Tonsil Stones
Tonsil stones or "tonsilloliths" are among the unknown causes of bad breath. There are slit-shaped cavities called crypt inside the tonsils. Dead cell debris and food debris can accumulate in these cavities over time, and in this case, white, smelly tonsil stones appear on the tonsils.
There are cavities called crypta in our tonsils. Over time, food residues, dead cells of the tonsils, cell debris may accumulate in these spaces and stone-like formations may occur. Since these formations called tonsil stones (magma, tonsil stones, tonsilloliths, tonsilloliths) remain in a hot, humid and stuffy space, they provide an environment for the growth of many different bacteria over time and may cause bad odor in the mouth.
The biggest problem in patients with tonsil stones is usually bad breath. In patients with very large stones, they can be mistaken for a tumor and cause pain when swallowing or pain that hits the ear.
Tonsil stones ultimately occur in people with mechanically recessed and hollow tonsil surfaces. In patients with tonsils in this way, dietary changes or medical treatment are not sufficient to prevent or treat stone formation. According to several publications, feeding with watery food or gargling with mineral water, warm salt and carbonated water can reduce stone formation (1 teaspoon of salt and half a teaspoon of baking soda can be mixed in 1 glass of warm water and then gargle can be made with natural mineral waters. gargle can be done).
In the surgical treatment of tonsil stones, the flattening of the surface of the tonsil crypts with laser (the process of making deep and cake pits less deep and wide-mouthed) is called "laser cryptolysis". In this process, tonsils are not removed, only the surfaces of the tonsils are tried to be made smooth. The process has three drawbacks:
- The cost of the laser makes the operation fee more expensive than the entire tonsil removal procedure
- The effect of this procedure is not as effective as removing the whole tonsil.
- Laser-induced mucosal damage may be more than thermal welding tonsillectomy, and the patient may be hurt after the procedure.
The advantages of laser cryptolysis over tonsil surgeries are:
- Not changing the anatomy
- Practical use of the laser, reducing the depth of the hollow areas in the areas where the stones are mostly formed with a short-term application without blood.
I usually perform tonsil surgery with Thermal Welding Method, which is said to be a bloodless, knifeless and painless method for my patients who come with tonsil stones and have large tonsils.
Tonsil Stone Symptoms
Symptoms of tonsil stones can be listed as follows:
- Tonsil stones usually do not cause symptoms other than bad breath.
- Rarely, it may cause pain when swallowing
- When they grow too large, they can be mistaken for tonsil abscess or tonsil tumors
(Source:
Giant tonsillolith: report of a case)
Different Features of Tonsil Stone From Tonsillitis
In tonsillitis, there are symptoms such as pain, fever, weakness which are signs of inflammation. Especially when there are more than one tonsillitis, it can be confused with cryptic tonsillitis, which is a severe form of tonsillitis, by patients. Sometimes, tonsillitis can be seen in the form of "cryptic tonsillitis" with whites on the tonsils or "membranous tonsillitis" with white membranes. Cryptic tonsillitis is perhaps the most severe form of tonsillitis with symptoms between tonsillitis and tonsillitis abscess. In cryptic tonsillitis, inflammation residues cover the tonsil surface and the tonsil tissue is redder than normal. As seen in the photo above, the tonsil tissue is covered with infected, red and white inflammatory tissue.
Symptoms of tonsillitis can be briefly summarized as follows:
- Sore throat and increase when swallowing, increasing in severity
- There are symptoms associated with infection such as general body malaise, weakness, muscle aches, fever.
- Tonsil tissue is generally redder. No redness in tonsil stones or tonsils
While tonsil stones sometimes cause no complaints in patients, some tonsil stones may
cause the following complaints;
- Foreign object sensation
- Metallic taste
- Coughing attacks
- Choking sensation
- Bad breath
- Throat ache
- Bad taste in the back of the throat
- Difficulty swallowing
- Reflected pain in the ear
In the treatment of tonsillitis, it is also necessary to take aqueous food orally, to extend the resting period, to use antiseptic painkillers, antiseptic sprays or mouthwashes, and to use antibiotics if the fever continues for more than 2 days above 38 degrees.
When there are more than one tonsil stones, it can be compared to tonsillitis in appearance, however, the tonsil tissue other than the tonsil stone is generally pink in color.
In the photo above, while there is tonsil stone view in the lower part of the right tonsil; It is seen that membranes due to new tonsillitis have started to form in the left tonsil and upper parts of the right tonsil.
What is the Structure of Tonsil Stones?
Tonsil stones are generally composed of calcium salts; However, it has been shown that magnesium salts can also be found in tonsil stones. Dead cell residues, mucus, debris due to bacterial infection, food residues accumulate over time, this formation hardens and calcifies over time and tonsil stones appear.
Causes of Tonsil Stones?
It is argued that tonsil stones can occur especially in people with recurrent tonsillitis and with excessive indentations on the surface of the tonsils. However, it has been reported that tonsil stones may be seen more frequently in people with postnasal drip (Source:
Tonsil Stones (Tonsilloliths))
Tonsil stones do not cause symptoms of tonsillitis such as fever, malaise, body malaise and muscle joint pain. Sometimes it can be found with tonsillitis, and in this case, these symptoms may accompany bad breath in the patient.
How is Tonsil Stone Diagnosed?
Diagnosis is usually made during the examination. Imaging methods can detect a radiopaque mass, which can interfere with foreign bodies, teeth or calcified blood vessels. Eagle (eagle) syndrome, acute and chronic tonsillitis, tonsil hypertrophy, peritonsillar abscess, foreign bodies, ectopic bone or cartilage, lymph nodes, granulomatous lesions or calcification should be considered in the differential diagnosis.
How to Treat Tonsil Stones?
In people with tonsil stones, if there are no symptoms related to tonsil stones, treatment is not necessary. There are sources that offer many different suggestions such as mouthwash with warm salt water, drinking carbonated beverages in the mouth, and using electric net washing systems (Source:
Tonsillolith).
Usually, tonsil stones do not require treatment. Some people can remove tonsil stones by using tongue tips. Irrigators connected directly to the sink faucet are suitable for tonsil stone removal and daily washing of the tonsils. In a simpler way, mouthwash with warm and salt water helps alleviate the discomfort of the tonsil infection accompanied by tonsil stones. The mouthwash applied every morning also keeps the tonsils clean.
The treatment options made by many ENT specialists in current resources for tonsil stones can be summarized as follows:
Curettage
Curettage may be required to remove larger tonsil stones, but washing is also required afterwards in order to effectively clean small parts. Even larger lesions require local anesthesia and removal, but all these treatments cannot completely cure the bad breath caused by this condition. The tonsil stone can be curetted from the hollow area on the surface of the tonsil in which it sits.
Laser therapy
Another option is to reduce the tonsil surface area with a laser. Carbon dioxide laser specifically vaporizes and smoothes the surface of the tonsils. In this method, which can also be performed under local anesthesia, the sharp edges of the crypt pit are melted and flattened (this process is called "laser resurfacing" or "cryptolysis"), especially using a carbon dioxide laser. In this way, the accumulation of epital debris, mucus, food residues and bacterial infection products on the surface of the tonsils is prevented.
Surgical
If there is bad smelling breath accompanying persistent tonsil stones, tonsillectomy (removal of tonsils) can be applied.
Tonsillectomy can be performed in people who cannot be successful with other treatment methods and who constantly develop irritating tonsil stones. Tonsillectomy surgery is the definitive treatment method for tonsil stones.
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| In the photo above, the tonsil stones on the removed tonsil surface of the patient, who had tonsil stones and had a bloodless tonsil surgery by thermal welding method, are seen. |
Do Not Consider "Tonsil Stone Removal" as a Guaranteed Halitosis Treatment Method!
The effectiveness of this procedure can vary depending on factors such as the severity of the tonsil stones, the individual's overall health, and whether there are underlying conditions contributing to the formation of tonsil stones. In patients whose tonsils have rough surfaces and deep pits, simply removing tonsil stones cannot provide long-term relief.
For some people, tonsil stone curettage provides relief from symptoms such as bad breath, sore throat, or difficulty swallowing associated with tonsil stones. However, it's important to note that tonsil stones may recur even after removal, especially if the underlying cause is not addressed.
In cases where tonsil stones become a chronic issue or significantly impact quality of life, a healthcare provider may recommend more aggressive treatments, such as tonsillectomy (surgical removal of the tonsils). This procedure is generally considered effective at preventing recurrent tonsil stones but involves a longer recovery period and potential risks associated with surgery.
Ultimately, the decision to pursue tonsil stone curettage or other treatments should be made in consultation with a healthcare professional who can assess the individual's specific situation and recommend the most appropriate course of action.
Does anyone have tonsil stones?
Tonsil stones are more common in patients with deep pits (crypts) on their tonsils, and sometimes stones can be found in the tonsil tissue without the appearance of stones on the outer surface of the tonsils.
Will tonsil stones fall off on their own?
As the tonsil stones grow, they can fall off spontaneously; It can also fall as a result of coughing or being hit by a food. Do not use the products that are sold as "tonsil stone removal device" or "tonsil stone removal set" on the internet without consulting your doctor.
Tonsil stone drop
Unfortunately, sometimes patients with bad breath (halitosis), which is one of the situations where medicine is inadequate, can apply to ENT specialists considering that cleaning the stones on the tonsil surfaces is a permanent and correct method for bad breath.
Tonsil stone removal is only the process of removing the tonsil stones, usually partially, and there is a risk of bleeding in the tonsils in the neck or aspiration of the stone into the lower respiratory tract. In patients with tonsil stones, the process of smoothing the tonsil surfaces with different devices such as laser or coblators or partial tonsillectomy (partial tonsillectomy) can also be performed. Unfortunately, these transactions usually provide temporary or partial benefits. The most effective operation in patients with tonsil stones is the complete removal of the tonsils. Partial tonsil surgeries can be performed on patients with tonsil stones "Thermal Welding Method", which is a bloodless and knifeless surgery method.
Bad breath causes are usually very basic and not easily understood. For example, bad breath may occur due to many reasons such as reflux, gum disease, chronic sinusitis, chronic pharyngitis. Sometimes one or more of these reasons can be found together.
Just because it is bad breath, I recommend that you do research on tonsil stones and its treatment without the thought of "I will go clean my tonsil stone and get rid of bad breath as guaranteed ..." without causing your disappointment.
Sometimes what I read on the internet can surprise people, for example, a video titled "Those With Severe Halitosis Should Do It Tonsil Removal" and in its explanation it says "Those with bad breath can get rid of bad breath by doing tonsil cleaning procedure" (To watch tonsil stone surgery, many You can access the video).
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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