What Are Tonsil Stones?

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Sometimes, feeling like you have a lump in your throat has nothing to do with strong emotions. Sometimes, it’s just tonsil stones, those pebble-like white things that some people periodically find nestled inside their tonsils. Just what are these gross throat squatters?

The answer is both simple and complicated. Tonsil stones are normally white-ish yellow and can range in size from microscopic bits to chunks several centimeters in diameter. These tonsilloliths—the official medical term—are made of material that accumulates in the crevices of the tonsils.

You see, tonsils aren’t just smooth mounds of tissue. They have folds called tonsillar crypts that form pits in the tissue. The tonsils act as the body’s defender against any foreign substances that come in through your mouth, and tonsillar crypts increase the surface area of the tonsils to give them more of a chance to catch anything coming in that the body needs to mount an immune response to. A normal tonsil usually has dozens of crypts.

Just how tonsil stones are formed within those crypts is a little more complicated. Mental Floss spoke to three different otolaryngologists (ear, nose, and throat doctors) on the subject, and each of them provided slightly different answers.

A medical diagram of a tonsil
An Atlas of Human Anatomy for Physicians (1919), The Internet Archive // Public Domain

Like any tissue in your body, tonsils are constantly regenerating. Just like your skin peels, that dead tonsil tissue gets sloughed off. It normally ends up going down your throat, but it can also get trapped in these crypts. There, bacteria from your mouth can start to grow on it, turning that material into a semi-hard stone that Dr. Erich Voigt, the director of general otolaryngology at NYU Langone Health in New York City, likens to “a cheesy ball.” (Apologies if we’ve now ruined cheese for you.)

Tonsillar crypts are the perfect environment for bacteria, because they’re poorly oxygenated but rich in blood supply. “It becomes an opportune area for the bacteria to populate and adhere to each other, and they form what’s called a biofilm structure,” Dr. Yosef Krespi, an otolaryngologist who practices in the North Shore-LIJ Health System in New York, tells Mental Floss. A tonsil stone is just a lump of biofilm, he says. In a 2008 study, he and his colleagues examined tonsilloliths in the lab, finding that structurally, they look a lot like dental plaque, another biofilm in the mouth.

But Dr. Jay Shah, a pediatric otolaryngologist at Cleveland’s University Hospitals Rainbow Babies and Children’s Hospital, explains that the yellowish lump you remove from your throat isn't exclusively bacteria. When researchers have examined what tonsil stones are made of, he says, “there’s calcium, there’s sulfur—there’s a whole host of other elements within them,” he explains.

That's not to say the bacteria aren't involved. Scientists studying the microbial makeup of tonsil stones have found that the types of anaerobic bacteria commonly found around and inside tonsilloliths are associated with producing volatile sulfur compounds, which is why people with really bad cases of tonsil stones can suffer from bad breath.

While Voigt and Shah emphasized the tissue and keratin (proteins found in the lining of the mouth, as well as in hair and skin) from the tonsils that gets trapped in these crypts as the source of stones, other studies have noted that trapped food debris in the tonsillar crypts can cause tonsilloliths. One study even suggests they could be formed by trapped spit alone.

Often the tonsil stone that you see in your throat isn’t the whole thing, according to Krespi. You may only be seeing a portion that has broken off from the “mother” stone that’s still lodged down in a very deep tonsillar crypt, he says, meaning that you’ll continue to see stones. Voigt, however, says that while some patients do have recurring stones, for others, the problem is temporary and may go away after a few weeks or months.

Everyone has tonsillar crypts, dead skin cells, and bacteria in their mouth, but not everyone gets tonsil stones. “The biggest question is, why do some people get them and some don’t? We don’t know,” Shah says. Some people have bigger crypts than others in their tonsils, and, since it’s easier for stuff to accumulate in larger crypts, those people seem to be more likely to have a problem with tonsil stones. But large tonsil stones are very rare, and you’re much more likely to be dealing with a few harmless small tonsilloliths than a sizable stone. In general, tonsil stones are more common if you have a history of tonsillitis or just have large tonsils that have a lot of big nooks where bacteria can get trapped.

