Picture of a tonsillolith emerging from a crypt in the right tonsil.
What are tonsilloliths?
Concretions of varying size and consistency can form within the substance of the tonsils. Repeated episodes of inflammation may produce fibrosis at the openings of the tonsillar crypts. Food, epithelial and bacterial debris then accumulate within these crypts and produce a chronic inflammation. Calcification occurs subsequent to the deposition of inorganic salts, and contributes to the gradual growth of the concretion. This process may be facilitated by the oral flora and may include fungi and actinomyces-like organisms. The resultant calculus may reach a significant size and even ulcerate through the surface of the tonsil.
Tonsilloliths occur more frequently in adults and may cause symptoms of recurrent sore throats, chronic cough or otalgia. There is also a sensation of constant irritation, foreign body sensation in the back of the throat, and above all, halitosis (bad breath). Initially, these concretions are soft and cheesy, but with time, they calcify and become hard calculi. It is not uncommon for patients to pick them with various sharp objects, such as crochet needles, knitting needles, pencils, etc. Patients invariably complain about the foul smell that emanates from these cheesy concretions.
Examination of the throat demonstrates a whitish tonsillolith within the tonsil. There may be local inflammation and enlargement of the affected tonsil.
Treatment includes the removal of these concretions from the tonsillar crypts when possible, by the use of curettes and probes. Larger calculi may require incision and extraction. Tonsillectomy is reserved to patients who suffer from chronic recurrent infection, bad breath and persistent pain.