I ran across this forum while researching tonsilloliths online.
From what I have found, tonsilloliths seem to be poorly understood and I have a hypothesis regarding them.
Let me state at the outset that I am a layman, and I AM NOT SEEKING MEDICAL ADVICE. Rather, I want to foster some discussion because I think tonsilloliths might be misunderstood and if my hypothesis about their formation is correct, it may help doctors treat them.
There have been a number of threads on this forum regarding the topic before and I encourage any readers of this thread to read them.
Unfortunately, the other threads seem to get shut down due to writers crossing the line regarding medical advice, so please try to avoid that on this thread.
Given that I am a layman, I plan to stay out of the discussion after starting this thread unless someone has something they want to ask me.
What interested me in the topic is that I have had tonsilloliths for some time. I've mentioned them to doctors when getting exams and no doctor has expressed any familiarity with their cause.
While I must apologize in advance for the length of this post, I think it might be helpful to present the reader with an account of my case prior to offering up my hypothesis.
The first time I noticed them was 19 years ago at the age of 25 when I hacked a couple up. I didn't know what they were and after puzzling over them for a while, I washed them down the sink and didn't think about them for about 10 years.
At about the age 35, I was driving to work and had been experiencing a localized irritation on the right side of my throat for a few days. I also had a stuffy right ear and my lymph nodes under my jaw on that side were swollen. The sun was low in the morning sky dead ahead and traffic was light, so I said, "Aaah," and tilted me head back and took a look at my throat in the rear view mirror. Back on the right side of my throat was a large white spot the size of a pencil eraser. It looked like the head to a giant zit and freaked me out.
When I got to work, I located an emergency flashlight and locked myself in the bathroom. After checking it out in the mirror for a bit, I did what I'm sure every doctor dreads their patients will do - I decided to experiment a bit rather than make an appointment with a doctor.
Since it sure looked like a big zit, I located a paperclip and unfolded it and figured that by sticking it into what I thought was a whitehead, I'd drain it. As I gently pushed the end of the bit of metal wire into it, I felt no sensation at all. When I removed the wire, a whitish/yellowish lump the size of a cooked pea came out, transfixed by the wire, and I found myself holding what looked like a miniature lollipop, a metal stick with a cream-colored lump at the end. The lump was cauliflower-like. When I squished the lump between my fingers, to see what, exactly, I was dealing with, I found it had a pastlike texture and smelled extremely foul.
I don't know if any of the readers have gone out camping for a few days without a toothbrush, but it smelled just like the plaque that I scraped off my teeth after such an experience.
After removing the tonsillolith, I could see that the part of the tonsil right around the hole where I'd removed the tonsillolith was very red and irritated. By the end of the day, the irritated feeling in that spot subsided a bit and the stuffiness in my ear lessened.
A day later, at home, I used a flashlight to check the spot out again in the mirror because it was irritated again and noticed another white spot on what I had by then learned was my right tonsil.
This time, I was a bit smarter. I unfolded another paperclip, leaving the smallest u-shaped section intact, and taped the straightened-out part to the end of a plastic pen. This way, I figured, I wouldn't poke myself and cause bleeding/infection if my aim was off.
I used some rubbing alcohol to sterilize the rounded end of the paperclip and used it to dislodge the tonsillolith. This one was bigger than the first, and had the same texture and smell.
Over the next few hours, several trips to the bathroom resulted in several more tonsilloliths, these much smaller. Gargling water would bring them to the point where I could remove them and sometimes gargling itself would remove them. They were also smoother and lighter in color, rounded, and more flexible. While the first two had been lumpier and yellowed to the point of almost an orange tint, these later ones were pale, yet smelled the same when squished (they had no odor when whole).
For months, I'd check my tonsil just about every day and when I saw a white spot, I'd remove the tonsillolith. Then I decided to get proactive.
Now, both of my tonsils are larger than average (I've been told this by a few doctors). Both of them have a large hole that is usually obscured by the flap of tissue in front of the tonsil (please forgive the lack of correct anatomical terminology). Yet, the tonsilloliths only occured on my right tonsil.
Instead of waiting for a tonsillolith to protrude to the point of visibility, I decided to go looking for them. I could insert the u-shaped unfolded paperclip into the hole a bit and push to one side, so I could get a look well inside the tonsil, like a good 3/8 inch. Unlike a cavity, it seemed more like the end of a tube, of sorts. Sometimes there was nothing in sight, sometimes there was a little tonsillolith.
I got the impression that tonsilloliths were passing out of my tonsil all the time on their own and that only when they occasionally got stuck and built up into larger ones that a problem arose.
