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Jai Ganesh

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Registered: 2005-06-28

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Tonsils

Tonsils

Gist

Tonsils are two oval-shaped, immune-system tissue pads located at the back of the throat that act as a first line of defense against ingested or inhaled pathogens. They commonly become inflamed (tonsillitis) due to viruses or bacteria, causing sore throat, swelling, and difficulty swallowing. Treatments include antibiotics for bacterial infections, rest, and sometimes surgical removal (tonsillectomy).

Causes of tonsil issues (tonsillitis) are primarily viral or bacterial infections, like the cold, flu, or strep throat, but can also involve tonsil stones (tonsilloliths) from trapped debris, or more rarely, tonsil cancer, linked to HPV, tobacco, and alcohol. Tonsils, as part of the immune system, often get inflamed fighting germs, especially in children, leading to symptoms like sore throat, fever, and difficulty swallowing. 

(HPV:  human papillomavirus)

Summary

The tonsils are a set of lymphoid organs facing into the aerodigestive tract, which is known as Waldeyer's tonsillar ring and consists of the adenoid tonsil (or pharyngeal tonsil), two tubal tonsils, two palatine tonsils, and the lingual tonsils. These organs play an important role in the immune system.

When used unqualified, the term most commonly refers specifically to the palatine tonsils, which are two lymphoid organs situated at either side of the back of the human throat. The palatine tonsils and the adenoid tonsil are organs consisting of lymphoepithelial tissue located near the oropharynx and nasopharynx (parts of the throat).

Function

Tonsils are key components of the immune system, acting as the body's first line of defense against inhaled or ingested pathogens. Located at the entrance of the respiratory and digestive tracts, they monitor and respond to microbes by initiating immune responses. The tonsils contain a dense network of immune cells including B lymphocytes, T lymphocytes, macrophages, and dendritic cells. These cells interact within specialized regions called germinal centers, which become especially active during infections. Within these centers, B cells undergo activation, class switching (changing the type of antibody they produce), and somatic hypermutation of their antibody genes to better recognize and neutralize pathogens.  Tonsils have a unique lymphoepithelial structure, with immune cells embedded within epithelial tissue, creating a direct interface with the external environment. This architecture facilitates efficient sampling of incoming bacteria and viruses through specialized M cells in the epithelium. The crypts in palatine tonsils significantly increase the surface area for antigen sampling, enhancing immune surveillance. The tonsillar immune response produces various antibodies—particularly immunoglobulins like IgA, IgG, and IgM—which contribute to both local and systemic immunity. Secretory IgA is especially important as it provides mucosal protection against pathogens before they can establish infection. In essence, the tonsils serve as immune surveillance stations, training grounds for antibody-producing cells, and barriers against infection at the body's entry points.

Details

Your tonsils, located in the back of your throat, are part of your immune system. They help fight infection and disease. Sometimes, you can develop issues with your tonsils, such as pain, swelling and infection. If these issues are chronic, your healthcare provider might recommend a tonsillectomy (tonsil removal).

Overview:

What are tonsils?
Your tonsils are two round, fleshy masses in the back of your throat (pharynx). Part of your immune system, your tonsils are like lymph nodes. They help filter out germs that enter through your nose or mouth to protect the rest of your body from infection. Tonsils are also called palatine tonsils or faucial tonsils.

Sometimes tonsils can become red, swollen or infected. If this issue becomes chronic or doesn’t get better, your healthcare provider might recommend a tonsillectomy (tonsil removal). Typically, people who have their tonsils removed can still fight off infection without any problems. Your body can find other ways to combat germs.

Function:

What’s the purpose of tonsils?

The main function of tonsils is fighting infection. Your tonsils contain a lot of white blood cells, which help kill germs. As your tonsils are in the back of your throat, they can “catch” germs that enter your body through your nose or mouth.

Anatomy:

Where are your tonsils?

Your tonsils are near the back of your throat, just behind your soft palate. There are two of them — one on each side.

What do my tonsils look like?

If you still have your tonsils, you can see them when you open your mouth wide and look in the mirror. They’re oval-shaped, pinkish mounds of tissue located on each side of your throat.

