I hope this doesn't sound too gross, but both my sister and I get white particles in the pockets of our tonsils. She thinks it is food buildup but I think it is the bacteria that the tonsils build up. The stuff is like cauliflower, kind of hard and with a foul odor. She thinks she needs to have her tonsils out. Can you advise us on this? We both have it regularly, but our throats are not really sore.

K.C.

Doesn't sound gross to me, but it's probably a pretty gross problem for you and your sister.
These things are called tonsilloliths ("tonsil stones"). You have described them perfectly. They are typically white or whitish-yellow, irregularly shaped, foul-smelling and usually smaller than a pea. The tissue lining the tonsils (called oral mucosa) is fairly sensitive, so people with this problem often report that they feel an irritation in the back of the throat and are able to pick these critters out of their tonsils.

Like your skin, oral mucosa sheds continuously. The dead cells become incorporated in your saliva and then you swallow them. Yum! One more anatomical fact that you need to know: The surface of your tonsils is pockmarked with deep pits, appropriately called "crypts" (since dead stuff accumulates in these pits). Oral mucosa lines the crypts. As this mucosa sheds, normally the dead cells leave the crypts and are swallowed. In some unlucky people, like you and your sister, the dead cells accumulate and glom together to form hard little balls. All of this dead stuff makes great food for bacteria, and all kinds of bacteria normally colonize the mouth. Consequently, the tonsilloliths are ripe with bacteria. This accounts for the smell.

The only sure-fire method for ridding yourself of this problem is to have your tonsils removed (tonsillectomy), but there are nonsurgical alternatives you should certainly pursue before you ask an ear, nose and throat surgeon (ENT) to take out your tonsils:

• You could try gargling frequently with warm saltwater (one teaspoon of table salt mixed with one pint of water). Gargle with about 1/4 cup of this mixture three times per day, after meals.
  
• You could also gargle with a mouthwash called Alkalol, which is essentially saltwater combined with a variety of natural aromatic extracts. Some people prefer Alkalol to plain saltwater. Most other commercial mouthwashes contain sugar or alcohol, which are pleasant-tasting but, in the long run, fairly irritating if used frequently.
  
• If you want a more aggressive technique than gargling for clearing out those nasty crypts, a doctor in Los Angeles, Murray Grossan, markets a water-jet device for "hosing down" the tonsils.
  
• Finally, antibiotics might help. In the hopes of avoiding tonsillectomy, I will often put my patient on a long (three- to four-week) course of antibiotics on the chance that this will allow the tonsils to "settle down" (become less inflamed). I must admit that antibiotics are not a very effective cure for this problem.
  If I had this problem, I would try all of these things before resorting to a tonsillectomy. You should also discuss your problem with an ENT, since he or she may have other suggestions to help eradicate these nasty critters, and could also give you information on what to expect from a tonsillectomy.