It is not so uncommon to find small concretions in the tonsil, but a well formed giant tonsillolith is comparatively rare.Symptoms include throat pain ,odynophagia ,referred otlgia.

1. A Giant Tonsillolith
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. Tonsillolith
• Tonsillolith is a well recognised clinical
• entity, yet only a few cases of lithiasis in the
• tonsils have been reported. It is not so
uncommon to find small concretions in the
• tonsil, but a well formed giant tonsillolith is
• comparatively rare.
• Tonsilloliths or calculi of the tonsil are
• calcifications that form in the crypts of the
palatine tonsil or around it.

3. Tonsillolith
• The commonest accepted hypothesis
• is that Tonsilloliths form from retained
caseous secretions in the tonsillar crypts in
conjunction with filaments of
• leptothrix buccalis – a common oral
saprophyte,sometimes
• in association with chronic purulent tonsillitis

4. Tonsillolith Causation
• The etiopathogenesis of tonsillolith, is still
uncertain. It is postulated that chronic tonsillitis
associated with repeated episodes of
inflammation produce fibrosis of the openings of
the tonsillar crypts followed by accumulation of
bacterial and epithelial debris in these crypts
leading to the formation of retention cysts.
Calcification occurs subsequent to the deposition
of inorganic salts following which gradual
enlargement of the concretion takes place .

5. Symptoms
• Small concretions are asymptomatic while large
• Calculi can cause symptoms such as sore throat
and referred otalgia.
• A foreign body sensation and halitosis may also
be presenting symptoms.
• It is not unusual for tonsillolith to be diagnosed
on routine radiological studies.
• Large calculi are clinically seen as a hard mass in
the tonsil

6. Tonsillolith : Composition
A mineralogical analysis of the tonsillolith
reveals primarily carbonates and / or
phosphates of calcium but other minerals like
magnesium, sodium, silica, potassium,
ammonium radicals, copper, aluminium, iron
have also been reported.

7. Treatment
consists of surgical removal of the stone.
Tonsillectomy isindicated if the calculi
are embedded in the tonsillar tissue
or when associated with chronic
tonsillitis.

8. Tonsillolith
A 23 years old female presented
with symptoms of repeated Right
sided throat pain.
On examination yellowish stony
mass seen in the Right Tonsil. It
was hard on palpation.
Neck nodes were not palpable.
Blood investigations were normal.
CECT Neck was done.
Tonsillolith was removed under
General Anaesthesia
Yellowish stony mass in right tonsil

9. Tonsilolith
CT Scan Radioopaque shadow in Right
Tonsil
Removed tonsiollith

10. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT post graduates.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

11. Tonsillolith
• Thank you