When food particles, mucus, bacteria, or other debris become lodged in the folds of the tonsils, over time, it hardens, creating tonsil stones. Tonsil stones often lead to other issues, including bad breath, tonsillitis, infection, and abscesses. A tonsillectomy can treat the issue, but doctors don’t typically recommend surgery for tonsil stones alone.
If you get tonsil stones after a tonsillectomy, there may have been tissue left behind. Alternatively, you may be suffering from salivary stones. It’s rare to find a recurrence of tonsil stones post-tonsillectomy. A tonsillectomy is usually effective at permanently eliminating the stones, but they can develop in other areas of the throat.
Tonsil stones post-tonsillectomy may be due to several causes—and it may not even be tonsil stones at all. Read on to learn more about tonsil stones after a tonsillectomy.
Symptoms of Tonsil Stones
Tonsil stones typically present with many symptoms. Smaller tonsilloliths may not have any symptoms at all. Some signs of tonsil stones include:
- Halitosis (bad breath)
- Globus pharyngis (the sensation of something in the throat)
- Sore throat that doesn’t improve
- Foul-smelling “stones” in the mouth
- Yellow spots in the back of the throat
Tonsil Stones vs Conditions With Similar Symptoms
If you continue to experience the above symptoms post-tonsillectomy, it could mean that you’re experiencing symptoms of something other than tonsil stones. After removal, the tonsils have only a two percent chance of regrowth if the surgeon leaves behind tonsillar tissue.
Because of the low rate of tonsil regrowth, it’s more likely that the symptoms are related to a different issue altogether.
Other causes of the symptoms mentioned above, aside from tonsil stones, include:
- Tooth decay, infection, or poor oral hygiene – Cavities, abscesses, oral infections, or improper oral hygiene may lead to halitosis.
- Acid reflux or throat infections – Reflux or throat infections, such as streptococcal pharyngitis (strep throat), often cause a sensation of having something stuck in the throat.
- Streptococcal pharyngitis or another virus – A sore throat that doesn’t improve may result from strep throat or another virus, such as infectious mononucleosis. Strep throat can also leave pale-colored streaks or spots on the back of the throat.
- Salivary stones – Finding “stones” in the mouth may be salivary stones, calcium deposits that occur inside the salivary ducts.
- Post-nasal drip (PND) – In some cases, PND causes excess mucus buildup that gets caught in the throat. These firm, yellow lumps are often dislodged during coughing and may be mistaken for tonsil stones.
A thorough exam by a doctor is the best way to determine whether you’re dealing with tonsil stones or something else.
Causes of Tonsil Stones
The tonsils contain small pockets or wrinkles, called tonsillar crypts. Each tonsil has several crypts, usually from 10 to 20, although some tonsils may have more than others. In that case, doctors refer to them as “cryptic tonsils.”
Cryptic tonsils are more susceptible to tonsil stones (tonsilloliths) simply because there are more wrinkles, folds, or pockets that allow debris to become lodged. They are like catcher’s mitts for stones.
Because tonsillar crypts have low levels of oxygen, it’s a prime location for anaerobes to grow.
Anaerobic organisms don’t need oxygen to survive. In fact, they thrive and grow in an environment that lacks it. This bacterial growth accumulates within the tonsillar crypts and can lead to an infection that results in caseation.
Caseous means “cheese-like” and refers to the soft, dry, crumbly lumps that form. Over time, these crumbly lumps calcify and form tonsil stones.
Doctors don’t typically recommend removing the tonsils for tonsil stones unless a patient is experiencing severe, recurring cases. Removing the tonsils is usually effective at permanently getting rid of tonsil stones.
Removing the tonsils is typically a permanent solution to tonsil stones, but that doesn’t mean your bad breath problems are solved. The most common removal methods include carefully cutting the tonsils out with a scalpel, using ultrasonic vibration, or cauterizing with heat.
The surgical method most often used by surgeons for tonsil removal is an “extracapsular tonsillectomy.” During an extracapsular tonsillectomy, surgeons completely remove the tonsils down to the muscle, leaving no tissue behind.
A less commonly used surgical method is the “intracapsular tonsillectomy.” This method involves removing most of the tonsillar tissue but leaving behind the tonsillar capsule. Surgeons use this method to reduce pain associated with healing and decrease the risk of bleeding.
