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Arch Otolaryngol Head Neck Surg. 2009;135(9):943.

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Diagnosis: Giant tonsillolith

Tonsilloliths, or tonsil stones, are calcified bodies that develop in enlarged tonsillar crypts that are packed with bacteria and organic debris.¹ They arise as a result of dystrophic calcification in the crypts of the palatine tonsils owing to chronic inflammation of the tonsils. They are usually single and unilateral but occasionally may be multiple or bilateral. They are composed of calcium salts such as hydroxyapatite or calcium carbonate apatite, oxalates, and other magnesium salts and ammonium radicals² and are usually of small size, although there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. Small stones are asymptomatic, but large tonsilloliths can produce a variety of symptoms, eg, halitosis, referred otalgia, and foreign body sensation in the throat, and some may mimic an abscess or neoplasia. Tonsilloliths are difficult to diagnose in the absence of definite clinical symptoms and are often incidentally found on radiographs and computed . . . [Full Text of this Article]

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Arch Otolaryngol Head Neck Surg. 2009;135(9):941.
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