Tonsil stones can still be seen even in a patient with a strong gag reflex.
Using the High Definition video endoscope a view of the tonsils is possible without actually putting the endoscope into the patients mouth, as in this case where the gag reflex was so strong there was no chance of putting anything in the mouth. This man wasn’t suitable for local anaesthetic laser tonsillectomy though. The stone itself could probably be eradicated using the laser from a distance but proper removal of the tonsil would not be possible. He needs a general anaesthetic laser tonsillectomy to get around this problem.