Tonsils fight infection and are an important part of the lymphatic and immune systems. Ironically, tonsils are most commonly associated with sore throats, infections and missed days of school in children. Despite their role in the immune system, tonsils often become more of a liability than an asset, necessitating a tonsillectomy.
Lymph is protein-filled fluid filling the spaces between muscles, organs and other body structures. Lymph circulates through the lymphatic system, which is an extensive and interconnected system of vessels, tissue (such as tonsils), nodes, thymus, spleen and bone marrow. This system is a drainage system, removing and transporting interstitial fluid from tissues and removing and transporting fats from the gastrointestinal system. The lymphatic system, including the tonsils, also plays a crucial role in immune system function by producing and transporting lymphocytes and antibodies.
The tonsils are oval-shaped masses of lymphatic tissue (concentrations of lymphocytes and macrophages) strategically located to defend the body against bacteria and viruses entering the body through the mouth or nose. The tonsils are divided into three categories: two palatine tonsils at the back of the throat, two lingual tonsils on the base of the back of the tongue and a single pharyngeal tonsil (the adenoid) in the posterior wall of the nasopharynx. The tonsils act like filters to trap bacteria and viruses entering the body and also produce lymphocytes and antibodies to fight infection.
Because their normal function is to trap incoming bacteria and viruses, tonsils can easily become overwhelmed with bacteria and viruses and become infected, causing tonsillitis. Symptoms of tonsillitis include pain or discomfort when swallowing, fever, sore throat and swollen glands in the neck. Diseased tonsils, due to tonsillitis, neoplasia or other causes, are ineffective in fighting infection and can become a liability.
Complications of Tonsilitis
Complications of tonsillitis include: tonsillar enlargement disrupting breathing, swallowing, and sleep (and causing sleep apnea); tonsillar abscesses; streptococcus pyogenes infection (“strep throat”); spread of infection into the bloodstream; recurrent or chronic throat and ear infections; tonsillar crypts (pockets of pus on the tonsils); tonsoliths (stone-like particles on the tonsils); and rheumatic fever. Tonsillar cancer is also a rare complication.
Indications for Tonsillectomy
Tonsillectomy generally refers to the removal of the palatine tonsils. According to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), absolute indications for tonsillectomy include: enlarged tonsils causing upper airway obstruction, severe dysphagia, sleep disturbances, and cardiopulmonary dysfunction; peritonsillar abscess unresponsive to conservative treatment or drainage; tonsillitis causing febrile convulsions; and need for a tonsillar biopsy. Relative indications include: three or more cases of tonsillitis per year; persistent bad breath due to tonsillitis; chronic or recurrent tonsillitis in a streptococcal carrier not responsive to antibiotics; and presumed neoplasia. The surgery is more painful in adults than children.