Tonsilloliths a.k.a. throat poo

"I have a throat infection," announced the patient when asked the reason for her visit, through the interpreter.

I couldn't elicit much on history: no pain, no fever, no cough. Her only complaint was recurrent "white stuff" in her throat for months.

Strep throat? Thrush?

She sat on the exam table and I shone a light onto her pink, uninflamed, exudate-free pharynx. The rest of the exam was similarly unremarkable.

"Do you ever spit out pieces of the white stuff?" I asked. "And is it particularly foul-smelling?"

"Yes! Yes!"

Yet another diagnosis of tonsilloliths, more aptly christened 'throat poo' by one of my friends. I refrained from sharing that phrase with the patient, being quite certain that something would be lost in translation and the patient would be very, very alarmed. Instead, I gave my tonsillolith spiel.

Tonsilloliths, also called tonsil stones or calculi, are white or yellow foul-smelling concretions that form in the tonsillar crypts, the deep crevices in the tonsils. They consist of a calcified accumulation of food matter, bacteria and white blood cells. The stones gradually increase in size until they are expelled from the tonsil, at which point they are swallowed or spit out.

* Not my photo or tonsilloliths. Image from Answers.com

Tonsilloliths are typically smaller than a pea, although there are case reports of calculi reaching several centimetres in diameter.

The stones are usually asymptomatic, but may cause sore throat, a chronic cough, a foreign body sensation in the pharynx or bad breath.

I can tell you from my work at the refugee clinic that tonsillolithiasis is a global problem.

If you are unwilling to wait for the stone to fly its tonsillar nest, some removal methods I've heard from patients include sucking it out with a medicine dropper, milking it out with a q-tip or directing a stream of water at it.

(Disclaimer: This does not constitute medical advice. I do not advocate any of the above methods, which can result in tonsillar injury or infection. Present your pharynx to your own physician and get her opinion.)

A physician may remove a tonsillolith by curettage, or by excision it if it is extraordinarily large. Rarely, a tonsillectomy may be performed.

I confess I suffer from this affliction. I suffered in shame until a friend raised the issue one evening at a party and it turned out roughly half the attendees had the same condition. I can't find any statistics on the incidence of throat poo, but anecdotally I'm going to put it at 35%. 

Maybe we can hold an informal poll in the comments. Are you a tonsillolith former, or not? I won't blame you if you comment anonymously.

Comments

Thanks for the information!! I have wondered in the past few years what it was, but since it never caused any pain (just the occasional bad breath), I did nothing about it. I usually expel them bi-weekly with gentle pressure applied by the index finger (i.e., the method you used to use to induce vomiting as a child).

[Amy Hoogstad]

Very interesting! I've never heard of this until today. So much to learn here:)

[Amy Hoogstad]

P.S. "Sha-ZAMing" takes less than five minutes once you know what you're doing. I won't use it too often on my pictures as the "high contrast" look is a matter of personal preference. Read: I love it, Kevin does not!

Hey, thanks. I've always wondered what this little crud in my throat was. Since I was never actually sick when it appeared, I never asked my doctor. ellen.

[DoctorMama]

I once curetted out a 3 cm one from a patient. She almost passed out from the shock and horror.

I have them, and it seems like folks with allergies/postnasal drip are the ones most afflicted. I find the qtip method too brutal, but gentle rinsing with water from an eye dropper usually does the trick.

[Leslie]

Martina - it is so interesting that you bring this up. I have had them for years and never thought much about it. a few months ago i asked my mom about it and she hadn't any idea what it was. then my sister sue said she knew. the rest of the medical family were all mystified by it. So thanks for the info.

[slydi]

i collect mine in an antique pillbox. i can't wait to show them to my future grandchildren!

[JeanMac]

Kind of glad I had 'em (tonsils) removed years ago - I think my preferred method would be to suck them out with a dropper. They look like wisdom teeth.

[Danielle]

I remember the dinner conversation where the name "throat poo" was spoken aloud. The reaction around the table ranged from disgust (by those whose were throat-poo free) to relief (by the throat-poo afflicted). I admit I was one of those who felt relief, knowing that I wasn't the only one with stinky chunks in my throat.

The dreaded poo. It's not uncommon for me to find hair clips that have been unbent and made into crude digging instruments lying around the house and I know what my wife has been up to.

[lynn]

"eye poo" is used in my circles to describe the residues of sleep...any other types of "poo" out there?

What is Sha-ZAMing? I metasearched it but couldn't find anything. Thanks. Ellen.

[Martina]

Being able to provide this information has been strangely gratifying. Glad to be of help.

@ Ellen: Sha-ZAMing was a Photoshop technique that Amy referred to on her blog (kahoogstad.blogspot.com), about which I had left a comment. Nothing to do with tonsillar stones.

