Differential Diagnosis for Foul Smelling Pebbles from the Back of the Throat

• Single Most Likely Diagnosis
  • Tonsilloliths (Tonsil Stones): These are small, hard white or yellowish formations that can develop on the surface of the tonsils. They are made up of trapped debris, such as dead cells, mucous, and bacteria, which can cause bad breath and a feeling of something being stuck in the throat. The description of "foul smelling pebbles" closely matches the presentation of tonsilloliths.
• Other Likely Diagnoses
  • Postnasal Drip: This condition involves the accumulation of mucus in the back of the throat, which can harden into small, foul-smelling clumps. While not exactly "pebbles," the sensation and odor can be similar.
  • Sinus Infection: Chronic or acute sinusitis can lead to the production of foul-smelling discharge that may be coughed up or felt in the back of the throat.
• Do Not Miss Diagnoses
  • Lung Abscess: Although rare, a lung abscess can cause foul-smelling sputum, which might be perceived as coming from the back of the throat. Missing this diagnosis could lead to severe consequences, including sepsis.
  • Oral or Pharyngeal Cancer: While less common, cancers in the mouth or throat can cause bad breath and the sensation of something being stuck. Early detection is crucial for effective treatment.
• Rare Diagnoses
  • Foreign Body: It's possible, though rare, for a small object to be lodged in the throat, causing a foul odor. This would typically be associated with a history of ingestion or insertion of an object.
  • Esophageal Diverticulum: A condition where a pouch forms in the wall of the esophagus, potentially leading to the accumulation of food and debris, which can cause bad breath and the sensation of something being stuck in the throat.