Bad Breath Halitosis Forum

Hi guys. I saw two ENT's in a span of one week. My concerns are, aside from the cH that comes out of my mouth and nose, there are small white dots that come out with my phlegm. I understand that these could be the tonsiloliths, but my tonsils are small and have no visible crypts.

I had a problem with the CR-rom of my sinuses CT scan the time I saw ENT no.1 but he saw the written report anyway. He said that my sinuses are clear. He advised me to have a tonsillectomy (palatine). However, since he did not see the photos of my endoscopy, he doubted if I still have adenoids.

This is a university associate professor so he was very elaborate in explaining stuff to me. He says that there is no way that halitosis-causing bacteria (or tonsiloliths) can hide in the adenoids as the surface of the crypts in the adenoids,although wavy, are very smooth.

Now, since I have already undergone chest x-ray, gastric scope, tests on salivary glands, endoscopy and CT scan, and have eliminated any diseases on these areas, it is the best time to focus on my palatine and lingual tonsils - these two are the only breeding places left for bacteria and small tonsil stones that come out with my mucous.

He said that tonsil stones breed mainly in the palatine but they also breed in the lingual. However, lingual has so much fewer crypts.

He said that he does not normally advise lasering the lingual tonsils as I will be required to stay in the ICU during my full recovery period. The procedure is not complicated but post-procedure is very risky as it is located directly in the airway. However, it can be done.

He advised palatine tonsillectomy for about $5,000 as outpatient (about US$3500). A little pricey because he does procedure mainly at an upscale medical suit. He can also do cryptolysis but this will cost way much more.

The ENT no.2 said almost exactly the same thing. But since I have the proper CT scan CD rom, the only difference is that he performed another set of endoscopy to see whether my adenoids are normal. And they are.
However, tonsillectomy in the hospital where his clinic is located will cost me about $3,000 (about US$2,000).


I need advise on:

1. My insurance has a pre-requisite clause of procedure being non-elective. The ENT no.2 said that anything that does not fall into any of the 2 categories (life-threatening and clinically urgent) is considered elective. Recurrent tonsilitis of 6-7 times a year is still considered elective. He is a senior consultant at a private hospital that is government-linked, so I was thinking that maybe their set of criteria will be more strict than most. I have not asked ENT no.1 yet. But guys, would you know the criteria of being elective/non elective in general, especially in the private clinics?

2. Both doctors did not think that my adenoids has anything to do with my cH. So both said there is no need for adenoidectomy. However, I noticed that most people here who have some success have had both palatine tonsils and adenoids removed. Should I insist on adenoidectomy as well?

Hi!

Thanks for bringing up the lingual tonsils with the ENT. It may have smaller crypts, but it is the area where we stink the most (at least, most of us do). Did he explain how the lasering of the linguals is done? Do they smoothen the entire area?



As for the palatine tonsils, I've had mine out for more about 10 years and it made very little, if any, difference. I did have little white tonsil stones before the surgery, but not after, so that vanished. But the general bb problem was not affected.

Adenoids: I've only heard of one case on this forum who had a genuine problem with them. She said they were kind of rotten inside ... like the entire adenoids were filled with abscess. Most adults don't even have adenoid tissue so it's generally not a problem...

If it is the case that the very far back of your tongue smellst the worst, I'd recommend asking the doc more about lasering of the lingual tonsils (possible side effects after surgery etc) and possibly go down that route.

Larc, yes he (ENT no.1) does laser the entire lingual tonsil. He told me that any form of swelling or bleeding in the lingual may likely shut the airway, so staying in the ICU is a must.

However when I mention lasering my lingual tonsil to ENT no.2, he looked shocked and said he does not advise that, unless the patient is in critical condition. I kinda think that private upscale doctors are more lenient to patients request provided you have the dough.

I will try palatine tonsillectomy as this is the only procedure and risk that I can afford at the moment.