Tonsils: Function, Anatomy, and Diseases

What are the tonsils?

The tonsils (tonsils) are part of the body’s immune defenses – the first “guardians,” so to speak, of all that is inhaled or ingested. They include:

  • Palatine tonsil (Tonsilla palatina)
  • Tonsil (Tonsilla lingualis)
  • Pharyngeal tonsil (Tonsilla pharyngealis) – colloquially known as “adenoids” in children
  • Tubal tonsil or “lateral cord” (Tonsilla tubaria)

Palatine and tubal tonsils are present in pairs, lingual and pharyngeal tonsils are present in unpaired pairs. All together form the lymphatic pharyngeal ring (Waldeyer’s pharyngeal ring).

When people colloquially refer to tonsils or tonsillitis, this usually refers to the palatine tonsils – the highly furrowed islands of tissue behind the palatal arch.

What is the function of the tonsils?

The function of the tonsils is local immune defense, which is why they contain a great many white blood cells (leukocytes and lymphocytes). If viruses, bacteria or fungi enter the throat with food or breath, they are eliminated by the tonsils as far as possible. If germs enter, the rest of the immune system is alerted to take up the fight against the invaders.

Where are the tonsils located?

The palatine tonsils are located in the so-called oral pharynx (oro- or mesopharynx), the middle part of the pharynx, on both sides of the palate behind the palatal arch. They are usually visible when the mouth is wide open. Also located in the oral pharynx are the lingual tonsils.

In the upper pharyngeal section (nasopharynx), the pharyngeal tonsils are found, and on the side walls, the lateral tonsils (tubal tonsils).

What problems can the tonsils cause?

Acute and chronic tonsillitis (tonsillitis acuta or chronica) refer to inflammations of the palatine tonsils. They occur independently or as a concomitant of flu-like infections and are quite painful. In addition, tonsillitis can lead to abscesses in the surrounding tissue (peritonsillar abscess).

Germs that spread through the bloodstream from inflamed tonsils are often responsible for otitis media. However, they can also colonize the heart valves and lead to valvular insufficiency (heart failure). If someone gets tonsillitis more than four to six times a year (children over six) or more than three times a year (adults), the tonsils should be surgically removed (tonsillectomy).

Bacterial inflammation of the tubal tonsils (side strands) is called side-strand angina. The pharyngeal tonsils and the base of the tongue tonsils can also become inflamed.