When I read about tonsilloliths, the writers often describe them as forming in seemingly-random cavities in tonsils. Now, I don't know anatomy as well as you doctors, but the hole in each of my tonsils is in exactly the same spot on both of them. There is just one hole on each tonsil that I can see and on both tonsils, the hole is the same size in both. These holes don't gape, but rather appear as a vertical slit about as tall as a pencil is thick.
When I insert my now-ten-year-old paperclip-turned-homemade-medical-instrument into them and push to the side, both holes go way back and appear to be the end of some sort of tube that drains something.
The tonsil seems somewhat tough and rubbery and when I see a tonsillolith, if i push the U-shaped wire to the side and past it, it easily slides out when I pull the wire forward again.
After the initial rush of tonsilloliths when I first discovered them protruding, they tapered off and didn't occur too often. It was as though they had backed up in there for a while.
Like some of the others who have posted in other threads, I learned to identify the sensation of a stuck tonsillolith and would remove it when necessary.
Then came my eureka moment. I was swimming in a pool and inhaled a bit of water. I clung to the side of the pool hacking and coughing and spluttering for some time, nearly to the point of vomiting. I've never hacked that hard before or since at any point in my life. At the end of this fit of lung clearing, I felt something dislodge from my right tonsil. It landed on the pool tile and I picked it up.
It was made of the same material (as far as I could tell) as a tonsillolith, but was more flexible and seemed, for lack of a better word, fresher.
It was also a very different shape than the tonsilloliths I'd been dealing with. It was over 1/2 inch long and was tubular and about half the diameter of a pencil and had a feature that was hard to describe, but I'll try...
Picture a plastic pipe with something that could feed bacteria or yeast flowing through it. As the bacteria/yeast colony grows on the inside of the pipe and builds up, gravity will make the distribution uneven. The layer of slime will be thicker at the bottom, thinner on the sides, and thinnest at the top. Over time, as the slime thickens, it may reach a point where the force of gravity detaches the layer from the roof of the pipe and it collapses down onto the bottom layer, effectively closing off the pipe.... plugging it.
The thing in my hand looked like it had collapsed once, then broken at the upstream end, and had a new layer form with the top of the collapsed layer forming the base of the newer, smaller, tube before breaking off and passing out through my tonsil.
It sure looked like the small tonsilloliths that I could find if I went searching for them within the tonsil were bits that had broken off the end of this thing and got rounded as they passed down and out of the tonsil.
One of the posters in another tonsillolith thread mentioned that tonsilloliths seem to be layered.
So, here's the hypothesis...
At some point or another, some bacteria or yeast or whatever, possibly related to the microorganisms that build up as dental plaque, find their way into the hole on the tonsil or tonsils, migrate some distance inside, and establish a colony in the tube.
As the colony grows and coats the inside of the tube, from time to time it reaches a point where it closes off the tube, creating some sort of blockage to whatever is draining through the tube.
Maybe there are a lot of differences in tonsils that are genetic, but the hole in each of mine sure seems to go somewhere as opposed to being a random cavity. That would mean that rather than the problem being a food-up issue, it would be a microorganism-up issue where the growing colony is feeding off whatever is coming down. As my right ear feels stuffed up when my right tonsil has noticeable a tonsillolith, this would make sense.
When this blockage happens, the plug, which I'll call a micro-tonsillolith, eventually breaks free and is carried down the tube, exiting out the tonsil during swallowing and most people never notice it at all. These are the small, smooth ones that I occasionally see if I probe into the hole on the tonsil. For the most part, they seem like they pass out on their own and cause no problems.
Sometimes, for any number of reasons, the micro-tonsillolith becomes lodged near the end of the tube and subsequent micro-tonsilloliths build up into an agglomerated macro-tonsillolith.
In my case, a bicycle accident at the age of 16 resulted in a broken nose through which I don't breathe real well. At night, I mouth-breathe to the point that often I have a dried-out throat in the mornings. I suspect that this might be what sticks the initial micro-tonsillolith in place.
As the micro-tonsillolith builds into a macro-tonsillolith and begins to protrude, some food residue can get between the relatively stationary macro-tonsillolith and the tonsil tissue, fostering bacteria and hence irritation. This is when most people feel irritation, go looking in the mirror and notice it.
Now, I don't know if I'm violating forum rules by bringing this up, but the treatments mentioned in other threads; waiting until a tonsillolith is stuck and in need of manual removal to remove it via palpation or water pik, removing the tonsils, lasering the tonsils, gargling a lot with mouthwash, et cetera, don't really address what may really be causing the tonsilloliths - a colony of something growing well inside the tube that ends at the tonsil.
