Conservative management technique which is typically the first-line recommendation for small, symptomatic tonsilloliths

 # Which conservative management technique is typically the first-line recommendation for small, symptomatic tonsilloliths?

a) Daily high-dose Vitamin D supplementation

b) Long-term prophylactic antibiotics

c) Vigorous gargling with salt water or a non-alcoholic mouthwash

d) Chemical cautery of the crypts

The correct answer is c) Vigorous gargling with salt water or a non-alcoholic mouthwash

Vigorous gargling is the first-line conservative management for small, symptomatic tonsilloliths (tonsil stones <5 mm causing mild halitosis, foreign body sensation, or low-grade discomfort), as it mechanically dislodges trapped debris from crypts without instrumentation risks. A warm saline solution (1/2–1 tsp salt in 8 oz water) or alcohol-free mouthwash (e.g., chlorhexidine-free to avoid irritation) is recommended 2–4 times daily for 1–2 weeks, with success rates of 60–80% in mild cases per otolaryngology guidelines (e.g., AAO-HNS and NICE). It promotes crypt flushing, reduces bacterial load, and alleviates symptoms cost-effectively at home.

The other options are not first-line: Vitamin D (a) lacks evidence for tonsillolith prevention; prophylactic antibiotics (b) are reserved for secondary infection and risk microbiome disruption; chemical cautery (d) is an office-based procedure for refractory crypts, not initial therapy. If ineffective, escalate to manual expression or laser cryptolysis before surgery.