What Are Tonsil Stones?

iStock
iStock

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.

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Why Are We So Scared of Clowns?

Warner Bros.
Warner Bros.

With the recent box office-smashing success of Stephen King's It, it’s safe to say that coulrophobia (fear of clowns) isn’t a fringe phenomenon. The colorful circus performers are right up there with vampires and werewolves on the list of iconic horror villains. But unlike other movie monsters, clowns were originally meant to make kids laugh, not hide under their beds in terror. So what is it about clowns that taps into our deepest fears?

According to Yale doctoral candidate Danielle Bainbridge, the unsettling clown stereotype goes back centuries. In the inaugural episode of the PBS digital series Origin of Everything, Bainbridge explained the long history of this pervasive part of our culture.

Before clowns wore floppy shoes and threw pies at each other’s faces, early versions of the performers could be found in royal courts. The court jester wasn’t evil, but he was the only person in the kingdom who could poke fun at the monarch without fear of (literally) losing his head. The fact that fools didn’t fall within the normal social hierarchy may have contributed to the future role clowns would play as untrustworthy outsiders.

From the medieval era, clowns evolved into the harlequins of 16th-century Italian theater. Again, these weren’t bloodthirsty monsters, but they weren’t exactly kid-friendly either. The characters were often mischievous and morally bankrupt, and their strange costumes and masks only added to the creepy vibes they gave off.

Fast-forward to the 19th century, when the white-faced circus clowns we know today started gaining popularity. Unlike the jesters and harlequins that came before them, these clowns performed primarily for children and maintained a wholesome image. But as pop culture in the 1970s, '80s, and '90s showed us, that old perception we had of clowns as nefarious troublemakers never really went away. Steven King’s It, the cult classic Killer Clowns From Outer Space (1988), and that scene from Poltergeist (1982) all combined these original fears with the more modern association of clowns with children. That formula gave us one of the most frightening figures in horror media today.

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Why Do We Call a Leg Cramp a Charley Horse?

iStock.com/Jan-Otto
iStock.com/Jan-Otto

If you’re unlucky enough to have experienced a charley horse—a painful muscle spasm or cramp in your leg—then you may have found yourself wondering what this nonsensical phrase even means. Who is this Charley character? Where did he come from? And what does he know about my pain?

Like the words flaky and jazz, this term likely entered the language from the baseball field. While the idiom’s etymology isn’t 100 percent certain, archived newspaper articles suggest it was coined by a baseball player in the 1880s. We just don’t know which player said it first, or why.

According to a January 1887 article in the Democrat and Chronicle, the phrase was well-known to baseball players at the time—but to the average person, charley horses were as enigmatic as “an Egyptian hieroglyphic.” That year, charley horses were mentioned in a slew of newspapers across America, and some attempted to tackle the phrase’s murky origin. “Nearly every sporting journal gives a different version as to how the term charley horse originated in baseball circles,” the Oakland Daily Evening Tribune reported at the time.

The likeliest tale, according to the paper, centered around John Wesley "Jack" Glasscock, a shortstop who at the time was playing for Indianapolis. At some point a few years earlier, the player had strained a tendon in his thigh during a game and afterwards went home to his farm, where his father looked after a lame old horse called a "Charley horse." When the senior Glasscock saw his son limping along, he reportedly exclaimed, “Why, John, my boy, what is the matter; you go just like the old Charley horse?” John supposedly shared the funny turn of phrase with his teammates, and from there it spread. Similar accounts were reported in other newspapers, but they were attributed to various other players.

Other reports say the phrase has nothing to do with a live animal, but rather the fact that an injured player, while running, resembles a rocking horse or a child riding astride a wooden hobby horse.

The New Dickson Baseball Dictionary by Paul Dickson details a few other theories. In two versions of the same basic tale, Orioles or Chicago Cubs players went to the races and bet on a horse named Charlie who "pulled up lame in the final stretch." The next day, a player pulled a tendon in his leg and was said to resemble “our old Charlie horse.”

Alternatively, its origin may relate to an old workhorse that was tasked with pulling a roller across the infield. “Often in the 1800s, old workhorses kept on the grounds of ballparks were called Charley. The movements of the injured, stiff-legged ballplayers were likened to the labored plodding of these old horses, and the injury itself eventually became known as a ‘charley’ or ‘charley horse,'" Tim Considine wrote in 1982's The Language of Sport.

It also appears that charley horse originally implied a much more serious injury—or perhaps there was a bit of hysteria surrounding a condition that seemed new and scary in the late 19th century. The Democrat and Chronicle described a charley horse as a “giving way of one of the small tendons of the leg” and said an injured baseball player might need an entire season to recover. Another article from 1887 said ballplayer George Van Haltren’s relatives were worried he would get a charley horse, “although they do not know what that is.” He was said to have been “very fortunate” because he had “not yet encountered the terrible charley horse.”

For comparison, Healthline.com now says charley horses “are generally treatable at home” by stretching, massaging, or icing the afflicted area, although the muscle pain can linger for up to a day in some cases. So there you have it. We may never know the exact etymology of the charley horse, but the next time you get a sharp pain in your leg, you can thank an old-timey ballplayer for making your struggle sound so silly.

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