From what I have found, tonsilloliths seem to be poorly understood and I have a hypothesis regarding them.
Let me state at the outset that I am a layman, and I AM NOT SEEKING MEDICAL ADVICE. Rather, I want to foster some discussion because I think tonsilloliths might be misunderstood and if my hypothesis about their formation is correct, it may help doctors treat them.
There have been a number of threads on this forum regarding the topic before and I encourage any readers of this thread to read them.
Unfortunately, the other threads seem to get shut down due to writers crossing the line regarding medical advice, so please try to avoid that on this thread.
Given that I am a layman, I plan to stay out of the discussion after starting this thread unless someone has something they want to ask me.
What interested me in the topic is that I have had tonsilloliths for some time. I've mentioned them to doctors when getting exams and no doctor has expressed any familiarity with their cause.
While I must apologize in advance for the length of this post, I think it might be helpful to present the reader with an account of my case prior to offering up my hypothesis.
The first time I noticed them was 19 years ago at the age of 25 when I hacked a couple up. I didn't know what they were and after puzzling over them for a while, I washed them down the sink and didn't think about them for about 10 years.
At about the age 35, I was driving to work and had been experiencing a localized irritation on the right side of my throat for a few days. I also had a stuffy right ear and my lymph nodes under my jaw on that side were swollen. The sun was low in the morning sky dead ahead and traffic was light, so I said, "Aaah," and tilted me head back and took a look at my throat in the rear view mirror. Back on the right side of my throat was a large white spot the size of a pencil eraser. It looked like the head to a giant zit and freaked me out.
When I got to work, I located an emergency flashlight and locked myself in the bathroom. After checking it out in the mirror for a bit, I did what I'm sure every doctor dreads their patients will do - I decided to experiment a bit rather than make an appointment with a doctor.
Since it sure looked like a big zit, I located a paperclip and unfolded it and figured that by sticking it into what I thought was a whitehead, I'd drain it. As I gently pushed the end of the bit of metal wire into it, I felt no sensation at all. When I removed the wire, a whitish/yellowish lump the size of a cooked pea came out, transfixed by the wire, and I found myself holding what looked like a miniature lollipop, a metal stick with a cream-colored lump at the end. The lump was cauliflower-like. When I squished the lump between my fingers, to see what, exactly, I was dealing with, I found it had a pastlike texture and smelled extremely foul.
I don't know if any of the readers have gone out camping for a few days without a toothbrush, but it smelled just like the plaque that I scraped off my teeth after such an experience.
After removing the tonsillolith, I could see that the part of the tonsil right around the hole where I'd removed the tonsillolith was very red and irritated. By the end of the day, the irritated feeling in that spot subsided a bit and the stuffiness in my ear lessened.
A day later, at home, I used a flashlight to check the spot out again in the mirror because it was irritated again and noticed another white spot on what I had by then learned was my right tonsil.
This time, I was a bit smarter. I unfolded another paperclip, leaving the smallest u-shaped section intact, and taped the straightened-out part to the end of a plastic pen. This way, I figured, I wouldn't poke myself and cause bleeding/infection if my aim was off.
I used some rubbing alcohol to sterilize the rounded end of the paperclip and used it to dislodge the tonsillolith. This one was bigger than the first, and had the same texture and smell.
Over the next few hours, several trips to the bathroom resulted in several more tonsilloliths, these much smaller. Gargling water would bring them to the point where I could remove them and sometimes gargling itself would remove them. They were also smoother and lighter in color, rounded, and more flexible. While the first two had been lumpier and yellowed to the point of almost an orange tint, these later ones were pale, yet smelled the same when squished (they had no odor when whole).
For months, I'd check my tonsil just about every day and when I saw a white spot, I'd remove the tonsillolith. Then I decided to get proactive.
Now, both of my tonsils are larger than average (I've been told this by a few doctors). Both of them have a large hole that is usually obscured by the flap of tissue in front of the tonsil (please forgive the lack of correct anatomical terminology). Yet, the tonsilloliths only occured on my right tonsil.
Instead of waiting for a tonsillolith to protrude to the point of visibility, I decided to go looking for them. I could insert the u-shaped unfolded paperclip into the hole a bit and push to one side, so I could get a look well inside the tonsil, like a good 3/8 inch. Unlike a cavity, it seemed more like the end of a tube, of sorts. Sometimes there was nothing in sight, sometimes there was a little tonsillolith.
I got the impression that tonsilloliths were passing out of my tonsil all the time on their own and that only when they occasionally got stuck and built up into larger ones that a problem arose.
