Sunday, November 04, 2007

I am totally disgusting, and untreatable:

"I've seen several patients with a hard, white malodorous exudate often stuck between the folds of the tonsils. It's not associated with tonsillitis," writes VIVIAN CHOW, MD, of Toronto, ON. She'd like to know: "What is this substance?"      

The white exudate you're referring to is called a tonsillolith, or calculus of the tonsil. Typically it presents with gritty particles trapped in the crypts of tonsils and is often referred to under the clinical entity of "chronic cryptic tonsillitis." There's often associated halitosis. Acute bacterial tonsillitis may be associated with this condition, but isn't necessarily so. The calculi themselves can vary in appearance, from a whitish yellow to a yellowish grey hue. They're often concentric laminated structures. In most cases, treatment is expectorant only. I often recommend mouth rinses. Many patients will disimpact the tonsilloliths themselves while looking in a mirror. If the volume of debris is excessive or the patient finds the halitosis intolerable, this is a rare relative indication for tonsillectomy. Medical therapy generally isn't helpful. SK

1 comment:

  1. a) Your habit of leaving out post titles makes it hard to tell from my Google homepage whether you've actually updated or not. I plead for titles! ("Untitled 352" would be okay, even.)

    b) You poor baby! That sounds very uncomfortable. Wikipedia (ever helpful) mentions "laser tonsillectomy," but that's probably a drastic solution.

    Sending you hugs! Also, more exhortations to travel to Chicago for job interviews.

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