The palatine tonsils are two oval-shaped masses of fleshy, lymphoid tissue situated at the back of the throat, technically known as the oropharynx. In their normal, healthy state, these structures have a pinkish color and their size can vary considerably from one person to another. If you open your mouth wide and look in a mirror, you can see these lumps of tissue on either side of the uvula, the fleshy extension that hangs from the soft palate.
Anatomy and Immune Function
The palatine tonsils are a component of the mucosal-associated lymphoid tissue (MALT) system. They are part of a larger structure called Waldeyer’s ring, a circle of lymphatic tissue that also includes the adenoids and lingual tonsils. This ring is positioned at the entrance of the respiratory and gastrointestinal tracts, allowing it to act as a first line of defense against pathogens entering the body through the mouth or nose. The tonsils’ main role is to sample materials that are ingested or inhaled and then help to stimulate an immune response.
The surface of each palatine tonsil is not smooth; it is covered in small pits known as tonsillar crypts. These crypts increase the surface area of the tonsils, which enhances their ability to trap incoming bacteria, viruses, and other foreign materials. Within the tonsil tissue are specialized immune cells, including B-cells and T-cells. When pathogens become trapped in the crypts, these cells are activated to help fight off potential infections.
Common Palatine Tonsil Conditions
Because the tonsils are trapping germs, they are prone to infection and inflammation, a condition called tonsillitis. Tonsillitis can be acute, meaning it is a short-term infection, or chronic, where the infection persists over a longer period. Viral infections are the most frequent cause, accounting for up to 70% of cases, though bacteria like Streptococcus can also be responsible. Symptoms include a sore throat, fever, swollen tonsils that may appear red, and difficulty swallowing.
Another issue is the formation of tonsil stones, or tonsilloliths. These are small, hard deposits that form when debris, such as dead cells, mucus, and food particles, becomes trapped in the tonsillar crypts and calcifies. The primary symptoms are persistent bad breath, also known as halitosis, and a sensation that something is lodged in the back of the throat. The stones appear as white or yellow specks on the tonsils.
In some individuals, particularly children, the palatine tonsils can become persistently enlarged, a condition referred to as hypertrophic tonsils. This enlargement can occur without any active infection but may cause problems by physically obstructing the airway. Symptoms of hypertrophic tonsils include loud snoring, irregular breathing during sleep, and in more severe cases, obstructive sleep apnea, a condition where breathing repeatedly stops and starts.
Reasons for Tonsil Removal
A tonsillectomy, the surgical removal of the palatine tonsils, may be recommended when certain conditions become recurrent or severe. One of the most common reasons is experiencing repeated bouts of acute tonsillitis. Healthcare providers may consider removal if a person has had a specific number of throat infections over the course of one to three years. Chronic tonsillitis that does not resolve with other treatments is another indication for surgery.
Enlarged tonsils that cause airway obstruction are another primary reason for removal. When tonsillar hypertrophy leads to conditions like obstructive sleep apnea, which disrupts sleep and can affect mood and behavior, a tonsillectomy is advised.
Less common reasons for a tonsillectomy include complications like a peritonsillar abscess. This is a collection of pus that forms near the tonsil and can cause pain and difficulty opening the mouth. A tonsillectomy might also be performed if there is a suspicion of a tumor on one of the tonsils or if tonsil stones are a recurring problem that other treatments cannot resolve.