Sir, a 42-year-old female attended my surgery for an emergency appointment, complaining of a swelling in her throat. This swelling appeared sporadically, and was most perceptible immediately after eating. Following two visits to her GP, who found nothing on examination, she felt I was her last resort as she was becoming increasingly frustrated by the irritating sensation when swallowing. My examination revealed extremely large but healthy tonsils. Thanks to her patience and lack of pharyngeal reflex, I was able to see a single white mass present in a crypt of her right tonsil. My initial impression, due to its irregular occurrence and soft lumpy appearance was either food debris or perhaps a tonsil stone (although she had no history of tonsillitis).

As a foundation dentist, I have had little experience in this area. Fortunately, I had seen an episode of Channel 4's 'Embarrassing Bodies' where a patient had experienced a similar problem. I removed the mass carefully with a cotton bud. It was indeed food debris, accumulating most likely due to her large tonsils. I advised her to adopt this method in the future, along with salt-water mouth rinses, and I also sent a letter to the GP.

The patient was relieved and extremely grateful to have a solution to this frustrating problem, which she has lived with for a number of years. However, I felt it best not to tell her where I came across the answer!

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