Tonsils

When we refer to the tonsils we usually mean the collections of lymphoid tissue at the entrance to the pharynx, on either side of the uvula (i.e. the palatine tonsils). There are also lingual tonsils at the base of the tongue. All of these as well as the adenoids are part of Waldeyer’s ring (Figure 24.1), which is a collection of lymphoid tissue that forms a circle around the entrance to the upper respiratory tract and forms the first line of defence against infection.

The tonsils are lined with squamous epithelium. This lining forms crypts that extend well into the body of the tonsil, where pus and debris can collect. Tonsils, like adenoids, are especially well developed in children and reduce in size as the child gets older. They can still be large and troublesome in teenagers and young adults, less so in middle-aged and older patients.

Pharyngeal lymphoid tissue is important for developing immunity in very young children. After the age of 2 years this effect seems to tail off, hence surgical removal of the tonsils and adenoids in older children (adenotonsillectomy) has no adverse effect on the child’s resistance to infection.

Diseases of the Tonsils

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