Can they cause ear pain (referred pain)?

Yes, absolutely it's possible! That "referred pain" you mentioned is precisely the key. Many people have experienced this kind of feeling: throat discomfort followed by a dull ache in the ear, while the actual source of the problem lies in the tonsils.

Why Do Tonsil Stones Cause Ear Pain?

Simply put, our throat and ears are in very close proximity and share some nerves. Think of these nerves as a shared electrical wire connecting two neighbors (the throat and the ear).

When the tonsils become swollen, inflamed due to the stone, or if the stone itself is large enough to press on these nerves, pain signals travel along this "wire." When the brain receives these signals, it can sometimes "get confused" and mistakenly think the "neighbor" (the ear) is the source of the problem.

This is called Referred Pain. Your ear itself isn't damaged; it's your tonsils sending out a "remote alarm."

What Are the Characteristics of This Ear Pain?

It's usually one-sided, affecting the ear on the same side as the tonsil with the stone.
The pain is often a persistent, dull ache or a vague sense of discomfort, rather than the sharp, severe pain typical of acute ear infections.
You might also experience other symptoms of tonsil stones, such as a foreign body sensation in the throat, bad breath, or a feeling that something is stuck when swallowing.
Typically, this ear pain will not be accompanied by signs of ear infection like fever, ear discharge (pus), or significant hearing loss.

What Should I Do?

Check First: Open your mouth wide and use a flashlight to look carefully at both tonsils to see if there are any small white or yellowish particles. Sometimes they can be hidden in the crypts and hard to spot.
Try Gentle Methods: If you see stones, try vigorously gargling with warm salt water, especially while tilting your head back and gurgling near the back of the throat. This agitation can help dislodge them. Alternatively, you can use a water flosser (oral irrigator) set to the gentlest mode to carefully flush the tonsil crypts. DO NOT attempt to dig them out with sharp objects like toothpicks or fingernails, as this easily injures the throat and can worsen inflammation.
See a Doctor: If the ear pain is significant or if you cannot remove the stones yourself, the safest course is to see an ENT (Ear, Nose, and Throat) doctor. Doctors have professional tools to remove stones easily and safely. Usually, once the stones are removed, the referred ear pain subsides or disappears quickly.

Hope this explanation helps! Don't worry too much – this is a fairly common situation.