Management of Symptomatic Tonsilloliths in Adult Patient

Case at a Glance

A 34-year-old female with a history of GERD and allergies presented with odynophagia, initially suspecting a throat infection. Physical examination revealed tonsil stones (tonsilloliths) rather than infectious etiology.

Patient's Story

The patient reported painful swallowing that developed over several days, leading her to suspect a throat infection. She has a medical history significant for gastroesophageal reflux disease (GERD) and seasonal allergies, currently managed with proton pump inhibitor therapy (Protonix), antihistamine (Xyzal), and intranasal corticosteroids (Flonase). She denies tobacco, alcohol, or recreational drug use. Her BMI is within normal limits.

Initial Assessment

Upon presentation to primary care, the patient complained of odynophagia without fever or systemic symptoms. Physical examination of the oropharynx revealed visible calcified deposits in the tonsillar crypts consistent with tonsilloliths. No signs of acute tonsillitis or pharyngitis were observed.

The Diagnostic Journey

The primary care physician identified the white/yellowish deposits as tonsil stones rather than infectious material. The patient was educated about the benign nature of tonsilloliths and their association with food debris and bacteria accumulation in tonsillar crypts. Given the patient's symptoms and visible stones, conservative management was initially recommended.

Final Diagnosis

Symptomatic tonsilloliths (tonsil stones) with associated odynophagia

Treatment Plan

Conservative management was initiated with saline gargling for symptomatic relief and oral hygiene optimization. The primary care physician suggested gentle mechanical removal using a cotton swab as a potential option, though emphasized proper technique to avoid trauma. ENT referral was arranged for specialized evaluation and potential alternative removal techniques or consideration for tonsillectomy if conservative measures fail.

Outcome and Follow-up

The patient was scheduled for ENT consultation within one month for further evaluation and management options. She was advised to continue saline gargling and maintain good oral hygiene. Follow-up instructions included returning if symptoms worsen or signs of infection develop.