CherelleV Asked :

I am a 27 year old female and recently when I cough I find some food particles collect in my mouth. It doesn’t always happen but it is often. If I am alone I spit out these particles and they look like small grains of rice – more like risotto rice grains. They are almost white and very soft. Its not tonsil stones. If I smell it closely it has a terrible odor, like something rotting. I am worried because I am not sure where this is coming from. I don’t even eat much rice.

The other problems that I have been experiencing recently is like a a dull ache of the throat. It’s not a sore throat but I think this may be related to my acid reflux which has been a problem for years. I had these types of throat irritation before but now I constantly feel like I need to clear my throat and while I know it is not very polite to do so in public, I can’t help it. This has become a bit awkward and sometimes when I hold it in I feel like I am going to gag. Sometimes when I clear it I get some mucus collecting at the back of the throat.

I have seen two doctors and they both gave me a different diagnosis. The first doctor said that I was coughing up food particles that were coming from my stomach due to the GERD. He also said the throat ache is due to the rising gastric acid at night. He gave me some meds for acid reflux – it helped a little but after completing, it has stayed the same.

Another doctor says that I have chronic tonsillitis which is worse due to my post nasal drip and that food particles are getting stuck in the tonsils. He told me to take out my tonsils because my they are practically eaten up. I refused so he put me on a long course of antibiotics, nasal spray and so on. He told me to stop smoking, which I did somewhat, but the symptoms never went down and I went back to smoking. I have only been smoking for 3 years and I don’t have a smoker’s cough or anything.

So what could be the problem and what’s next?

This question was posted under the Causes of Chronic Cough – Persistent, Constant Coughing article.

Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.

Dr. Chris Answered :

It is most likely that both your doctors are correct but looking at the problems separately. Post nasal drip often aggravates a case of tonsillitis and so does GERD. Rising gastric acid, especially when you are sleeping, irritates the already inflamed tonsils. Food easily gets trapped in the tonsillar crypts of the swollen tonsils. When you cough, these food particles are pushed out of the tonsils and into your mouth.

The second doctor may mean that parts of your tonsils are becoming necrotic (What is Necrosis?)and in this case it should be removed. If left untreated, it can be prone to repeated infections, affect surrounding healthy tissue, cause bad breath (halitosis) and lead to a host of complications – some of which can be serious. Treatment of the condition will only be effective in the short term. Regurgitating food as a result of GERD is a possibility but it would not always be these small specks and it should mainly occur in the mornings or after sleep.

In terms of the ‘rice’ – it may not actually be rice. Small specks of food may be getting trapped in the tonsillar crypts where it decays slightly and coalesces into these ‘grains’ that you see. As with any decomposing matter, it smells putrid. The mucus may be as a result of the post nasal drip or it could be exudate from the tonsils itself. The irritation caused by the inflamed tonsils plus the ‘dripping’ mucus as a result of post nasal drip will constantly give you that urge to clear the throat.

You need to see an otolaryngologist (ENT specialist) who will  be able to examine the area better and decide on the most appropriate course of treatment. In all likelihood a tonsillectomy may be necessary. Take note that tobacco smoking will aggravate your tonsillitis, post nasal drip and GERD.

Article reviewed by Dr. Greg. Last updated on May 16, 2010