[Xavier]

I was afraid that I had some sort of weird disease until Fat Doctor mentioned them on her blog a few months ago. That was a HUGE sigh of relief, let me tell you!

[Lisa G]

Lovely! I am enjoying this one- I keep going from near wretching and gagging to laughing. I know of a lady who scrapes them out with Q-tips. I must confess I thought she was weird, not being a suffer-er myself. I guess I have another thing to add to my head to toes. Too bad it's not an "infection" because I might really have impressed the intensivists with a diagnosis of throat poo when we are stumped by a septic patient. Now I have nothing to look forward to after my maternity leave.

Martina, thanks. (I did realize that Sha-ZAMing was a photo-editing tool, not a medical technique. Although that actually would be much more interesting.) Ellen.

[JC Jones RN]

How did we know anything before the INet? wow- thanks for enlightening us!

[Kim]

Being old enough to have been a part of the take-the-tonsils-out-at-the-first-episode-of-tonsilitis generation (circa 1962), I have repeatedly been reminded of how glad I am NOT to have these troublesome pieces of anatomy, as in never having "tonsilitis" or ever getting as sick as those who still carry them around.

Now I have one more reason to not miss them!

: D

Seriously? I never knew these existed.

[Anne]

Yes, I've also heard them described as food lythes (spelling?). I think your explanation has a bit more clout.

[Allison]

I first had them as a child, around the time that I had terrible sinus infections. I remember that I could pull them out with my fingers by pushing on my tonsils. eventually, i learned to push them out with my tongue before the got past a few millimeters.

then, they went away. entirely away for years. didn't get one again until I was pregnant at 33. now they come back occasionally, but are especially bad during pregnancy.

[laystranger]

Yeah, I get these too.

I sort of express them out by pressing on my tonsil. I believe I might have given myself an abscessed tonsil doing this a couple of times though and am very, very cautious about doing it now. (I know I had an abcess on my tonsil - just not sure whether I caused it by doing this.)I've tried other methods but there must be something about my tonsils that make my original method of evicting the little stinkers the only one that works at all well. I always "know" when I've got one - I must be able to smell it at a subliminal level.

I have found that gargling with salty water every night before bed maybe helps prevent them - I find it hard to remember to do this regularly though and I don't know if it really works or if it was just a happy co-incidence.

Martina, are these "stones" hard? They look very much like something I used to get on a pretty regular basis (although I never witnessed them protruding from my tonsils...), but mine were soft and squishable. Not the same thing???

[Martina]

They're typically well-formed but not rock-hard. Your soft, squishable phenomena could be tonsilloliths. Especially if they smelled/tasted particularly foul.

[RH+]

This is gross, but once in college I chased someone around the dorm with my throat nugget on my finger.

[holly=]]

OMG! i am so happy that i looked at this site. i noticed that i started getting them a few months ago and was scared that there was a bump on my tonsil. i usually scrape them out with a nail file of a pointy object i can find. but after reading this i think im going to try the salt walter and tongue scraper. THANKS!

[Kathryn S]

I get them, my husband does too.

[Matt]

My breath started smelling like "poo" in the morning about 2 1/2 years ago. Around this time I also started feeling like I had a constant frog in my throat.. clearing it and spitting up mucus all day long. I was just doing pushups and felt what seemed like a piece of oatmeal come up my throat into my mouth. I spit it into my hand and it was the foulest smelling stuff I've ever witnessed. I've washed my hands 3 times and still can't get the smell off my finger where I touched it. Oddly, or not so oddly enough.. it has the same characteristic bad breath smell I've had all this time.. in fact I think it was the source of it. Nasty! I think I might get a dentist to do some sort of endoscopy on me to see if there's any more. Nasty stuff!

[sassytoon]

i am obsessed with cleaning my tonsils. i thought i was the only weird crazy one.

my sister has it and she has the worst breath ever!

[Melissa]

I have never ever heard of anything like these before, and am kind of grossed out by the thought. However, Matt's observation that his "breath started smelling like 'poo' in the morning" made me realize that these MUST have been what a guy I was dating once had. I couldn't figure out the cause, and I think we broke up partially because I had no desire to kiss him when it was like that and wasn't comfortable telling him his breath smelled like a dirty public restroom.

I kind of feel bad now. But man, I really had never heard of these before today. All you people with these things need to speak up, because otherwise the rest of us are clueless! :)

Just discovered the blog today. How come all the cool bloggers live western Canada?

[Mynda]

I am five months pregnant and just started getting one white bump on my left tonsil. I've had it three or four times since August 25. I usually just cough it out. I can't gargle or stick anything in my throat 'cause of my now weak gag reflex.
Nice to know what I have now, though. My last doctor (who I don't see anymore 'cause I found him to be stupid) said it was from bad air and gave me an inhaler to get rid of it.

