Tonsil stones: what they are and when to see a doctor

A child opens their mouth, you shine a phone flashlight — and white spots or patches are visible on the pink tonsils. The first urge is to remove something from there as quickly as possible, the second is to look up the most frightening diagnosis online. Let's calmly sort out what this could be, what symptoms occur with tonsillitis, and when a doctor is really needed.

What tonsil stones are

The tonsils are lymph nodes deep in the mouth and in the upper part of the throat. They help trap bacteria and other microbes so they don't spread further through the body. When inflamed, the tonsils become red and swollen, and white spots or patches may appear on them. In everyday speech such white spots are called plugs or stones, but what exactly you see in the mirror cannot be determined by appearance: the cause of the inflammation and the nature of the changes are assessed by a doctor — with a throat swab if necessary.

Pus spots and white patches: what the doctor sees

With tonsillitis, there may be pus spots or white patches on the tonsils, and in more severe cases also bad breath. It is difficult to assess the nature of the changes from a photograph, so the question is settled by a doctor's examination and, if necessary, a throat swab.

Why pus appears on the tonsils and what tonsillitis has to do with it

Tonsillitis is inflammation of the tonsils. It is most often caused by viruses, for example with a common cold, and less often by bacteria, including streptococcus. Tonsillitis is a common illness in children, but teenagers and adults get it too. Tonsillitis itself is not contagious; most of the infections that cause it — colds and flu — are contagious. Complications are rare, but one of them is a collection of pus between the tonsil and the wall of the throat.

What symptoms occur with tonsillitis

Tonsillitis can feel like a severe cold or flu: the tonsils are red and swollen. Enlarged tonsils without pain and other problems do not require treatment.

• sore throat and difficulty swallowing;
• high fever, cough, headache, earache, fatigue;
• nausea and a feeling that you are about to vomit;
• painful enlarged lymph nodes in the neck — felt as a lump on the side;
• pus spots or white patches on the tonsils and bad breath.

Symptoms usually subside within 3–4 days, although they may last longer.

Diagnosis and when to see a doctor

The doctor looks at the mouth and throat and can suspect tonsillitis from its appearance alone. A throat swab may additionally be needed to determine whether the cause is bacterial; a rapid test may come back normal even though streptococcus is present, so the swab is sometimes sent to a laboratory and the result takes several days. For severe or persistent symptoms, a blood test for infectious mononucleosis is ordered.

You should see a doctor if symptoms do not go away within a week or if tonsillitis recurs frequently. Other reasons include a temperature of 38.3 °C or higher, pus deep in the throat, severe difficulty swallowing or breathing, painful enlarged lymph nodes in the neck, excessive drooling in a small child, and a red rough rash.

Tonsil stones on their own are not a reason to call an ambulance; 103/112 — if severe sore throat is rapidly worsening, there is swelling inside the mouth and throat, it is difficult to speak, swallow or breathe, or you cannot open your mouth wide: this may be a collection of pus between the tonsil and the wall of the throat (an abscess).

This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer