Tonsil stones more common than you think

Dear Dr. Roach: Could you share some information about tonsil stones? I had never heard of them until I took my 15-year-old granddaughter to the doctor for a sore throat and she was shown one. It stayed there for about four days until it came out. B.H.

The tonsils have deep pouches called crypts. There, food and secretions can collect and become calcified. When the tonsils are large, as happens in a viral illness, this is more likely.

Stones are more common than you think, but they only come to a person’s attention if they cause discomfort, or sometimes because of their unpleasant odour. They usually can be removed with saltwater gargles, but I don’t recommend trying to remove them with a cotton swab or your finger, as this can make you gag and occasionally can cause bleeding.

Very rarely, a stone is large enough to cause symptoms requiring removal. I have heard of cases where the stones kept forming, causing such bad breath that a tonsillectomy was necessary. In most people, however, they will pop out on their own. Dear Dr. Roach: I’m going to be 90 years young, and my doctor says I’m considered a prediabetic. I now live in a senior-living home, and my new doctor is great — and gives me printouts of my labs. My glucose level is 120 (it should be 65-99). I was told to watch my diet. What do you suggest?

T.S. A blood glucose level between 100 and 125 does indicate prediabetes, a risk factor for developing Type 2 diabetes. Risk for diabetes increases with age.

I agree with your doctor that a good diet can reduce your risk of developing overt diabetes, and this means limiting the amounts of simple sugars while consuming plenty of vegetables. There are many different dietary styles that are healthy, and you should eat what you enjoy, as long as you stay away from too many sweets.

I am sure there are nutrition experts at your senior-living home — hopefully, a highly trained one, a registered dietitian nutritionist — who can work with you to help you choose a healthy diet plan. At age 90, I think you should eat what you enjoy, but I bet you can find ways to do so while still reducing your risk of diabetes. Dear Dr. Roach: Why would a person lose his or her voice after carotid surgery? It’s been more than three months.

Anon. Some changes to the voice are common after any surgery. This is due to the placement of the endotracheal tube, which passes through the vocal cords.

However, that usually goes away in a few hours, or a day or two. Three months makes me worry about damage to the recurrent laryngeal nerve, which provides the nerve supply to the vocal cords. Damage to the nerve can cause variable symptoms, from hoarseness to a complete loss of voice.

Damage to the recurrent laryngeal nerve is fairly common in carotid surgery. One study found that 18 per cent of people undergoing carotid surgery had some damage to vocalcord function — some had no symptoms, and the remainder recovered, except for one patient out of 50, who had permanent damage.

Damage to the vocal cord can be diagnosed by an ENT doctor via laryngoscopy or videostroboscopy. It’s important to make a diagnosis, since there are other causes.

Although the timing of the carotid surgery seems to make it definitive as the cause, hoarseness and vocal loss are important signs of neck tumours. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu.