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 Stuffing and Dressing?

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iStock

For carbohydrate lovers, nothing completes a Thanksgiving meal quite like stuffing—shovelfuls of bread, celery, mushrooms, and other ingredients that complement all of that turkey protein.

Some people don’t say stuffing, though. They say dressing. In these calamitous times, knowing how to properly refer to the giant glob of insulin-spiking bread seems necessary. So what's the difference?

Let’s dismiss one theory off the bat: Dressing and stuffing do not correlate with how the side dish is prepared. A turkey can be stuffed with dressing, and stuffing can be served in a casserole dish. Whether it’s ever seen the inside of a bird is irrelevant, and anyone who tells you otherwise is wrong and should be met with suspicion, if not outright derision.

The terms are actually separated due to regional dialects. Dressing seems to be the favored descriptor for southern states like Mississippi, Tennessee, South Carolina, and Georgia, while stuffing is preferred by Maine, New York, and other northern areas. (Some parts of Pennsylvania call it filling, which is a bit too on the nose, but to each their own.)

If stuffing stemmed from the common practice of filling a turkey with carbs, why the division? According to HuffPost, it may have been because Southerners considered the word stuffing impolite, and therefore never embraced it.

While you should experience no material difference in asking for stuffing or dressing, when visiting relatives it might be helpful to keep to their regionally-preferred word to avoid confusion. Enjoy stuffing yourselves.

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

Why Do Tires Have to Be Filled With Air?

BookyBuggy/iStock via Getty Images
BookyBuggy/iStock via Getty Images

Paul Misencik:

This is an issue that has perplexed me for most of my life, because pneumatic tires filled with air seem like the last anachronistic, 19th-century component of a modern automobile, and an idea which should have disappeared many decades ago. In an era where even the internal combustion engine itself is giving way to electric motors, and where a new economy hatchback has exponentially more computing power than the Space Shuttle, pneumatic tires don’t seem to make sense any longer.

(And before I get flamed, I know modern tires are vastly more advanced and reliable and capable than their 1930s counterparts. Blowouts, which were a common occurrence when I was a kid, are pretty much unheard of today. Modern tires are great, but they are still vulnerable and maintenance-intensive in a way that doesn’t make any sense to me.)

Companies have experimented with non-pneumatic passenger vehicle tires in the modern age—one of the primary drivers was Michelin. But the tires weren’t filled with solid rubber. In fact, they didn’t even have sidewalls. They were open on the sides, and they had a support lattice of structural polyester ribs, with a ton of air space between the contact patch and the (now deformable) wheel.

One of the big problems with switching from pneumatic tires to non-pneumatic tires is the fact that the current air-filled tire is an important component of the suspension of a vehicle. The flex in the sidewall is a critical part of the compliance of the suspension and substantially affects a vehicle's ride and handling. (Which is why race car drivers sweat tire pressures at each corner of the vehicle so much, as even a small change in tire pressure can have a big effect on the handling and grip of a vehicle.)

If a company like Michelin wants to make a non-pneumatic tire, they'll improve their chances of finding success with it if the new design mimics the compliance and flex characteristics of the outgoing, air-filled models as closely as possible. That way, Michelin would be able to sell the new, non-pneumatic design as a retrofit to older vehicles whose suspensions were originally designed with pneumatic tires in mind. And that is hugely important because if they can’t, it becomes much more difficult to convince manufacturers to change over to the new design—particularly after the mild debacle of Michelin’s failed “TRX” metric tire idea of the 1980s, which required the use of a special wheel and which, despite being by most accounts a superior design in almost every way, never really took off. (Owners of 1980s Ferrari 512 Berlinetta Boxers and some Saab 900 turbos will know what I’m talking about here.)

Non-pneumatic Michelin tires are also rather weird looking, and it’s not clear which manufacturers, if any, would take the risk of being the first to offer them on a new car.

So that is the real issue: Any non-pneumatic tire design must be not only clearly superior to the pneumatic designs of the past, but it must be functionally identical to the outgoing models they would replace, and they must be visually acceptable to consumers.

I hope it happens, though. I hope someone cracks the nut. Pneumatic tires are a 19th-century application still being used on 21st-century vehicles, and at some point that needs to change.

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

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