What Are Tonsil Stones?

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iStock

Sometimes, feeling like you have a lump in your throat has nothing to do with strong emotions. Sometimes, it’s just tonsil stones, those pebble-like white things that some people periodically find nestled inside their tonsils. Just what are these gross throat squatters?

The answer is both simple and complicated. Tonsil stones are normally white-ish yellow and can range in size from microscopic bits to chunks several centimeters in diameter. These tonsilloliths—the official medical term—are made of material that accumulates in the crevices of the tonsils.

You see, tonsils aren’t just smooth mounds of tissue. They have folds called tonsillar crypts that form pits in the tissue. The tonsils act as the body’s defender against any foreign substances that come in through your mouth, and tonsillar crypts increase the surface area of the tonsils to give them more of a chance to catch anything coming in that the body needs to mount an immune response to. A normal tonsil usually has dozens of crypts.

Just how tonsil stones are formed within those crypts is a little more complicated. Mental Floss spoke to three different otolaryngologists (ear, nose, and throat doctors) on the subject, and each of them provided slightly different answers.

A medical diagram of a tonsil
An Atlas of Human Anatomy for Physicians (1919), The Internet Archive // Public Domain

Like any tissue in your body, tonsils are constantly regenerating. Just like your skin peels, that dead tonsil tissue gets sloughed off. It normally ends up going down your throat, but it can also get trapped in these crypts. There, bacteria from your mouth can start to grow on it, turning that material into a semi-hard stone that Dr. Erich Voigt, the director of general otolaryngology at NYU Langone Health in New York City, likens to “a cheesy ball.” (Apologies if we’ve now ruined cheese for you.)

Tonsillar crypts are the perfect environment for bacteria, because they’re poorly oxygenated but rich in blood supply. “It becomes an opportune area for the bacteria to populate and adhere to each other, and they form what’s called a biofilm structure,” Dr. Yosef Krespi, an otolaryngologist who practices in the North Shore-LIJ Health System in New York, tells Mental Floss. A tonsil stone is just a lump of biofilm, he says. In a 2008 study, he and his colleagues examined tonsilloliths in the lab, finding that structurally, they look a lot like dental plaque, another biofilm in the mouth.

But Dr. Jay Shah, a pediatric otolaryngologist at Cleveland’s University Hospitals Rainbow Babies and Children’s Hospital, explains that the yellowish lump you remove from your throat isn't exclusively bacteria. When researchers have examined what tonsil stones are made of, he says, “there’s calcium, there’s sulfur—there’s a whole host of other elements within them,” he explains.

That's not to say the bacteria aren't involved. Scientists studying the microbial makeup of tonsil stones have found that the types of anaerobic bacteria commonly found around and inside tonsilloliths are associated with producing volatile sulfur compounds, which is why people with really bad cases of tonsil stones can suffer from bad breath.

While Voigt and Shah emphasized the tissue and keratin (proteins found in the lining of the mouth, as well as in hair and skin) from the tonsils that gets trapped in these crypts as the source of stones, other studies have noted that trapped food debris in the tonsillar crypts can cause tonsilloliths. One study even suggests they could be formed by trapped spit alone.

Often the tonsil stone that you see in your throat isn’t the whole thing, according to Krespi. You may only be seeing a portion that has broken off from the “mother” stone that’s still lodged down in a very deep tonsillar crypt, he says, meaning that you’ll continue to see stones. Voigt, however, says that while some patients do have recurring stones, for others, the problem is temporary and may go away after a few weeks or months.

Everyone has tonsillar crypts, dead skin cells, and bacteria in their mouth, but not everyone gets tonsil stones. “The biggest question is, why do some people get them and some don’t? We don’t know,” Shah says. Some people have bigger crypts than others in their tonsils, and, since it’s easier for stuff to accumulate in larger crypts, those people seem to be more likely to have a problem with tonsil stones. But large tonsil stones are very rare, and you’re much more likely to be dealing with a few harmless small tonsilloliths than a sizable stone. In general, tonsil stones are more common if you have a history of tonsillitis or just have large tonsils that have a lot of big nooks where bacteria can get trapped.

It’s hard to say just how common tonsil stones are. Some studies estimate their prevalence at around 8 percent of the population, while others suggest that they might affect as much as 25 percent of the population. Both of those might be low estimates. The researchers Mental Floss spoke to reported seeing them regularly in their practice, even in patients who weren’t aware that they had them.

The fact that there isn’t firm data on how many people deal with tonsil stones may reflect the fact that they don’t usually require seeing a doctor. As the authors of one large study on tonsil stones from a Japanese dental hospital noted in 2013, tonsilloliths are “relatively commonly encountered in daily clinical practice, but patients rarely have complaints related to them.”

A tonsillolith next to a ruler showing it to be slightly less than 1 centimeter wide
Tonsillolith, Wikimedia Commons // Public Domain

Because while it can be alarming (or, depending on your perspective, fascinating) to look into your throat and see white specks in the back of your mouth, tonsil stones are typically harmless. One ear, nose, and throat doctor likens them to acne of the tonsils. They’re a little gross, but for most people, tonsil stones don’t come with any major side effects.

