Hi,

Thank you for your query.

1. A differential will include mostly benign conditions such as a tonsillolith, area of lymphoid hypertrophy, accessory lymphoid tissue, inflamed minor salivary gland tissue, abscess in the peritonsillar space. However this would be unusual without local inflammation and lymph node tenderness in the neck.

2. Tonsilloliths are concretions of food particles and pus lodged in the natural crypts of the palatine tonsils. The white discharge is sometimes referred to as 'cheesy' or even 'toothpaste' like in consistency. The largest crypt is known as the crypta magna and is located near the upper pole of the palatine tonsil. This may cause a local swelling.

3. When we swallow, our palatine tonsils rub against the food bolus and pick up food particles. This food debris decays there while it is analysed for antigens, foreign bodies and organisms by the lymphoid tissue which forms the bulk of the tonsils. Below the age of five years, this is especially important in the deveopment of immunity.

4. The simplest course of action will be a course of antibiotics, anti-allergics, anti-inflammatory agents and medicated gargles. If there is no improvement, an excision biopsy and a histopathological examination which will reveal the true diagnosis of the bump. As long as it is a limited mass, surgery will be minor. You may follow up with the HPE report here.

5. For recurrent large tonsilloliths or peritonsillar abscesses, the only definitive treatment is tonsillectomy. As you have halitosis (bad breath), you may try regular use of a medicated gargle and continue manually expressing them while brushing your teeth.

6. I must emphasize that the chance of a cancerous growth at your age is rare. Tonsilloliths may be ignored and treated with simple medication as above, however the fleshy lump should be shown to a doctor.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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