Tonsil Stones Aren’t Just Food Stuck in Your Throat
If you’ve ever coughed up a foul-smelling white chunk from the back of your throat, you’ve likely encountered a tonsil stone, also known as a tonsillolith. While many people assume these are just bits of food that got trapped, the truth is far more complex and fascinating.
Tonsil stones are actually living biofilms, not just inert debris. That means they are made up of bacteria, food particles, sloughed-off cells, and mucus that have organized themselves into a protected community. Over time, this biofilm becomes calcified and emits a strong sulfuric odor (think: rotten eggs), which is why one of the most common symptoms of tonsil stones is chronic bad breath, or halitosis. These odors are largely due to volatile sulfur compounds (VSCs) released by anaerobic bacteria-the same “bacteria farts” responsible for morning breath.
But why do some people get them more than others? While the crypts (natural crevices) in the tonsils can certainly act as a trap, there are several modifiable risk factors that integrative care can help address:
🦠 Oral microbiome imbalance: An overgrowth of sulfur-producing bacteria and lack of microbial diversity can contribute to biofilm formation.
🍬 High sugar intake: Sugar feeds oral bacteria and contributes to an acidic environment, promoting the buildup of stones.
👄 Mouth breathing: Whether from chronic nasal obstruction or habit, mouth breathing dries out the oral cavity, disrupting saliva’s natural cleansing action.
🚬 Smoking: Tobacco smoke directly alters oral pH, damages mucosal tissue, and promotes bacterial overgrowth.
Prevention Strategies:
An integrative approach to preventing tonsil stones begins with daily consistency, not expensive gadgets or silver bullet cures:
Oral Hygiene: Brush and floss twice daily. Don’t forget the tongue-use a tongue scraper to remove bacteria-laden coating.
Gentle Gargling: Skip alcohol-based mouthwashes that disrupt the microbiome. Try warm salt water or a pH-neutral rinse to reduce debris.
Reduce Sugary Foods: Limiting refined sugar can decrease acidification and bacterial fuel.
Nasal Breathing: If you’re a mouth breather, talk to your ENT about evaluating for nasal obstruction or allergies. Restoring nasal airflow can dramatically reduce stone formation.
Quit Smoking: Your tonsils-and your lungs-will thank you.
There is no evidence that specific foods or food sensitivities can cause tonsil stones, just like there is no evidence to support probiotic administration for prevention.
But in the end…sometimes you are doing everything right and those pesky stones are still a problem! For those plagued by recurring or large stones, procedural options do exist. Intracapsular tonsillectomy and laser tonsil resurfacing (called cryptolysis) are less invasive than full tonsil removal (tonsillectomy) and may reduce stone formation however there are no long term studies and recurrence is still possible. Tonsillectomy completely eliminates tonsil stones however carries a risk of higher complications and longer recovery compared to the less invasive options.
Here are my thoughts:
1. If it’s your first time dealing with tonsil stones, learn how to safely extract them and see what happens with more time. I have many patients who get them in waves but often separated by years in between.
2. If you have been dealing with them on a regular basis-weekly for months or years, then after checking that you are up to date on the preventative measures above, start the discussion with an ENT about surigical options.
Remember, tonsil stones aren’t just something people post on TikTok—they’re a sign that something in your upper airway and oral environment needs attention.
References:
Stoodley P, Debeer D, Longwell M, Nistico L, Hall-Stoodley L, Wenig B, Krespi YP. Tonsillolith: not just a stone but a living biofilm. Otolaryngol Head Neck Surg. 2009 Sep;141(3):316-21. doi: 10.1016/j.otohns.2009.05.019. PMID: 19716006.
Wong Chung, J. E. R. E., van Geet, R., van Helmond, N., Kastoer, C., Böhringer, S., van den Hout, W. B., Verschuur, H. P., et al. (2022). Time to Functional Recovery After Laser Tonsillotomy Performed Under Local Anesthesia vs Conventional Tonsillectomy With General Anesthesia Among Adults: A Randomized Clinical Trial. JAMA network open, 5(2), e2148655–e2148655. United States: American Medical Association.
