My husband frequently complains that he coughs up small, foul-smelling white chunks. Is this a sign of something serious?

Your husband probably has tonsilloliths, also known as tonsil stones. These small white stones form when food particles, mucus and other debris build up in the crypts (or “holes”) of tonsils and eventually harden. Tonsil stones can be as tiny as a grain of rice or as big as a pencil eraser. Some people have only one stone, but others have several tiny ones all over both tonsils.

Big or small, all tonsil stones may have a foul odor! Here’s why: Bacteria that produce the smelly volatile sulfur compounds methyl mercaptan and hydrogen sulfide build up on stones and cause bad breath (halitosis).

Most tonsil stones aren’t painful, but they can become rock hard. When this happens, it can produce the sensation of having a pin in your throat. Other symptoms include sore throat, ear pain, swelling in the throat and difficulty swallowing.

What causes tonsil stones? Poor dental hygiene and chronic sinus problems are factors. To help keep stones away, your husband should brush his teeth and tongue twice a day.

How it’s done: After regular brushing, the toothbrush should be swept across the tongue—from back to front and side to side. Be careful not to break the skin. Then the mouth should be thoroughly rinsed with water. Some people find it more convenient to use a tongue cleaner (available at drugstores for a few dollars).

If these steps don’t eliminate your husband’s tonsil stones, he can try to gently remove them with a toothbrush or cotton swab, but pulling too hard can cause tonsils to bleed. It’s best to use a water irrigator, such as the HydroPulse (a product that I invented), to flush stones. It comes with a special throat adaptor designed specifically for tonsil stones. You can also find tonsil stone removers from Airgoesin and Tonsil Tools Co. All these products are available online. For instructions of their use, follow the manufacturer’s directions.