It’s hard to say just how common tonsil stones are. Some studies estimate their prevalence at around 8 percent of the population, while others suggest that they might affect as much as 25 percent of the population. Both of those might be low estimates. The researchers Mental Floss spoke to reported seeing them regularly in their practice, even in patients who weren’t aware that they had them.

The fact that there isn’t firm data on how many people deal with tonsil stones may reflect the fact that they don’t usually require seeing a doctor. As the authors of one large study on tonsil stones from a Japanese dental hospital noted in 2013, tonsilloliths are “relatively commonly encountered in daily clinical practice, but patients rarely have complaints related to them.”

A tonsillolith next to a ruler showing it to be slightly less than 1 centimeter wide
Tonsillolith, Wikimedia Commons // Public Domain

Because while it can be alarming (or, depending on your perspective, fascinating) to look into your throat and see white specks in the back of your mouth, tonsil stones are typically harmless. One ear, nose, and throat doctor likens them to acne of the tonsils. They’re a little gross, but for most people, tonsil stones don’t come with any major side effects.

In serious cases, big tonsil stones can cause trouble, leading to ear pain, difficulty swallowing, and other discomfort, but that’s fairly rare. Most people with tonsil stones manage to handle them without any medical intervention, removing them with a Q-Tip, a finger, or gargling with salt water. While a doctor has specialized tools that can be used to safely remove tonsilloliths, as long as you’re not poking something sharp into your tonsils or pushing them deeper into those crypts, you’re probably fine. If you’re prone to tonsil stones, Voigt suggests gargling with a 50/50 mixture of hydrogen peroxide and water to clean out your tonsillar crypts. You can also use a water pick for the same task.

The only way to totally get rid of tonsil stones permanently is to remove the tonsils entirely. But for most people, gargling or a periodic Q-tip session works fine–and makes for some pretty good video.

Have you got a Big Question you'd like us to answer? If so, let us know by emailing us at bigquestions@mentalfloss.com.

Why Do Bats Hang Upside Down?

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iStock.com/CraigRJD

Stefan Pociask:

The age-old question of upside down bats. Yes, it is awfully weird that there is an animal—a mammal even—that hangs upside down. Sure, some monkeys do it when they're just monkeying around. And a few other tree climbers, like margays, hang upside down if they are reaching for something or—again, like the margay cat—may actually even hunt that way ... But bats are the only animals that actually spend most of their time hanging upside down: feeding this way, raising their young this way, and, yes, sleeping or roosting this way.

There is actually a very good and sensible reason why they do this: They have to hang upside down so that they can fly.

First off, we have to acknowledge that bats are not birds, nor are they insects. These are the other two animals that have true powered flight (as opposed to gliding). The difference between bat flight and bird or insect flight is weight—specifically, the ratio of weight to lift-capacity of the wings. If you walk up to a bird or insect, most species will be able to fly right up into the air from a motionless position, and do it quickly.

Bats, on the other hand (or, other wing), can’t do that. They have a lot of difficulty taking off from the ground (not that they can’t do it ... it’s just more difficult). Insects and birds often actually jump into the air to give them a start in the right direction, then their powerful wings take them up, up, and away.

Birds have hollow bones; bats don’t. Insects are made of lightweight chitin or soft, light tissue; bats aren’t. And bats don’t have what you could call "powerful" wings. These amazing creatures are mammals, after all. The only flying mammals. Nature found a way to evolve such an unlikely thing as a flying mammal, so some compromises had to be made. Bats, once airborne, manage perfectly well in the air, and can literally fly circles around most birds in flight. The problem is in first getting off the ground.

To compensate for the extra weight that mammals must have, to compensate for the problem of getting off the ground, evolution found another way for bats to transition from being motionless to immediately being able to fly when necessary. Evolution said, “How about if we drop them from above? That way they are immediately in the air, and all they need to do is start flapping."

It was a great idea, as it turns out. Except bat feet aren’t any good for perching on a branch. They are mammals, not birds, so their musculature, their bones, and their tendons are set up in a completely different way. When a bird squats down on a branch, their tendons actually lock their toes into an even tighter grip on the perch. It happens automatically. That’s part of being a bird, and is universal. That’s why they don’t fall off in their sleep.

