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Tonsil Stones

by , last modified on 4/13/21.


What are tonsils stones? In a nutshell, they are small, foul-smelling pebbles that are produced and eventually pop out of the tonsils. They taste bad and smell even worse. Consider them kind of like acne of the tonsils. They occur at any age and can spontaneously come and go. (Read Washington Post article on this.)

Tonsil stones also known as tonsilloliths are NOT food that has gotten caught during chewing or swallowing.

Treatment can be divided into non-surgical or surgical management.


Conservative treatment includes gargling, water pick rinses, and even manual expression to pop them out (typically with blunt end of toothbrush or a finger).

Gargling works to some degree, but not very well as cleaning occurs only at the surface of the tonsils and not into the holes and caverns where the stones are produced. It may help with bad breath, but it is very transient given the superficial manner gargling cleans the tonsils.

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Better than gargling is the use of water picks. Mainly used for dental cleaning, it can be repurposed to clean the holes from which tonsil stones are produced. Using a jet of water, the holes can be cleaned much more aggressively and deeply leading to better control of tonsil stones. Unfortunately, if the holes are small, even water picks have a hard time cleaning thoroughly the hole's inside to prevent stone formation.

That's where manual expression is required. There are two ways of popping the stones out of the tonsil holes once they have formed. The first is by blunt pressure whether with a finger, back end of a toothbrush, or q-tip. It is STRONGLY advised NOT to use a sharp instrument to try and dig the tonsil stones out. Sharp instruments (like a toothpick) work poorly and traumatizes the tonsil itself which can trigger an infection.

The second method is by using a ring curette much akin to acne whitehead poppers. Similar to such facial pimple poppers, a ring curette can be firmly pressed over the tonsil stone causing them to pop out. There aren't any tonsil stone poppers specifically on the market, but medical grade earwax ring curettes work perfectly as a tonsil stone popper. However, make sure the curette is made of metal and the ring is large enough to accomodate the typical size of your tonsil stones otherwise it will not work. The ring itself can be angled into different positions to ensure it is flush against the surface of the tonsil.

curettecurette zoomed in

Such ring currettes can be purchased from a durable medical equipment store. Jedmed has a decent selection here.

Surgical Management

Then there is surgery...

First of all... NO... we do not offer laser cryptolysis. However, we do offer what we feel is a better alternative which is coblation cryptolysis. This innovative procedure developed by Dr. Chang is performed awake and using only local anesthesia (in most patients) in order to try and cure patients of tonsil stones. Rather than using laser, we use a technology called coblation (watch movie; requires Quicktime) that in effect does the same thing, but in a much safer way for the patient. Although there is no guarantee that this method will cure folks of tonsil stones (no more or less than laser cryptolysis), it is a less painful alternative method to consider and try before tonsillectomy which is the only known near 100% cure for tonsil stones (ie, as long as tonsils exist, there's always the potential for tonsil stones).

For more information on surgical management of tonsil stones, click here.

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