Tonsils in the throat: what they are, why we need them, and how they relate to adenoids

The tonsils are clusters of lymphoid tissue in the nasopharynx and oral cavity. Together with other lymphoid formations, they make up the pharyngeal lymphoid ring of Pirogov–Waldeyer and serve as the first line of defense against inhaled pathogens. Below: what tonsils are, why we need them, how they differ from adenoids, and why the throat hurts after their removal.

What the tonsils are and where they are located

The tonsils (Latin tonsillae) are clusters of lymphoid tissue in the nasopharynx and oral cavity. The name "tonsils" goes back to the Greek word for "almond," and "glands" to the French glande and Latin glans, "acorn."

The palatine tonsils lie in the recess between the soft palate and the tongue and are visible on the sides of the throat. The tubal tonsils are at the pharyngeal opening of the auditory tube, the lingual tonsil is under the back of the tongue, and the pharyngeal tonsil is in the region of the vault and posterior wall of the pharynx; the palatine and tubal tonsils are paired, while the pharyngeal and lingual tonsils are unpaired.

Tonsils and adenoids: how they differ

"Glands" is the everyday name for the tonsils, most often the palatine tonsils. Adenoids are a pathologically enlarged pharyngeal (nasopharyngeal) tonsil: it lies higher up, behind the nose, and cannot be seen through an open mouth.

Both structures are part of the lymphatic system, which clears the body of infection and maintains fluid balance. The adenoids usually shrink after age five and almost disappear by adolescence.

Enlarged adenoids are a common problem in children. They interfere with nasal breathing, cause snoring, restless sleep, a runny nose, and ear infections, and mouth breathing leads to dry mouth and cracked lips.

What role the tonsils play in protecting the body

The tonsils and adenoids catch microbes entering through the mouth and nose. An analogy from acoustics: they are microphones right at the stage — they are the first to pick up the signal and the first to suffer from overload.

The full immunological role of the tonsils, however, remains unclear.

Tonsil diseases: what types there are

Acute tonsillitis is inflammation of the palatine tonsils. It is most often caused by viruses, as with a cold, and less often by bacteria, such as the causative agent of streptococcal pharyngitis.

Tonsillitis is a common childhood illness, but adolescents and adults get it too. The symptoms resemble a severe cold or flu:

• sore throat and difficulty swallowing;
• high fever, cough, headache, earache, fatigue, nausea;
• enlarged and tender lymph nodes in the neck;
• white patches or pus spots on the tonsils, bad breath.

Symptoms usually resolve within 3–4 days but may last longer. Tonsillar hypertrophy occurs mainly in childhood and requires no treatment in the absence of functional impairment. Complications of tonsillitis are very rare: sometimes pus accumulates between the tonsil and the pharyngeal wall (an abscess, called peritonsillar or "quinsy").

Why the throat can hurt without tonsils

After removal of the palatine tonsils, the lymphoid tissue of the ring does not disappear completely: the lingual, tubal, and pharyngeal tonsils remain. Sore throat is a common symptom, and it is caused by various conditions, not only the tonsils. That is why a throat without tonsils hurts for the same reasons as a throat with them.

When the condition of the tonsils requires a doctor's examination

A doctor usually recognizes tonsillitis from the history and examination of the throat. Sometimes a swab from the posterior pharyngeal wall is needed to determine whether the cause is bacterial, and a blood test for glandular fever if symptoms are severe or do not resolve.

You should see a doctor if symptoms last more than a week or throat infections recur. The adenoids are located above the level of the throat, so their size is assessed with a mirror in the oral cavity, a flexible endoscope, or an X-ray.

Tonsil removal is performed very rarely — for severe tonsillitis that keeps coming back again and again.

Inflammation of the tonsils itself is not a reason to call an ambulance. Call 103 or 112 if severe sore throat is rapidly worsening, there is swelling inside the mouth and throat, it is difficult to speak, swallow, or breathe, or it is difficult to open the mouth — these are signs of pus accumulating behind the tonsil.

This material is for reference and does not replace a doctor's consultation: only an in-person examination will show what is happening with the throat.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer