Tonsil disorders

Tonsil disorders include diseases mainly of the tonsils and the concha, which are located in the throat, the gateway to the respiratory system. Above the tonsils, however, are the nasal tonsils and these are also affected by various diseases or malfunctions. The tonsils are affected not only by classical respiratory diseases, but also by various infectious diseases, or the tonsils may also be affected by rash-type diseases, which affect not only the outer skin, but also the internal mucous membranes.

Both the tonsils and the nasal tonsils are part of the throat and are located very close to the oral cavity, which in practice means that several infections or inflammations that enter the body also pass through these tonsils. Particularly in the case of the cervical or palatine tonsils, it is the tonsils that are responsible for tonsil disorders as a result of infection being trapped in the oral cavity, and so in a sense the tonsils protect, for example, other parts of the upper and lower respiratory tract from inflammation and infection.

Both the tonsils and the nasal tonsils become enlarged due to several inflammatory diseases and thus cause difficulty breathing or swallowing. In addition, these two organs are also affected by various other diseases of a non-inflammatory nature, for example, hypertrophy, scarring, ulcers, problems of the local adenoid tissue, and sometimes even abscesses from necrotizing tissues can occur. Cysts and tumours may also form on the tonsils as part of oral tumours.

Tonsils

The cervical tonsils, also called the palatine tonsils, are a paired organ within the Waldayer's lymphatic circuit. These tonsils are located between the palatine arches at the back of the throat, and when palpated are soft tissue masses covered with pink mucous membrane. The tissue of the tonsils is similar to that of the lymph nodes, and there are pits called crypts in the lining of the tonsils that can trap infections. It is the defence against infections from the oral cavity that is the main purpose of the tonsils.

As such, the tonsils are part of the lymphatic system, whose main function is to fight infections. This is why, for example, the tonsils can be swollen or reddened in the case of infectious diseases, because this is where inflammatory and immune reactions against infectious diseases take place. The tonsils are a paired organ and there are two in the throat, one part on each side, that is, on both the left and right side of the throat. The tonsils are also the primary point of contact with antigens during air inhalation and food intake.

Palatine tonsils are just one part of the overall Waldeyer's lymphatic circuit, which provides immune responses against infections. In addition to the tonsils, the nasal tonsils, the lingual tonsils and the mouth of the Eustachian tube are also part of this circuit. The most common goal of immune responses is to prevent respiratory and upper respiratory tract infectious diseases, and due to the location of the tonsils in the oral cavity, several infections in the oral cavity are also related to them.

Due to the fact that these tonsils are located at the entrance to both the digestive and respiratory systems, they are able to capture, recognize and filter out various pathogens from the air and food that enter the body through the oral route. In addition, due to the lymphoid composition of the tissue of the tonsils, antibodies are also produced in them, especially during childhood. On the other hand, there is a tendency to remove the tonsils many times, especially in the case of frequent chronic diseases, but this can have unpleasant consequences for the passage of infections further into the body.

Adenoid (nasopharyngeal tonsil)

Like the palatine tonsils, the adenoid is part of the Waldeyer ring of lymphoid tissue of the pharynx, with the nasal tonsils located above the cervical in the nasopharyngeal cavity. They are also close to the mouth of the Eustachian tube, and so immune reactions in this area regularly occur not only in diseases related to the upper respiratory tract, but also in many diseases within the ears when swelling of these tonsils occurs in the nose.

The tonsils are located behind the nasal cavity and this organ is also made up of lymphoid soft tissue, which can produce white blood cells or allow their circulation and transport from other lymphoid tissues. Unlike the tonsils, which are still present in adulthood, unless of course they are surgically removed, the nasal tonsils tend to shrink with adolescence and even disappear altogether in adulthood, as this lymphoid tissue in the nasopharynx disappears.

This is why tonsil problems are most common in children or during adolescence, and over time the frequency and incidence of various diseases associated with them decreases. Unlike the tonsils, the nasal tonsils are most often plagued by inflammation and infections that enter the oral cavity through the nose, so it is not also inflammation reacting to pathogens contained in food. However, there are other situations where these tonsils can cause a problem, such as with sleep apnea.

During life, there is also a temporary enlargement of the tonsils around the 5th year of life, but in the case of some medical conditions also at other times. If the tonsils are more frequently affected by infections, they do not shrink and disappear during puberty and adulthood, but instead become chronically enlarged, which must then be treated surgically. Within the framework of diseases, the nasal tonsils, like the cervical tonsils, are affected by various inflammatory as well as non-inflammatory pathologies.

