Persistent Bad Breath After Tonsillectomy: Possible Causes and Solutions

Bilateral tonsillectomy performed?

I have been experiencing an unpleasant odor in my mouth for over three years.
Last year, I visited an ENT specialist and was diagnosed with tonsil stones.
However, when they were removed, they were in a paste-like form rather than individual stones.
Despite this, the doctor recommended surgery, which I underwent in November 2023.
Initially, the odor persisted, and I thought it would take some time to completely disappear.
However, nearly six months have passed, and the taste and symptoms are exactly the same as before the surgery.

I am unsure if the stones only form in the tonsils or if there are other areas in the throat that could harbor stones.
I recall that there are three areas in the throat where tonsils are located.
Is it possible that since only the palatine tonsils were removed, the stones could still be forming elsewhere? Could you please list the possible reasons for this situation? The doctor had mentioned that after the surgery, there would be no odor, yet I am facing this outcome, and it has also been quite costly.

Niming, 20~29 year old female. Ask Date: 2024/04/01

Dr. Ji Zhaoyun reply Otolaryngology

Hello, theoretically, tonsil stones mostly occur in the palatine tonsils, while the likelihood of them forming in the lingual tonsils and pharyngeal tonsils is extremely low.
It is recommended to consult your original surgeon if you have any issues.
As for bad breath, in addition to tonsil stones, it can also be caused by post-nasal drip (such as from sinusitis), gastroesophageal reflux disease (GERD), periodontal disease, cavities, and more.
You may want to examine these possibilities yourself.

Reply Date: 2024/04/01

More Info

Persistent bad breath, or halitosis, after a tonsillectomy can be frustrating and concerning, especially when one expects a resolution following surgery. There are several potential causes and considerations to explore regarding your ongoing symptoms.

Possible Causes of Persistent Bad Breath After Tonsillectomy
1. Residual Tonsil Tissue: Even after a tonsillectomy, there may be residual tonsil tissue that can harbor bacteria and contribute to bad breath. If any tonsillar remnants remain, they can still form crypts where food particles and bacteria accumulate, leading to halitosis.

2. Other Lymphoid Tissue: The throat contains other lymphoid tissues, such as the adenoids and other small tonsils (lingual tonsils), which can also become inflamed or infected. If these areas are not addressed during surgery, they may still contribute to bad breath.

3. Infection or Inflammation: Post-operative infections can occur, leading to inflammation and the production of foul-smelling discharge. This could be due to bacteria or even a fungal infection, especially if antibiotics were used post-surgery.

4. Dry Mouth (Xerostomia): If you are experiencing dry mouth, this can significantly contribute to bad breath. Saliva plays a crucial role in washing away food particles and bacteria. If your mouth is dry, bacteria can thrive, leading to persistent halitosis.

5. Dietary Factors: Certain foods, such as garlic, onions, or spicy foods, can contribute to bad breath. Additionally, if you have changed your diet post-surgery, this might also affect your breath.

6. Gastroesophageal Reflux Disease (GERD): If you have GERD, stomach acids can reach the throat and mouth, leading to bad breath. This condition can be exacerbated by changes in diet or medication post-surgery.

7. Oral Hygiene: Poor oral hygiene can lead to the accumulation of plaque and bacteria on the teeth and tongue, contributing to bad breath. It is essential to maintain a rigorous oral hygiene routine, including brushing your teeth and tongue and using mouthwash.

Solutions and Recommendations
1. Follow-Up with an ENT Specialist: It is crucial to follow up with your ENT specialist to discuss your ongoing symptoms. They may perform a thorough examination to check for any residual tonsil tissue or other issues in the throat.

2. Oral Hygiene: Ensure you are practicing good oral hygiene. Brush your teeth at least twice a day, floss daily, and consider using an antibacterial mouthwash. Additionally, cleaning your tongue with a tongue scraper can help reduce bacteria that cause bad breath.

3. Hydration: Stay well-hydrated to combat dry mouth. Drinking plenty of water can help stimulate saliva production, which is essential for maintaining oral health.

4. Saliva Substitutes: If dry mouth is a significant issue, consider using saliva substitutes or oral moisturizers available over the counter.

5. Dietary Adjustments: Monitor your diet for any foods that may exacerbate bad breath. Reducing the intake of strong-smelling foods and increasing fresh fruits and vegetables can help.

6. Addressing GERD: If you suspect GERD, consult with a gastroenterologist for evaluation and management. Lifestyle changes, dietary modifications, and medications may be necessary.

7. Regular Dental Check-Ups: Regular visits to the dentist can help identify any oral health issues that may contribute to bad breath, such as gum disease or cavities.

In conclusion, persistent bad breath after a tonsillectomy can stem from various causes, including residual tonsil tissue, other lymphoid tissues, infections, dry mouth, dietary factors, GERD, and oral hygiene practices. It is essential to consult with your healthcare provider for a comprehensive evaluation and tailored treatment plan to address your specific situation.

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