Tonsillar calculi. Report of a case and review of the literature.

A large tonsillar calculus in a 77-year-old demented woman with a history of chronic oral infections and multiple episodes of pneumonia is reported. Earlier literature describes these calcium-laden tonsilloliths as occurring in adolescence following chronic tonsillitis. Improvement in health care of the young and antibiosis militate against tonsilloliths as a serious problem in the young patient. Conversely, an ever-increasing aged population, with impaired self-care abilities or diminished cerebral function, many of whom populate nursing care facilities, and increased routine oropharyngeal screening of the aged may add significantly to the number of reported cases. In view of the potential for continuous oropharyngeal disease and the possibilities of swallowing disturbances, pneumonia, or food or liquid aspiration, which may result in lethal complications the authors urge the clinician to assess masses or calcified objects viewed on physical examination or radiographs, explore their etiology, evaluate them for removal, and not dismiss them as clinically insignificant.