Acute and chronic inflammation

The most common diseases of the tonsils are acute and chronic inflammation. The acute ones include streptococcal tonsillitis, follicular, gangrenous, infectious and ulcerative tonsillitis, as well as acute tonsillitis caused by other unspecified organisms. A typical case is acute viral tonsillitis or bacterial tonsillitis. In addition, a peritonsillar abscess can also arise on an inflammatory basis, when purulent pockets form on the tonsils, and this very acutely.

This abscess many times arises as a complication of several inflammatory diseases not only directly on the tonsils, but also in the oral cavity and other nearby tissues. It is manifested by pain in the throat but also in the lymph nodes and occurs when the infection penetrates into the deeper tissues of the pharynx, when a pus-filled, hollow-shaped deposit forms between the tonsil sheath and its bed on the muscles of the pharynx. Usually as a result of such an abscess, it is necessary to perform removal of the tonsils.

The most common disease is clearly acute tonsillitis in the form of tonsillitis. However, tonsillitis can be not only an independent disease, but also a symptom of another infectious disease, such as scarlet fever, infectious mononucleosis, diphtheria or measles. Also, ulceromembranous angina and angina in bleeding disorders can occur. Angina pectoris occurs not only as inflammation of the palatine tonsils, but also as lingual tonsillitis affecting the lingual tonsils or retronasal tonsillitis affecting the nasopharyngeal tonsils.

Similarly, any type of tonsillitis is affected by the chronic form of tonsillitis, and a chronic form is said to be present when the inflammation affects a person more than three times in one year. Most often, this form is manifested by burning in the throat, pain on swallowing, lack of appetite, fatigue and a bad taste in the mouth. In chronic tonsillitis, the most common solution is tonsillectomy, or surgical removal of the tonsils, because conservative methods have previously failed.

Cysts, ulcers, abscesses and tumours

Due to the proximity of the location of the cervical and nasal tonsils to the oral cavity, various cysts or tumors are quite often found on the tonsils. There are also various plugs on the tonsils, but this is not a pathological condition in itself, but a symptom of mostly inflammatory diseases such as tonsillitis or scarlet fever, when there is an immune reaction in the lymphoid tissue of the tonsils and the formation of plaques or plugs is only part of this reaction.

Cysts on the tonsils are most often formed on the surface and arise from inflamed tissue, and are usually cavities lined with a lining containing fluid, for example, when a gland is closed or as a result of infection. They may also arise as a result of hyperplasia, or enlargement, of the local tissue affected. The most common type is a retention cyst of the tonsils, and in most cases it is an asymptomatic cyst and the treatment consists of incision and emptying of the volume of the cyst and later removal of the cyst by local surgery.

Very often tonsil cysts also arise from problems in the nasopharynx or pharynx, and sometimes they can also be so-called abscesses, when the inside of the lesion is filled with necrotizing native epithelial and mucosal tissue. Various ulcers are also a problem, which can occur on the tonsils and most often affect the adenoid tissue in the form of a localised deposit. Also, tonsil stones, which are lumps at risk of hardening and calcification, can form on the tonsils.

The tonsils of the palate as well as the tonsils located in the nasopharynx are also affected by various tumours. Most often these are squamous cell carcinomas, that is, they are opinions arising most often from contact with carcinogens such as alcohol or tobacco. The surfaces of the tumours also tend to ulcerate frequently, with the most common tumours appearing at an enlarged stage, when there are problems with breathing, swallowing and pain in the area. The solution is surgical removal and subsequent irradiation of the tumours.

Enlarged tonsils and other disorders

Both the cervical tonsils and the nasopharyngeal tonsils are also affected by various types of enlargements and swellings and other pathologies. Hypertrophy of the tonsils, hypertrophy of the adenoid tissue, concomitant hypertrophy of the tonsils with hypertrophy of the adenoid tissue, or even emergent adenoid vegetations are frequent. Sometimes amygdaloliths or scarring of the tonsils or scarring of the adenoid tissue may appear on the tonsils. A specific disease affecting the palatine tonsils is called tonsillar appendage.

In the throat, steptococcal bacteria can likewise get trapped on the tonsils, which subsequently cause strep throat, where sore throats and a febrile course of the disease occur. The tonsils are also affected by enlargements, whether due to adenoitis, or inflammation of the nasopharyngeal tonsils of a bacterial or viral nature, or as a result of enlargements in ear infections. Also, hypertrophy of the tonsils in the nose can cause blockage of the Eustachian tube.

The most common solution for enlarged and swollen tonsils is adenotomy, i.e. removal of adenoid vegetation and swelling. This procedure is also performed in adults if the tonsils have not disappeared for pathological reasons. In the case of swelling, these can also cause obstructive sleep apnoea, where the nasal tonsils irregularly block the flow of air through the throat and the person stops breathing for a few seconds, causing awakening and a breathing fit.