[Kiss]

FINALLY! I have lost sleep over this nasty stuff. I was sure that it was from my severe strep throat when I was younger. I was sure my tonsils were rotting out!
I use various methods to get it out. Sometimes, it is hard to get out. I find it worse when my allergies are spiked and I have sinus drip.

[Lori]

I'm staying anonymous but YES I have suffered from these things AND asked my doctor and she didn't shed a single bit of light on the subject. I can't believe I finally have the answer!

[sparky]

Hi . I have tried getting them out lots of ways but I have to admit that I find gently brushing with a toothbrush around the tonsils works a treat . Man these things stink !

[sparky]

Oh .And by the way I,ve spent a fortune on doctors trying to eradicate this problem ,and nobody in the medical proffession that I,ve visited ever heard of tonsilloliths. WE NEED A CURE MEDICAL PROFESSION!. I had to self diagnose this myself through the internet.Can you believe it.

[Emily Davitto]

I've had these quite often lately. I had one the past few days and swallowed it eating ice cream this morning. I still feel like there's some left in my throat cause I taste/smell it. No one I work with has had it or heard of it so they think i'm crazy. My mom and aunt have had it before. I've never gotten it out without swallowing it though. Not sure I could go digging that far back without gagging myself. It's so good to see that other people have this issue too.

[bo]

I have these as well. I never really knew what they were but knew it was pretty gross. I use the round end of a bobbypin to scrape them out. Gross, I know. Sorry. Just tonight I figured out that I could press next to the crevice in my tonisl and they pop out. I was pretty much gagging myself, and think that I've now inflamed my tonsil. This is when I decided to come online and see what they really are. By the way, my boyfriend has them too. Ick!

[bo]

I have these as well. I never really knew what they were but knew it was pretty gross. I use the round end of a bobbypin to scrape them out. Gross, I know. Sorry. Just tonight I figured out that I could press next to the crevice in my tonisl and they pop out. I was pretty much gagging myself, and think that I've now inflamed my tonsil. This is when I decided to come online and see what they really are. By the way, my boyfriend has them too. Ick!

[sufferer]

Once the stone has been swallowed / coughed out, does the sufferer still have bad breath ? Or only bad breath the more it grows? I never knew I had bad breath...but I must do? Oh no!!!!!!!!!!!

[adrian]

Had them often, didn't know what they were until now. I usually pick them out with a unwound hanger...or toothpick.

[Bre]

OMG LMAO because we all have the same afflictions and I stumbled upon this site looking for ways to get rid of this or finding some relief for my husband. I especially fell over laughing at the story about the person who couldn't get the smell off their hands good luck

[Rachel]

OMG!! This is SO funny! I mean a toothpick?? a hanger!?! REALLY!??? ouch! I find the other endI can say that only because I am a sufferer too...and until now, a closet sufferer. I had absolutely NO idea this was a commom thing! I keep feeling like something is stuck in my throat and then I would finally choke up white chunks. YUK! Had a terrible sore throat the other day, choked up a HUGE 'stone' and sha-zam, sore throat gone! WEIRD! I have not noticed a smell tho. of course that could be because my nose is always completely stuffed up, and I have a constant flow of mucus flowing down the back of my throat. Glad to know I'm not completely weird and abnormal! Personally, I find the "milking" method with the other end of a toothbrush works the best...a rounded end(not squared off) is best. Go slow and it cuts down on the gagging!

[rachel]

ignore the typo at the beginning of my last post...my computer randomly decides to change lines while I am typing....sigh.

[Heather]

Can you get them deeper in your throat? I've had these for years- but feel as though I have one deeper in my throat.

[Relieved]

I am currently taking prednisone for RA and have recently had several URIs--seems like I get over one and another begins. One day, I felt something in my throat and I couldn't clear it, so I looked in the mirror. I saw a white spot (that in my paranoid mind could only be one thing: CANCER!), so at my next appointment with the rheumy, I asked him to look at it and tell me what it was. He looked and then shrugged and said, "it's just a localised infection. Nothing to worry about and it should clear up on its own".

One day during my last bad cold, I coughed up a tonsil turd into my hand. I thought it was mucus from my lungs, but it smelled putrid. I Googled "white spots on tonsils" and found a message board where people were talking about these things called tonsilloliths.

After reading suggestions from other sufferers and trying a few methods (finger, Q-Tip, toothpick) with no success, I decided that I needed something sharper than a Q-Tip and longer than a toothpick. My finger only made me gag and I couldn't leave it back there long enough to do anything.

