What Are Tonsil Stones?

iStock
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.

Full vs. Queen Mattress: What's the Difference?

iStock.com/IPGGutenbergUKLtd
iStock.com/IPGGutenbergUKLtd

If you’re in the market for a new mattress this Presidents Day weekend (the holiday is traditionally a big one for mattress retailers), one of the first decisions you’ll need to make is regarding size. Most people know a king mattress offers the most real estate, but the difference between a full-sized mattress and a queen-sized one provokes more curiosity. Is it strictly a matter of width, or are depth and length factors? Is there a recommended amount of space for each slumbering occupant?

Fortunately, mattress manufacturers have made things easier by adhering to a common set of dimensions, which are sized as follows:

Crib: 27 inches wide by 52 inches long

Twin: 38 inches wide by 75 inches long

Full: 53 inches wide by 75 inches long

Queen: 60 inches wide by 80 inches long

King: 76 inches wide by 80 inches long

Depth can vary across styles. And while you can find some outliers—there’s a twin XL, which adds 5 inches to the length of a standard twin, or a California king, which subtracts 4 inches from the width and adds it to the length—the four adult sizes listed above are typically the most common, with the queen being the most popular. It's 7 inches wider than a full (sometimes called a “double”) mattress and 5 inches longer.

In the 1940s, consumers didn’t have as many options. Most people bought either a twin or full mattress. But in the 1950s, a post-war economy boost and a growing average height for Americans contributed to an increasing demand for larger bedding.

Still, outsized beds were a novelty and took some time to fully catch on. Today, bigger is usually better. If your bed is intended for a co-sleeping arrangement with a partner, chances are you’ll be looking at a queen. A full mattress leaves each occupant only 26.5 inches of width, which is actually slightly narrower than a crib mattress intended for babies and toddlers. A queen offers 30 inches, which is more generous but still well below the space provided by a person sleeping alone in a twin or full. For maximum couple comfort, you might want to consider a king, which is essentially like two twin beds being pushed together.

Your preference could be limited by the size of your bedroom—you might not be able to fit a nightstand on each side of a wider bed, for example—and whether you’ll have an issue getting a larger mattress up stairs and/or around tricky corners. Your purchase will also come down to a laundry list of options like material and firmness, but knowing which size you want helps narrow down your choices.

One lingering mystery remains: Why do we tend to shop for mattresses on Presidents Day weekend? One reason could be time. The three-day weekend is one of the first extended breaks since the December holidays, giving people an opportunity to trial different mattress types and deliberate with a partner. Shopping Saturday and Sunday allows people to sleep on it before making a decision.

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

Do Mission Control Personnel Go Through as Many Simulations as Astronauts?

David McNew, Getty Images
David McNew, Getty Images

Jared Olson:

Mission control personnel go through a lot more simulations than astronauts, as the flight controller needs to develop very specialized skills and knowledge. On the other hand, astronauts in general need to develop the appropriate depth of knowledge across many disciplines. So shorter classes targeted to their needs are used instead to make the best use of their limited time.

I was the robotics instructor for the EVA simulation (or sim) yesterday and the rig (the simulator system) was not behaving for me. Things were up and running quickly, but after I simulated the main robotics computer having a fatal software fault things went downhill. The team rebooted it to recover, as expected, but the rig did not cleanly handle the reboot.

Suddenly it would not accept any commands to the robot arm. The hand controllers were not communicating. And the astronauts' laptop would not connect.

Eventually, I ran out of troubleshooting options and had to tell my three robotics flight controllers in training that all this was unplanned and the sim was not going to go as expected for them. Other disciplines had "scripting priority," as there were controllers who were assigned to use this sim as an evaluation toward their certifications. I did not have the leverage to disrupt the sim by halting the rig to reset the robotics simulator.

Flight controllers go through so many sims partly because of days like this—where, for whatever reason, they don't get as much "content" as we'd like. I told my guys to greencard that the arm simulator was working as expected, which means that they had to pretend they were seeing all the telemetry indications that would normally happen for the arm supporting an EVA. Basically: Just follow along and pretend.

Each simulation is unique in terms of the coordination required with other disciplines, the malfunctions they get to work through, and the timing involved in planning. Throughout their training flow they need to display their ability to work through a broad enough variety of cases before we can call them "certified." How much they get out of each sim can be a roll of the dice.

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

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