Unfortunately, leaving tonsillar tissue behind slightly increases the risk for tonsil regrowth and the need for a second surgery.
No matter which surgical procedure a surgeon uses, a tonsillectomy doesn’t typically take longer than thirty minutes. Recovery time varies but is usually ten to fourteen days that are very painful.
A study conducted by the JAMA Otolaryngology concluded that adult tonsillectomy is a safe surgical procedure with a low mortality and morbidity rate. However, if you’re only wanting to deal with tonsil stones then it may be better undergo Cryptolysis of the tonsils.
Can Tonsils Grow Back?
Sometimes tonsils grow back after partial tonsillectomies, but regrowth is nearly impossible following a successful extracapsular tonsillectomy. It’s more common in patients who have had their tonsils removed before the age of eight.
The reason for regrowth in adolescent patients is that there’s lymphoid tissue left behind that allows the tonsils to grow back. It’s unlikely, however, for the tonsillar tissue to grow back to its original size.
Intracapsular tonsillectomies leave tissue behind. Sometimes, the small amount of tonsillar tissue is enough for tonsil stones to regrow.
Tonsil Stones Post-Tonsillectomy
The removal of the tonsils completely eliminates tonsillar crypts, which means there’s no longer a space for food, debris, mucus, and bacteria to settle. Therefore, it would seem impossible to continue suffering from tonsil stones post-tonsillectomy.
With that said, if tonsils grow back or tonsillar tissue remains, tonsil stones may recur.
A second tonsillectomy isn’t typically recommended for tonsil regrowth, except in cases of malignancy (tonsil cancer), sleep apnea, frequent infections, or breathing or swallowing difficulties.
Doctors may prescribe steroids to reduce inflammation.
Patients who experience tonsil regrowth or tonsil stone symptoms post-tonsillectomy should reach out to their doctor or tonsillectomy surgeon. A small part of the tonsils may be left behind, especially if the surgeon noticed heavy bleeding during surgery.
Lingual Tonsil Stones
Most of us think of the palatine tonsils when we think of our tonsillar system. However, there are also lingual tonsils. Lingual tonsils are located at the very back of the tongue, as it extends into the pharynx. Stones in this area are possible, so even if you’ve had your palatine tonsils removed, they may still appear in this area.
Tonsil stones in the lingual tonsils can cause:
- Sore throat
- Difficulty swallowing
- Expulsion of tiny stone-like masses
Other Conditions Similar to Tonsil Stones
As mentioned earlier in this post, sometimes other conditions have similar symptoms to tonsil stones. Salivary stones and adenoid stones may mimic tonsil stones, and even smell just as bad. Adenoid stones, however, are extremely rare.
The human body has three major salivary glands (parotid, sublingual, and submandibular) and hundreds of additional salivary glands located in the inner cheeks, lips, and throughout the mouth and throat.
If these salivary ducts become blocked with debris, food, or bacteria, it can lead to the formation of salivary stones.
A blocked salivary gland near the throat may feel similar to tonsil stones. If a stone dislodges, it may look, feel, and smell similar to a tonsil stone.
The adenoids, like the tonsils, are part of the body’s lymphatic system. They help young children stay healthy by preventing harmful bacteria and viruses from entering the body.
When a surgeon performs a tonsillectomy, they often perform an adenoidectomy at the same time. Sometimes, however, surgeons may leave adenoids intact since they typically shrink when a person reaches their teenage years.
While rare, there have been cases where stones are found in adenoids, usually in children.
If a child has undergone a tonsillectomy (but not an adenoidectomy) and continues to experience symptoms similar to those of tonsil stones, it could be that they’re experiencing adenoid stones.
However, adenoliths are very rare, so other conditions should be ruled out first.
Tonsillectomies are highly successful surgeries with only a two percent tonsil regrowth rate when tissue is left behind.
With that said, it isn’t impossible to experience a recurrence in tonsilloliths post-surgery. Any leftover tissue provides a place for debris, bacteria, and food to settle and calcify, leading to additional tonsil stones.
Anyone experiencing tonsil stone symptoms post-tonsillectomy should reach out to their healthcare provider and get a complete examination.
For more information on how to deal with these stinky invaders, check out the rest of my blog for tips, tools, and even diet tips.