What color are my tonsils?

Healthy, normal tonsils are pinkish in color. But your tonsils can appear red and swollen if they’re inflamed or infected.

How big are the average tonsils?

Tonsil size varies significantly from person to person. But based on one research study:

* The average overall tonsil size is 42.81 cubic centimeters (cu cm).
* The average tonsil size in women is 37.65 {cm}^{3}.
* The average tonsil size in men is 52.4 {cm}^{3}.

To put this into perspective, each of your tonsils is slightly larger than a marshmallow.

Conditions and Disorders:

What are some conditions that affect tonsils?

There are a few different conditions that can affect your tonsils. The most common is tonsillitis — an infection of the tonsils. Bacteria and viruses can cause tonsillitis, and the infection can be short-term (acute) or long-term (chronic). The most common tonsillitis symptoms include a sore throat and swollen tonsils.

Other conditions that can affect your tonsils include:

* Strep throat. Caused by a bacterium known as Streptococcus, strep throat can cause sore throat, neck pain and fever.
* Tonsil stones. Also called tonsilloliths, tonsil stones are small white or yellow lumps in your tonsils. They can lead to tonsil pain, bad breath or bad taste.
* Peritonsillar abscess. A pocket of infection that pushes your tonsil to the other side of your throat, a peritonsillar abscess can cause difficulty swallowing or breathing. (If this happens, contact your healthcare provider immediately. Prompt treatment is essential.)
* Mononucleosis. Caused by a herpes virus called Epstein-Barr, mononucleosis can result in swollen tonsils, sore throat, fatigue and skin rash.
* Enlarged (hypertrophic) tonsils. Larger-than-normal tonsils can block your airway, leading to snoring or sleep apnea.
* Tonsil cancer. The most common form of oropharyngeal cancer, tonsil cancer is often linked to the human papillomavirus (HPV). Symptoms include tonsil pain, a lump in your neck and blood in your saliva (spit).

Are there tests to check the health of my tonsils?

Yes. If your healthcare provider suspects an issue with your tonsils, they may recommend:

* A bacterial culture test. Your provider rubs a cotton swab on your throat and tonsils. Then, they send the sample to a lab for analysis. A throat culture can check for different bacterial infections, including tonsillitis, strep throat and pneumonia.
* Blood tests. If your provider thinks your tonsil pain is due to mononucleosis, they can request a monospot test. This blood test detects certain antibodies, which can help confirm your diagnosis. (If the monospot test comes back negative, they can check for Epstein-Barr antibodies in your blood. This can also help determine whether you have mononucleosis.)

Additional Information

The tonsils are part of the body’s immune system. Because of their location at the throat and palate, they can stop germs entering the body through the mouth or the nose. The tonsils also contain a lot of white blood cells, which are responsible for killing germs.

There are different types of tonsils:

* Palatine tonsils (tonsilla palatina)
* The adenoids (pharyngeal tonsil or tonsilla pharyngealis)
* Lingual tonsil (tonsilla lingualis)

The two palatine tonsils are found on the right and left of the back of the throat, and are the only tonsils that can be seen unaided when you open your mouth. The adenoids are found high up in the throat, behind the nose, and can only be seen through rhinoscopy (an examination of the inside of the nose). The lingual tonsil is located far back at the base of the tongue, on its back surface.

All of these tonsillar structures together are sometimes called Waldeyer's ring since they form a ring around the opening to the throat from the mouth and nose. This position allows them to prevent germs like viruses or bacteria from entering the body through the mouth or the nose. There are also more immune system cells located behind Waldeyer's ring on the sides of the throat. These cells can take on the function of the adenoids if they have been removed.

The palatine tonsils can become inflamed. Known as tonsillitis, this makes them swell up and turn very red. They often have yellowish spots on them as well. The most common symptoms are a sore throat and fever.

The palatine tonsils and the adenoids may become enlarged, especially in children. That makes it harder to breathe and causes sleep problems. Because of these problems, tonsil surgery is sometimes recommended.

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