Key words : dysphagia; tonsil stone
Key Clinical Message: Small tonsilloliths are usually asymptomatic, whereas large tonsilloliths are sometimes associated with recurrent sore throat and odynophagia.
A 68-year-old woman developed sudden right-sided sore throat and odynophagia, 3 weeks after she presented to our hospital. She visited an otolaryngologist and underwent fiberoptic laryngoscopy, which did not reveal any abnormalities, including a foreign body. She denied any past medical history, was concerned about her halitosis or bad breath. Physical examination revealed no tonsillar abnormalities. Detailed evaluation showed a firm, nodular mass in the tonsillar crypts. Laboratory data showed normal serum calcium levels. Computed tomography revealed a dense calcified mass in the right palatine tonsil (Figure 1). The mass was excised under local anesthesia; it measured 6 mm × 4 mm in size and appeared hard, with an irregular surface (Figure 2) and was diagnosed as a tonsillolith. The patient showed no recurrence of the tonsillolith at 3-month follow-up.
Tonsilloliths are products of calcified accumulates of food, cellular debris, and microorganism aggregates in the crypts of palatine tonsils.1 Small tonsilloliths are usually asymptomatic, whereas large tonsilloliths are sometimes associated with recurrent sore throat and odynophagia.1,2