create a vacuum with the help of a pump ball. The resulting negative pressure allows him to suck off the tonsil stones. In addition to the suction effect, there is also stimulation and massage of the tonsils. You can have this treatment done once a week.

Curettage: In medicine, curettage is the mechanical removal of tissue by scraping or scraping it out with a sharp-edged instrument. The tonsil stones are removed without damaging the tissue all around. If necessary, you can also have a local anesthetic.

Laser cryptolysis: In laser cryptolysis, the patient's tonsils are treated with laser and electrical pulses under local anesthesia. The surface of the tonsils and the edges of the crypts are smoothed to make it difficult for detritus to accumulate and to support the self-cleaning function. The advantage of the procedure is that the function of the immune system is preserved. In exceptional cases, however, tonsil stones can develop again.

Do antibiotics help against tonsil stones?

Unfortunately, antibiotics do not help against tonsil stones, as the bacteria hide behind a kind of protective wall in the mucous membrane and therefore cannot be reached by the antibiotics.

When does a tonsil stone have to be surgically removed?

Basically, tonsil stones do not have to be surgically removed, as there is no medical reason to do so. The permanent elimination of the tonsils would also make the tonsil stones disappear forever, but an important part of the immune system would also be missing. However, if tonsil stones are the result of recurring tonsillitis, it may be necessary to remove the tonsils.
 
If you would like to have the tonsils removed permanently for other reasons, there is no avoiding an operation. However, this should always be considered as a last resort, as the procedure involves an approximately one-week hospital stay and poses possible risks. Serious complications such as secondary bleeding, rarely even fatal, can occur after the operation.

What happens before the almond stone surgery?

Before the operation, the attending physician will have a detailed discussion with you, during which he will explain the procedure and explain any risks to you. The doctor will also carry out examinations and blood tests in order to prepare you for the operation in the best possible way. The laboratory will then determine how well your blood clots in order to assess the risk of bleeding.

What do I have to consider before the surgical removal of the white stones?


 

You shouldn't eat or drink anything six hours before the operation


 

Avoid nicotine before the procedure


 

Stop taking blood-thinning medication in a timely manner



 
Before the operation, you should not have eaten or drunk anything for at least six hours. You should also stop smoking the night before. If you have to take blood-thinning medication, you should inform your doctor beforehand, as you will have to stop taking them five to seven days before the operation.

How is the operation of the tonsil stones?

Doctors essentially differentiate between two surgical methods, whereby both methods are basically simple and associated with little pain:

Extracapsular tonsil removal or tonsillectomy: Both tonsils are completely removed. Under general anesthesia, the surgeon presses the tongue down with a self-holding metal spatula, thus keeping the mouth open. With a sharp instrument, he first cuts into the anterior floor of the palate and then peels the tonsils out of the capsule with special instruments such as scissors or loops.

Intracapsular tonsil removal or tonsillotomy: This method is also called intracapsular tonsillectomy or RF tonsillotomy in medicine. The surgeon only partially removes the tonsils using a radio frequency device or laser. The number of furrows in the almond tissue is reduced, which means that fewer deposits can form. This surgical form of therapy can therefore only be carried out with uninflamed or slightly inflamed tonsils, as the remaining tissue could otherwise become inflamed again. The procedure can also be offered on an outpatient basis.

What is the prognosis for tonsil stones?

As a rule, tonsil stones are not even noticed by those affected and only discovered by chance. The main complaints are larger stones. However, these can usually be easily removed using non-surgical procedures. Unfortunately, almond stones are created over and over again. Usually the tonsil stones form again after days to weeks.
 
There is no drug therapy for tonsil stones. Antibiotics also have no effect on tonsil stones. The only way to permanently remove them is to have the tonsils removed by surgery. However, doctors usually advise against surgical intervention, as this can have serious consequences for the immune system - after all, the tonsils are an important part of the immune system. How much this restriction affects the body depends from person to person and cannot be predicted .

Can I remove tonsil stones myself?

There are several methods you can use to remove tonsil stones yourself. If none of these methods work, you should consult an ENT doctor who uses special tools such as cuvettes or pipettes as well as cupping glasses for the removal.

Removal of tonsil stones with the tongue: If you have an articulated tongue, you can use this to remove the tonsil stones. To do this, you have to press your tongue against the tonsils and slowly push the deposits upwards. With this method, however, there is the risk that you will not remove the stones properly, but simply crush them.



