Ear Nose & Throat


Tonsils are lymphoid groups of tissue in the pharynx or back of the throat. There are actually 4 groups of tonsillar tissues in the throat:

  1. Palatine
  2. Lingual
  3. Adenoids
  4. Nasopharyngeal

Most treatments are centered on the palatine and nasopharyngeal tonsillar tissues.

Palatine Tonsils

The palatine tonsils are those seen at the back of the throat next to the uvula (punching bag/ dangling thing), and are what most people refer to as tonsils. They can have infections such as with the strep bacteria, herpes virus, or Epstein Bar Virus/ infectious mononucleosis. They can be impressively large and cause issues of obstruction such as:

  • Snoring
  • Apnea
  • Difficulty swallowing foods
  • Restless sleep
  • Bed wetting

Lingual Tonsils

Lingual tonsils are at the back of the tongue. They do not get infected as often as the palatine tonsils or adenoids, but their infections are more worrisome as they can cause a greater sense of difficulty with breathing or swallowing. In patients with sleep apnea they can be enlarged and need to contribute to the severity of the apnea.

Adenoids & Nasopharyngeal Tonsils

Adenoids or nasopharyngeal tonsils are at the back of the nose and partially surround the eustachian tubes. Their location causes them to play a role in difficult nasal breathing, sinusitis and ear infections.

Tonsil Size

The tonsils are sized on a scale from 1-4, with 4 being the largest. It is best to judge their size with the tongue resting comfortably in the mouth.

  • Size 1 – barely visible
  • Size 2 – tonsil tissue not beyond the tonsillar pillars
  • Size 3 – tonsils take up 75% of oropharyngeal airway
  • Size 4 – tonsils take up more than 75% of airway or are touching

Waldeyer’s ring are scattered blebs of tonsils along the back wall of the throat and can be the culprit in causing a person to still have pharyngeal strep tonsillitis even after tonsillectomy.

Patients are often seen for concretions or “stones” in their tonsils. These are firm, often white, foul smelling debris that a patient may Q-tip, “dig”, or spit out from their tonsils. While they may not represent an active infection, they can cause severe halitosis (bad breath), and throat discomfort.