Last revised by Yahya Baba on 1 Nov 2021

Tonsilloliths, also known as tonsil (or tonsillar) stones or calculi, are clusters of calcifications that form in enlarged tonsillar crypts, within the tonsils or around them. Although they are uncommon and benign, they may be symptomatic causing pain, halitosis, foul taste, irritable cough, dysphagia, otalgia or a foreign body-like sensation. When asymptomatic they are often found incidentally on OPG or CT. They mainly occur in adults due to saliva composition and underlying tonsillar chronic inflammation.

Radiographic features

Small foci of calcifications seen within the tonsils. On OPG, if the tonsils fall outside the focal trough, they may cause ghosting.

Differential diagnosis

Potentially more serious etiologies of tonsillar calcification, e.g. foreign bodies and neoplasm need to be excluded, although these entities will usually be easy to distinguish from simple tonsilloliths.

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