Vacation! As I watched my kids scamper across the beach today, I remembered a conversation I had with a family recently. “My kid sometimes coughs up sand,” the mom said to me. “Little hard specks sometimes come out of her mouth. ”
“Hmmm, bring me a speck of the ‘sand’ the next time he spits one out,” I said.
A few days later, rattling inside a small plastic container on my desk, I found a tawny-hued speck which resembled a chip of rock. The mom had kept her promise and now I was the owner of a tonsillolith. Pictured here next to a paperclip, this and other tonsilloliths are harmless hardened pieces of debris which lodge in crevices (crypts) of tonsils. No one is exactly sure why tonsilloliths form, but they do seem to run in families. A combination of the right type of saliva, food, and deep tonsillar crevices produce these white or tan specks which occasionally become the size of a small pebble. In fact, they are also known as tonsil stones. Most people consider tonsilloliths a nuisance, but sometimes they are associated with bad breath. Warm salt water gargles after meals (one teaspoon of salt per 8 ounces of warm water) is usually enough to dislodge the tonsilloliths and prevent new ones from sticking. People have been known to overcome gag reflexes and flick them out with their nails. Addressing any tonsillar irritation such as Strep throat infections (see our previous posts: part one and two) or post-nasal drip from allergies may also be helpful. For those having continual tonsillolith-induced bad breath, removal of the tonsils is the definitive answer.
Some people dream of getting away to Sannibel Island’s shell covered beaches, others to Bermuda’s wispy pink speckled beaches and still others to the jagged rock-strewn beaches of Maine. Do otolaryngologists (ENTs) dream of tonsillolith-covered shores?
Naline Lai, MD with Julie Kardos, MD
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