Bats, as mammals, are set up differently. Therefore, to compensate for that fact, nature said, “How about if we have them hang upside down? That way, their tendons will actually pull their toes closed, just like a bird does from the opposite direction.” So that’s what evolved. Bats hang from the bottom of something, and all they have to do is "let go" and they are instantly flying. In fact, with this gravity-assist method, they can achieve instant flight even faster than birds, who have to work against gravity.

Side note: In case you were wondering how bats poop and pee while upside down ... First off, pooping is no big deal. Bat poop looks like tiny grains of rice; if they are hanging, it just falls to the floor of the bat cave as guano. Pee, however ... well, they have that covered too. They just “hold it” until they are flying.

So there you go. Bats sleep hanging upside down because they are mammals and can’t take off into the air like birds can (at least not without difficulty). But, if they're hanging, all they do is let go.

Makes total sense, right?

Now, having said all that about upside down bats, I must mention the following: Not all of the 1240-plus species of bats do hang upside down. There are exceptions—about six of them, within two different families. One is in South America (Thyropteridae) and the other is in Madagascar (Myzopodidae). The Myzopodidae, which includes just one species, is exceedingly rare.

So it turns out that these bats roost inside the tubes of young, unfurled banana leaves and other similar large leaves. When they attach themselves to the inside of this rolled leaf, they do it head-up. The problem with living inside of rolled-up leaves is that within a few days, these leaves will continue growing, and eventually open up. Whenever that happens, the whole group of bats has to pick up and move to another home. Over and over again. All six of these species of rare bats have a suction cup on each wrist and ankle, and they use these to attach to the smooth surface of the inside of the leaf tube. Evolution: the more you learn, the more amazing it becomes.

This post originally appeared on Quora. Click here to view.

What's the Difference Between Tequila and Mezcal?

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iStock.com/mediaphotos

Aside from tacos, enchiladas, and other tasty tortilla-wrapped treats, tequila and mezcal are among some of Mexico’s best-known offerings in the food and beverage category. These tipples, made from the agave plant, are so embedded in the country’s culture that Mexico City even has a museum dedicated to the two drinks, and Jose Cuervo operates a "tequila train" to none other than the city of Tequila. These beverages can be used to make a variety of cocktails, from the tequila sunrise to the mezcalita, but unless you’re a bartender or a connoisseur of spirits, you might not know the difference between the two. Is mezcal just fancier tequila?

Not exactly. Tequila is a type of mezcal, but the reverse isn’t always true. It’s similar to the distinction between champagne and sparkling wine, in which the name of the beverage depends on whether it was produced in the Champagne region of France or elsewhere. While mezcal can be produced anywhere in Mexico, tequila is made in the Mexican state of Jalisco (though a few exceptions do apply).

Tequila and mezcal also differ in the ingredients from which they are derived. Mezcal can come from any of the dozens of agave plants—a type of desert succulent—that are grown throughout Mexico. Tequila is made specifically from blue agave and, depending on the variety and brand, a bottle will contain between 51 percent and 100 percent of the plant-based nectar. According to The Tierra Group, a wholesaler of agave products, blue agave nectar is especially sweet because it’s 80 percent fructose, per Mexico’s regulations.

Lastly, tequila and mezcal taste different because of the ways in which they are prepared. Mezcal tends to have a savory, smoky, earthy flavor because the agave hearts (or piñas) are left cooking for several days in a fire pit that has been lined with volcanic rock and covered with agave leaves and earth. The piñas destined to end up in tequila, on the other hand, are often cooked in a brick oven, then crushed up to extract the juice.

If you ever feel adventurous at the liquor store and decide to bring home a bottle of mezcal, just keep in mind that there’s a particular way to drink it. “The first mistake many people make is pouring mezcal in a shot glass and pouring it down their throat,” Chris Reyes, a mixologist at New York City’s Temerario bar and restaurant told Liquor.com. Instead, the spirit is best sipped in a clay cup known as a jicarita.

Some words of advice if you do go shopping for mezcal: If you ever see a worm at the bottom of the bottle, that means it’s probably not a very good mezcal, according to Reyes. By contrast, tequila bottles should never have worms in them (despite the common misconception). So if you’re looking to avoid invertebrate-infused concoctions at all costs, tequila is your best bet.

Have you got a Big Question you'd like us to answer? If so, let us know by emailing us at bigquestions@mentalfloss.com.

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