Stretching the throat: Stretch your head back and open and close your mouth several times in a row to tense the muscles in the roof of your mouth. Movement of the palate muscles should make the tonsils easier to loosen.



Removal of tonsil stones with a toothbrush, a cotton swab or a spoon handle: There are tools that you can use to remove tonsil stones easily. However, you should make sure that the tool is not too pointed, otherwise you can easily injure yourself with it. To get the stones out, you press gently with the end of the handle against the underside of the almonds in the palate and gently massage the deposits upwards. The stones should loosen. This method takes some practice, as touching the throat often triggers a gag reflex. You can lift your head a little so that you can more easily reach the affected areas.



Gargle with mouthwash, chamomile or sage tea or salt water as well as strong coughing can get the tonsils out of the furrows.



Removal of tonsil stones using a pipette: Although this method is usually carried out by a doctor, you can also use it yourself at home. To do this, you need a commercially available curved pipette that you place on the almonds. Due to the resulting negative pressure, the tonsil stones are sucked out of the crypts.



What remedies for almond stones can I buy in the pharmacy?

In pharmacies or in stores you can buy a mostly three-part “tool set” for removing tonsils. This contains special instruments, such as loops or curettes, which can be used to remove tonsil stones.

What home remedies can you use to get rid of tonsil stones?

In addition to mechanical methods, there are a few home remedies you can use to get rid of tonsils:

Removal of tonsil stones with an oral irrigator: An oral irrigator usually cleans teeth and spaces between teeth. However, since it generates a targeted jet of water, the intensity and type of which you can set on most models, this tool can also be used to remove tonsil stones. You have to position the mouthpiece of the oral irrigator in front of the opening in the oral mucosa so that you can rinse the tonsil stones out of the indentations with the water jet. The application is painless, quite simple and also suitable for beginners.

Mouthwash: Rinsing your mouth with sage or chamomile-based home remedies can also help get rid of tonsil stones. Sage has an anti-inflammatory effect and also prevents bad breath. Chamomile calms the mind and also has anti-inflammatory effects.

What can you do against bad breath caused by almond stones?

There are many ways you can reduce bad breath. Above all, pay attention to thorough oral and dental hygiene. Use mouthwashes and a tongue scraper as this is where a lot of bacteria settle. Black tea and sage tea also help to get fresher breath. Lemon water also works well against bad breath, as it inhibits the growth of bacteria in the mouth and stimulates the flow of saliva. This rinses the odor-causing pathogens out of the mouth more quickly. Another method would be to chew herbs like dill, mint, chamomile, parsley, or fennel. These herbs are true breath fresheners because they contain chlorophyll and essential oils.
 
A real secret weapon against bad breath is baking soda. To do this, you should add half a teaspoon of baking powder to a glass of water and rinse your mouth with it once a day. This removes the deposits on the tongue and rebalances the pH in the mouth.

Can I prevent tonsil stones?

Very good oral hygiene is very important with tonsil stones. It is best to use an oral irrigator regularly or massage the almonds with a toothbrush. Daily brushing of teeth should be on the daily schedule anyway. It is best to use antibacterial mouthwash as well, clean your tongue with a tongue scraper and gargle with salt water. You should avoid alcohol and dairy products, as these lead to increased deposits in the crypts.

What does the removal of almond stones cost?

Depending on the method, the costs can vary. For example, you pay about 15 euros upwards for an almond stone removal set, for an oral irrigator you have to reckon with costs between 35 and 75 euros. You can get toothbrushes or cotton swabs for a few euros. A Röder suction glass costs around 20 euros.

 

Surgical tonsil removal costs around 2,000 to 2,500 euros in the hospital, although these costs are usually covered by health insurance companies.

Does the health insurance company take care of the removal of tonsil stones?

The costs for an operative partial / removal of the tonsils are covered by the health insurance companies. You have to pay for tools for alternative methods yourself.

 


About the author: Dr. Simone Hermanns

Female medical specialist for gynecology and obstetric


Dr. med. Simone Hermanns works as a specialist at the University Hospital Zurich and has been supporting MOOCI as a medical expert in the field of gynecology and obstetrics since February 2020.

For 7 years she has been working full of energy and zest for life as a doctor in various clinical departments in Germany and Switzerland. She discovered her love for medicine especially in the operational area, as the diversity of this area is always fascinating.