When I read about tonsilloliths, the writers often describe them as forming in seemingly-random cavities in tonsils. Now, I don't know anatomy as well as you doctors, but the hole in each of my tonsils is in exactly the same spot on both of them. There is just one hole on each tonsil that I can see and on both tonsils, the hole is the same size in both. These holes don't gape, but rather appear as a vertical slit about as tall as a pencil is thick.
When I insert my now-ten-year-old paperclip-turned-homemade-medical-instrument into them and push to the side, both holes go way back and appear to be the end of some sort of tube that drains something.
The tonsil seems somewhat tough and rubbery and when I see a tonsillolith, if i push the U-shaped wire to the side and past it, it easily slides out when I pull the wire forward again.
After the initial rush of tonsilloliths when I first discovered them protruding, they tapered off and didn't occur too often. It was as though they had backed up in there for a while.
Like some of the others who have posted in other threads, I learned to identify the sensation of a stuck tonsillolith and would remove it when necessary.
Then came my eureka moment. I was swimming in a pool and inhaled a bit of water. I clung to the side of the pool hacking and coughing and spluttering for some time, nearly to the point of vomiting. I've never hacked that hard before or since at any point in my life. At the end of this fit of lung clearing, I felt something dislodge from my right tonsil. It landed on the pool tile and I picked it up.
It was made of the same material (as far as I could tell) as a tonsillolith, but was more flexible and seemed, for lack of a better word, fresher.
It was also a very different shape than the tonsilloliths I'd been dealing with. It was over 1/2 inch long and was tubular and about half the diameter of a pencil and had a feature that was hard to describe, but I'll try...
Picture a plastic pipe with something that could feed bacteria or yeast flowing through it. As the bacteria/yeast colony grows on the inside of the pipe and builds up, gravity will make the distribution uneven. The layer of slime will be thicker at the bottom, thinner on the sides, and thinnest at the top. Over time, as the slime thickens, it may reach a point where the force of gravity detaches the layer from the roof of the pipe and it collapses down onto the bottom layer, effectively closing off the pipe.... plugging it.
The thing in my hand looked like it had collapsed once, then broken at the upstream end, and had a new layer form with the top of the collapsed layer forming the base of the newer, smaller, tube before breaking off and passing out through my tonsil.
It sure looked like the small tonsilloliths that I could find if I went searching for them within the tonsil were bits that had broken off the end of this thing and got rounded as they passed down and out of the tonsil.
One of the posters in another tonsillolith thread mentioned that tonsilloliths seem to be layered.
So, here's the hypothesis...
At some point or another, some bacteria or yeast or whatever, possibly related to the microorganisms that build up as dental plaque, find their way into the hole on the tonsil or tonsils, migrate some distance inside, and establish a colony in the tube.
As the colony grows and coats the inside of the tube, from time to time it reaches a point where it closes off the tube, creating some sort of blockage to whatever is draining through the tube.
Maybe there are a lot of differences in tonsils that are genetic, but the hole in each of mine sure seems to go somewhere as opposed to being a random cavity. That would mean that rather than the problem being a food-up issue, it would be a microorganism-up issue where the growing colony is feeding off whatever is coming down. As my right ear feels stuffed up when my right tonsil has noticeable a tonsillolith, this would make sense.
When this blockage happens, the plug, which I'll call a micro-tonsillolith, eventually breaks free and is carried down the tube, exiting out the tonsil during swallowing and most people never notice it at all. These are the small, smooth ones that I occasionally see if I probe into the hole on the tonsil. For the most part, they seem like they pass out on their own and cause no problems.
Sometimes, for any number of reasons, the micro-tonsillolith becomes lodged near the end of the tube and subsequent micro-tonsilloliths build up into an agglomerated macro-tonsillolith.
In my case, a bicycle accident at the age of 16 resulted in a broken nose through which I don't breathe real well. At night, I mouth-breathe to the point that often I have a dried-out throat in the mornings. I suspect that this might be what sticks the initial micro-tonsillolith in place.
As the micro-tonsillolith builds into a macro-tonsillolith and begins to protrude, some food residue can get between the relatively stationary macro-tonsillolith and the tonsil tissue, fostering bacteria and hence irritation. This is when most people feel irritation, go looking in the mirror and notice it.
Now, I don't know if I'm violating forum rules by bringing this up, but the treatments mentioned in other threads; waiting until a tonsillolith is stuck and in need of manual removal to remove it via palpation or water pik, removing the tonsils, lasering the tonsils, gargling a lot with mouthwash, et cetera, don't really address what may really be causing the tonsilloliths - a colony of something growing well inside the tube that ends at the tonsil.