Endoscopy results showed Kim's tonsils had pus, congestion, and a hard block of stones in the right tonsillar crypt. Dr. Tran Xuan Nguyen, an Ear, Nose, and Throat specialist at Tam Anh District 7 General Clinic, diagnosed Kim with chronic tonsillitis with pus, bacterial accumulation, and trapped food debris, leading to persistent bad breath. The large tonsil stone block required removal.

Tonsil stones are whitish or pale yellow calcified masses that accumulate in the tonsillar crypts due to leftover food, bacteria, and dead cells. Initially, the stones are small, and the patient may not experience significant bad breath. As stones grow, they cause a foreign body sensation in the throat when chewing or swallowing, accompanied by pain and swollen tonsils. Patients may notice tiny, hard white or yellow fragments in their mouth while eating.

Dr. Nguyen performed an endoscopy to remove a whitish tonsil stone block measuring 0,5 x 0,5 cm. Following the procedure, the patient felt relief from pain and the foreign body sensation. One week later, Kim had a follow-up appointment; her bad breath had decreased, but she needed to manage the tonsillitis to prevent recurrence and limit new stone formation. The patient must complete the acute inflammation treatment as prescribed by the doctor, avoiding self-discontinuation of medication even if symptoms improve. This should be combined with proper daily oral and throat hygiene, including gargling with saline solution two times each day to clean plaque from the tonsillar crypts.

Dr. Nguyen performing an endoscopy on Kim. Photo: Tam Anh General Hospital

Tonsils produce cells that eliminate harmful bacteria from the respiratory tract. If a large number of bacteria and virus invade, overwhelming these cells, the degenerated cells accumulate over time along with food trapped in the tonsillar crevices, gradually calcifying and forming stones.

Tonsil stones can occur in individuals with chronic tonsillitis, where the tonsillar crypts are dilated, inflamed, and filled with pus. This creates an environment for food debris, shed cells, and bacteria to accumulate, eventually calcifying into stones. Repeated inflammation also impairs the tonsils' self-cleaning ability, facilitating stone formation and recurrence.

According to Dr. Nguyen, bad breath can stem from various causes, such as oral diseases, tonsillitis, sinusitis, gastroesophageal reflux, or upper respiratory tract infections. If bad breath persists despite thorough oral hygiene and is accompanied by symptoms like a recurring foreign body sensation in the throat, sore throat, nasal congestion, or postnasal drip, patients should consult an Ear, Nose, and Throat specialist for examination and endoscopy to identify the correct cause and avoid overlooking underlying conditions.

Uyen Trinh

*Patient's name has been changed