In serious cases, big tonsil stones can cause trouble, leading to ear pain, difficulty swallowing, and other discomfort, but that’s fairly rare. Most people with tonsil stones manage to handle them without any medical intervention, removing them with a Q-Tip, a finger, or gargling with salt water. While a doctor has specialized tools that can be used to safely remove tonsilloliths, as long as you’re not poking something sharp into your tonsils or pushing them deeper into those crypts, you’re probably fine. If you’re prone to tonsil stones, Voigt suggests gargling with a 50/50 mixture of hydrogen peroxide and water to clean out your tonsillar crypts. You can also use a water pick for the same task.

The only way to totally get rid of tonsil stones permanently is to remove the tonsils entirely. But for most people, gargling or a periodic Q-tip session works fine–and makes for some pretty good video.

Have you got a Big Question you'd like us to answer? If so, let us know by emailing us at bigquestions@mentalfloss.com.

What's the Difference Between Memorial Day and Veterans Day?

iStock/flySnow
iStock/flySnow

It may not be easy for some people to admit, but certain national holidays often get a little muddled—namely, Memorial Day and Veterans Day. In fact, the U.S. Department of Veterans Affairs sees the confusion often enough that they spelled out the distinction on their website. The two days are held six months apart: Veterans Day is celebrated every November 11, and Memorial Day takes place on the last Monday of May as part of a three-day weekend with parades and plenty of retail sales promotions. You probably realize both are intended to acknowledge the contributions of those who have served in the United States military, but you may not recall the important distinction between the two. So what's the difference?

Veterans Day was originally known as Armistice Day. It was first observed on November 11, 1919, the one-year anniversary of the end of World War I. Congress passed a resolution making it an annual observance in 1926. It became a national holiday in 1938. In 1954, President Dwight D. Eisenhower changed the name from Armistice Day to Veterans Day to recognize veterans of the two world wars. The intention is to celebrate all military veterans, living or dead, who have served the country, with an emphasis on thanking those in our lives who have spent time in uniform.

We also celebrate military veterans on Memorial Day, but the mood is more somber. The occasion is reserved for those who died while serving their country. The day was first observed in the wake of the Civil War, where local communities organized tributes around the gravesites of fallen soldiers. The observation was originally called Decoration Day because the graves were adorned with flowers. It was held May 30 because that date wasn't the anniversary for any battle in particular and all soldiers could be honored. (The date was recognized by northern states, with southern states choosing different days.) After World War I, the day shifted from remembering the fallen in the Civil War to those who had perished in all of America's conflicts. It gradually became known as Memorial Day and was declared a federal holiday and moved to the last Monday in May to organize a three-day weekend beginning in 1971.

The easiest way to think of the two holidays is to consider Veterans Day a time to shake the hand of a veteran who stood up for our freedoms. Memorial Day is a time to remember and honor those who are no longer around to receive your gratitude personally.

Have you got a Big Question you'd like us to answer? If so, send it to bigquestions@mentalfloss.com.

What Is the Kitchen Like on the International Space Station?

iStock/Elen11
iStock/Elen11

Clayton C. Anderson:

The International Space Station (ISS) does not really have a "kitchen" as many of us here on Earth might relate to. But, there is an area called the "galley" which serves the purpose of allowing for food preparation and consumption. I believe the term "galley" comes from the military, and it was used specifically in the space shuttle program. I guess it carried over to the ISS.

The Russian segment had the ONLY galley when I flew in 2007. There was a table for three, and the galley consisted of a water system—allowing us to hydrate our food packages (as needed) with warm (tepid) or hot (extremely) water—and a food warmer. The food warmer designed by the Russians was strictly used for their cans of food (about the size of a can of cat food in America). The U.S. developed a second food warmer (shaped like a briefcase) that we could use to heat the more "flexibly packaged" foodstuffs (packets) sent from America.

Later in the ISS lifetime, a second galley area was provided in the U.S. segment. It is positioned in Node 1 (Unity) and a table is also available there for the astronauts' dining pleasures. Apparently, it was added because of the increasing crew size experienced these days (6), to have more options. During my brief visit to ISS in 2010 (12 days or so) as a Discovery crewmember, I found the mealtimes to be much more segregated than when I spent five months on board. The Russians ate in the Russian segment. The shuttle astronauts ate in the shuttle. The U.S. ISS astronauts ate in Node 1, but often at totally different times. While we did have a combined dinner in Node 1 during STS-131 (with the Expedition 23 crew), this is one of the perceived negatives of the "multiple-galley" scenario. My long duration stint on ISS was highlighted by the fact that Fyodor Yurchikhin, Oleg Kotov, and I had every single meal together. The fellowship we—or at least I—experienced during those meals is something I will never, ever forget. We laughed, we argued, we celebrated, we mourned …, all around our zero-gravity "dinner table." Awesome stuff!

This post originally appeared on Quora. Click here to view.

Clayton "Astro Clay" Anderson is an astronaut, motivational speaker, author, and STEAM education advocate.

His award-winning book The Ordinary Spaceman, Astronaut Edition Fisher Space Pen, and new children's books A is for Astronaut; Blasting Through the Alphabet and It's a Question of Space: An Ordinary Astronaut's Answers to Sometimes Extraordinary Questions are available at www.AstroClay.com. For speaking events www.AstronautClayAnderson.com. Follow @Astro_Clay #WeBelieveInAstronauts

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