Tonsil Stones

Tonsilloliths or tonsil stones are clusters of chalky matter that form in the crypts of the tonsils. They are white or cream in colour and can range in size from a pinhead to the size of a pea. Oftentimes, they have an unpleasant smell because of hydrogen sulphide and other substances contained within the debris.

Large tonsil stones often give the sensation of a foreign object lodged in the back of the mouth. As a result, patients become concerned that this represents acute or chronic infection. Although tonsil stones are associated with bad breath, they are usually not harmful.

Tonsil Stones Symptoms

Tonsillolith - before Tonsillectomy

Tonsilloliths occur more frequently in adults than in children. Symptoms range from occasional bad breath, the need to cough, or a foul or metallic taste in the mouth. Usually, smaller tonsil stones do not cause any noticeable symptoms. In fact, some stones are only discovered incidentally on X-ray, or when patients notice them and believe they have an infection in the tonsils. On the other hand, larger tonsil stones can present with recurrent bad breath, sore throat, bad taste in the back of the throat, difficulty swallowing, and occasionally referred ear pain.


One method of treatment involves minimally invasive Laser Cryptolysis. However, the most definitive surgical option for tonsilloliths is Tonsillectomy. This is because it is permanently effective, but is usually only considered when less aggressive options fail.

After Tonsillectomy

Indications for tonsillectomy remain –

  • Five bouts of acute tonsillitis in a year
  • Three bouts of acute tonsillitis a year for three consecutive years
  • Failure of long course low dose antibiotics
  • Upper airway obstruction/sleep apnoea
  • Complications of tonsillitis

If you or a loved one is having regular tonsillar infections, or believe enlarged tonsils may be the cause of obstructive sleep apnoea, contact us for an appointment on (02) 9387 7360.