Here is how I finally resolved the problem. I'm sharing because there might be others who would find this method better than the others. BUT PLEASE BE CAREFUL WHEN DOING IT! Be very gentle and go very slowly.

First, I sprayed my throat with Chloroseptic to numb and disinfect the area. This helped with the gag reflex.

Next, using a Butler G*U*M "Go-Betweens" cleaner brushes, I gently rubbed the surface of the white spot until things started coming out. (ewww)

I couldn't believe how many of them were in there! I'd get several out and more would come to the surface. It was really gross.

Anyway, I kept a small cup of rubbing alcohol handy and periodically dipped the brush in it to sterilise it.

When I had successfully removed all of the stones, I gargled with warm salt water. When I woke up this morning, my breath didn't taste disgusting. Yay!!

Good luck to everyone who has these vile things.

[Amy]

These are truly the most disgusting things. I'm usually able to pop them out on my own, but sometimes I feel that I have to all but tear my tonsils up to get them out. And then, of course, the "pots" get deeper which only invites more of the little guys.
I think I'm going to have to go and find an EN&T doctor and BEG to have my tonsils removed.
Every doctor I've talked to says it's not a big deal. I beg to differ.

[Elizabeth]

Oh, the glorious tonsilloliths. I had gotten a few but never crushed them and smelled the horror, and then about a year ago I was at work and coughed one up. My coworker luckily told me what it was, and told me to squash it a bit and smell, and HOLY MOLY it was one of the most disgusting things I've ever experienced. Now, luckily, I know what they are and to dispose of them asap down the drain as soon as they happen. Strangely, I never actually see them sticking out of my tonsils, and in fact the couple of times I've felt one it's been further down in the back of my throat, so I don't have the pleasure of poking them out. Is it strange that that sounds fun to me? Haha, well poking things can be enjoyable sometimes, and plus it would be nice if I were able to remove them at will.

I was thinking about getting my tonsils out, since I was always told by friends who had gotten theirs out when I was younger that it barely hurt at all and you got lots of ice cream, but it seems like it's a lot more painful for adults. Maybe it's still worth it though--the thought of being free of throat poo for the rest of my life? It's mighty tempting. I think that's worth a couple weeks of pain.

[Kitty]

I just started getting these things last year when I was a foreign exchange student here in Japan. Man, I freaked. Away from home, barely able to communicate. It seemed every three months or so Id get a sore throat and be diagnosed with strep and even missed school (which, actually, I didnt enjoy)! Theyve started to come out more often recently and I hate them!! They smell awful and I am completely repulsed by them. I cough them up randomly at work and will be grossed out the entire day. I just started taking them out myself, just to avoid the little surprises during the work day, and I hate it. I want to get rid of them permanently! Or at least find a great way to prevent them. I live in Japan now and each time they pop up I am diagnosed with strep. Im glad I decided to look this up. Now I guess I will have to tell the doctor what it is, and not the other way around -_-

[Ex-sufferer]

I was a former sufferer of tonsilloliths. I first discovered them when I was a teen and even reported it to a doctor, who told me it was normal! Throughout my life I had terrible breath that no amount of gargling or brushing would mitigate. Because of recurrent infections, I had my tonsils removed when I was in my 30s. Since then, I've had NO problems with bad breath. The surgeon said, "those were some nasty tonsils."

[Natalie]

Ah, yes. A friend of mine turned me on to the actual, scientific term for what my brother and I, who both have chronically suffered from these, dubbed "lung cookies" many years ago.

I had tried to describe these "lung cookies" to both my husband and brother in law, who just stared at me blankly, and then announced that I was crazy and lying. Once my friend turned me on to the many websites dedicated to "lung cookies" and how to remove them, I triumphantly showed my husband, who simply said, "OK, that's gross."

But I digress. My method of removing them now consists of flushing them out with a curved oral irrigator given to me by my dentist. He gave it to me to flush out my prodtruding wisdom tooth (which is coming out in just two days). I mix up warm water with salt, suck it up the irrigator and just flush out the crypts. The first time yielded some icky "lung cookies" but since then it's seemed to help keep my crypts relatively "cookie" free.

[anonymous]

I had my first one this summer! And I'm pretty sure I was the medical student's funny story of the day. I was working at a high adventure base and noticed a big white lump on my tonsil, so I thought I had some sort of crazy infection. I went into the health lodge, partially staffed by medical students, and one of the students poked at it gently with a cute tip and then told me to gargle with salt water. I did and promptly coughed up a HUGE piece of weird crap into my hand. I yelled in shock "What the FUCK IS THIS?" and she burst into giggles. When she finally got over it, she explained that it was just dead cells and other debris that had accumulated in my tonsils and it was nothing to worry about.