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Tonsil Stones - Dealing with Tonsilliths

Unlike generations past when troublesome tonsils were removed at the discretion of a doctor, nowadays we tend to keep our tonsils for life. Tonsils are good and serve many important immunological functions by protecting us from certain diseases. There is really no reason to take ‘em out, unless they become seriously problematic.

Tonsils can become so large that they look like bookends when you peer into the throat. If they are so large as to cause difficulty with eating, swallowing, or breathing, they may need to live elsewhere – in a jar. Tonsils that collect strep several times a year, or worse, constantly harbor strep (strep carriers) may need to come out. Tonsils that become so infected that they form abscesses (peritonsillar abscess) usually need to be surgically removed.

Tonsils that become temporarily enlarged due to viral infections, mononucleosis (mono), or random bouts of strep are quite treatable without surgery. Viral infections and mononucleosis will self-resolve in time with a little gargling and chicken soup. Laboratory diagnosed strep tonsillitis responds well to a short course of antibiotics; usually plain ‘ol, cheap penicillin or erythromycin. Believe it or not, antibiotics are not used primarily to treat the tonsillitis, but to used to prevent possible strep complications (albeit, rare) of rheumatic fever, or heart/kidney involvement.

I constantly get miffed when people with enlarged tonsils, tonsils with “white stuff” on them, or sore throats are simply treated with antibiotics without a confirming lab test. Since most cases of tonsillitis and sore throats are viruses, it does not make sense to throw antibiotics at them. Antibiotics have absolutely NO EFFECT on viruses. When medical providers pronounce “Strep” based solely on a brief visual examination, they are wrong up to 50% of the time. They might as well flip a coin.

When people only look at their own throats, or the throats of their children, when they have a sore throat, you may no what this area normally looks like. Kids can have very big (normal) tonsils, and tonsils may have that ominous “white stuff” when there is nothing really wrong. While it is possible to get white material on the tonsils when there is an infection (called exudate), it is not necessarily a sign of strep, or an indication that you need antibiotics.

Some tonsils normally have holes, or crypts on the surface. Over time, these crypts can collect an impressive amount of food particles and other debris. This debris will decompose and rot due to the moist, warm environment of the throat. It can also calcify; becoming as hard as a stone. These tonsillar stones are called “tonsilliths”. Tonsilliths run in families; yet another thing we can blame on our parents. From time to time, the tonsilliths will dislodge, releasing the trapped, decomposed material underneath; resulting in a disgusting taste and smell. As nasty as these things are, this is not considered an infection.

There is very little that can be done medically to deal with tonsilliths. Once you overcome your own gag reflex, you can reach back and flick ‘em out of your tonsils when you see them; or you can use a moistened Q-tip to dislodge them (one of the few approved uses of these cotton-tipped applicators). If you get into a habit of gargling with warm water (or weak salt water) after every meal, you can effectively prevent most of the accumulation of food debris.

The only definitive cure for recurrent tonsilliths would be the surgical removal of your cryptic tonsils. Since money-pinching insurance companies rarely approve surgery for this reason alone, you will need your ENT to be a strong advocate, or you can pay out of pocket to have your tonsils removed (not cheap!). Since they may be genetically-linked, maybe you can convince your parents to chip in (not likely).

Like ugly toes, premature baldness, big noses, weird belly-buttons, tonsilliths are just one of life’s misfortunes.

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