Q. Why is there bad breath with tonsil stones?

Answered by
Dr. Shyam Kalyan N
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 06, 2020

Hello doctor,

I think I have tonsil stones. I have little white things in my tonsil pockets. When I cough them up or manage to get them out, they are whitish or yellowish hard clumps. I have mild sore throats all the time, bad breath (I brush my teeth constantly and I make sure I do not eat food that makes breath smell bad), and I get earaches. It constantly feels like food or something is stuck in my throat and it is really annoying. Should I go see a doctor about this? Or is there any way I can get rid of them at home?



Welcome to icliniq.com.

You suffer from tonsilloliths. Tonsils which are lymphoid organs in the throat produce secretions through the crypts in them. In a few people, these secretions calcify and become stones (called tonsilloliths). In a vast majority of people it stays asymptomatic, however, in a few like you, they produce symptoms such as food stuck in the throat and mild ache. The presence of these stones causes stasis of secretions in the crypts which otherwise freely flow into the mouth. The stasis causes the development of bacterial colonies which result in halitosis (bad breath) and associated throat ache. The tonsils act as a source of infection to the ears, as the bacteria rises up along the eustachian tube that connects back of the nose to the ears on each side. Sometimes a remnant of adenoids could also be causing the ear issue.

If this problem has been there for more than three to four months I suggest you go ahead and get your tonsils removed. The procedure is called a tonsillectomy. Before that, we would like to take a radiograph of your nasopharynx (to rule out adenoid enlargement). Adenoids usually regress by 10 years of age but in some, it remains longer and causes problems of mouth breathing, ear block, snoring, and ear infections. If adenoids are enlarged they also can be removed along with tonsils in the same setting, adenotonsillectomy.

If you ask me the merits and demerits of the procedure, in your case the merits clearly outweigh the demerits. These lymphoid organs in you have turned more harmful than protective. The tonsils are causing you bad breath, foreign body feeling in the throat along with tonsillar stones. The tonsils or the adenoids are causing you the ear ache as well. Post-operatively you may face mild pain for two days and you can resume your work or college in three to four days time. In my set up we do this operation on day care basis. We use radio-frequency ablation for removing the tonsils which is one of the most recent advances in the field of ent surgery.

Medically the problem can be managed but recurrences are the norm. You may gargle the throat using chlorhexidine dilutions or betadine dilutions multiple times a day. Drink plenty of fluids, treat an acute infection on a case by case basis using appropriate antibiotics and avoid cold spicy food items that may irritate the mucosa. However, a permanent solution for the problem will be evasive unless and until you rid yourself of the tonsils.

I hope this helps.

Investigations to be done:

X-ray of nasopharynx soft tissue lateral view for adenoids, serum IgE. Throat swab for culture and sensitivity.

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