Tonsil stones, also known as tonsilloliths, are mineralizations of debris within the crevices of the tonsils. When not mineralized, the presence of debris is known as chronic caseous tonsillitis (CCT). Symptoms may include bad breath. Generally there is no pain, though there may be the feeling of something present. Risk factors may include recurrent throat infections. Tonsil stones contain a biofilm composed of a number of different bacteria. While they most commonly occur in the palatine tonsils—they may also occur in the adenoids, lingual tonsils and tubal tonsil. Tonsil stones have been recorded weighing from 0.3g to 42g. They are often discovered during medical imaging for other reasons. If tonsil stones do not bother the patient, no treatment is needed. Otherwise gargling salt water and manual removal may be tried. Chlorhexidine or cetylpyridinium chloride may also be tried. Surgical treatment may include partial or complete tonsil removal. Up to 10% of people have tonsil stones. Biological sex does not influence the chance of having tonsil stones, but older people are more commonly affected. Signs and symptoms Tonsil stones may produce no symptoms or they may be associated with bad breath. The smell may be that of rotting eggs. Tonsil stones tend to happen most often in people with longterm inflammation in their tonsils. Occasionally there may be pain when swallowing. Even when they are large, some tonsil stones are only discovered incidentally on X-rays or CAT scans. Other symptoms include a metallic taste, throat closing or tightening, coughing fits, and choking. Larger tonsil stones may cause recurrent bad breath, which frequently accompanies a tonsil infection, sore throat, white debris, a bad taste in the back of the throat, difficulty swallowing, ear ache, and tonsil swelling. A medical study conducted in 2007 found an association between tonsilloliths and bad breath in patients with a certain type of recurrent tonsillitis. Among those with bad breath, 75% of the subjects had tonsilloliths, while only 6% of subjects with normal halitometry values (normal breath) had tonsilloliths. A foreign body sensation may also exist in the back of the throat. The condition may also be an asymptomatic condition, with detection upon palpating a hard intratonsillar or submucosal mass. Pathophysiology The mechanism by which these calculi form is subject to debate, though they appear to result from the accumulation of material retained within the crypts, along with the growth of bacteria and fungi—sometimes in association with