As a child,Meghan Swann had suffered several bouts of strep throat,and when she was a teenager,she thought she felt another one coming on. The main symptom was familiar a dull sore-throat pain. But this time something was different; there seemed to be a foreign object stuck in the back of her throat,something she couldnt quite swallow. So I pushed on my tonsil,and something popped out, Swann said. The yellowish object was about the size of a piece of gravel and had the sulfurous odour of bad breath. I thought it was a piece of food or something, she said. From then on,Swann,engaged in a secret ritual: popping the mushrooming bits of debris out of her tonsils with a cotton swab whenever they got big enough to cause discomfort. One day,she mentioned her problem to her mother and was surprised at the knowing response. Those squishy little things were tonsil stones,her mother explained,and she sometimes got them too. Formally known as tonsilloliths,the stones consist of mucus,dead cells and other debris that collect in the deep pockets of the tonsils and gradually condense into small,light-colored globs. Bacteria feed on this accumulated matter,giving rise to the odour. Most commonly,the stones are no bigger than a pencil eraser,although doctors have reported individual cases of patients with stones more than an inch wide. Indeed,tonsil stones appear to be a widespread affliction. In a 2007 study,French researchers found that in a sample of 515 CT scans,31 subjects about 6 per cent showed evidence of calcified matter in their nasopharyngeal tonsils,better known as adenoids. While tonsil stones are relatively common,they remain little understood among many ear,nose and throat specialists. Sufferers are used to hearing from doctors that theres nothing wrong with them or that the particles trapped in their tonsils are simply the dregs of last nights dinner. Perhaps because tonsil stones are not typically considered a pathological condition,few research reports have been published about them. Nevertheless,the stones can cause an array of uncomfortable side effects,including sore throat and ear pain,not to mention the maddening sensation of a foreign body in the throat. In a 2008 case report from India,doctors described removing a giant tonsillolith that was making it painful for a young patient to swallow. Some research suggests that tonsilloliths also have the potential to take a toll on sufferers social lives. Dr Toshihiro Ansai,an associate professor at Kyushu Dental College in Japan who has studied the link between tonsil stones and bad breath,does not think all stone sufferers need to be concerned. Most halitosis is caused by periodontal diseases and tongue coat, he said. Tonsillolith would be a minor cause. While having tonsils surgically removed is the only solution likely to banish tonsil stones for good,Dr Lee A Zimmer,an otolaryngologist at the University of Cincinnati,hesitates to recommend tonsillectomy to stone sufferers right off the bat. (In some patients,tonsil removal results in complications and excess bleeding.) Instead,Dr Zimmer offers an arsenal of less drastic remedies. Gargle with a non-alcohol-based mouthwash,and use a Waterpik literally blast the tonsils to see if you can force the stones out, he said. Try that for a month or so and see how it goes. Another doctor offers another alternative to surgery: oxygenating mouthwashes and sinus sprays,which neutralises the anaerobic bacteria responsible for stone formation. For Swann,non-invasive remedies have not helped much. For the time being,she is continuing her tried-and-true maintenance routine of dislodging the stones as soon as they get big enough to annoy her.
