ANATOMY AND

PHYSIOLOGY TONSILS
MRS. Priya Gerard
TONSILS
 The tonsils are a set of lymphoid organs facing into the 
aerodigestive tract, which is known as Waldeyer's tonsillar
ring and consists of the adenoid tonsil, two tubal tonsils,
two palatine tonsils, and the lingual tonsils. These organs
play an important role in the immune system.
 When used unqualified, the term most commonly refers
specifically to the palatine tonsils, which are two lymphoid
organs situated at either side of the back of the human
throat. The palatine tonsils and the adenoid tonsil are
organs consisting of lymphoepithelial tissue located near
the oropharynx and nasopharynx (parts of the throat).
 Humans are born with four types of tonsils: the pharyngeal tonsil, two tubal tonsils, two palatine
tonsils and the lingual tonsils.

Type Epithelium capsule Crypts Location

Adenoid (also
Ciliated pseudostratified No crypts,
termed Incompletely Roof of 
columnar ( but small
"pharyngeal encapsulated pharynx
respiratory epithelium) folds
tonsil")

Ciliated pseudostratified
Roof of
Tubal tonsils columnar (respiratory
pharynx
epithelium)

Sides of 
oropharynx
 between
Incompletely Long,
Palatine tonsils Non-keratinized stratified palatoglossal
squamous encapsulated branched[2]
and
palatopharynge
al arches
Behind 
Non-keratinized stratified Incompletely Long,
Lingual tonsils terminal sulcus
squamous encapsulated unbranched
(tongue)
DEVELOPMENT OF TONSILS
 The palatine tonsils tend to reach their largest size
in puberty, and they gradually undergo atrophy
 thereafter. However, they are largest relative to the
diameter of the throat in young children. In adults,
each palatine tonsil normally measures up to 2.5 cm
in length, 2.0 cm in width and 1.2 cm in thickness.
 The adenoid grows until the age of 5, starts to shrink
at the age of 7 and becomes very small in adulthood.
Function

 The tonsils are immunocompetent organs which serve as the 

immune system's first line of defense against ingested or inhaled
foreign pathogens, and as such frequently engorge with blood to
assist in immune responses to common illnesses such as the 
common cold. The tonsils have on their surface specialized
antigen capture cells called M cells that allow for the uptake of
antigens produced by pathogens. These M cells then alert the
underlying B cells and T cells in the tonsil that a pathogen is
present and an immune response is stimulated. B cells are
activated and proliferate in areas called germinal centers in the
tonsil. These germinal centres are places where B memory cells
are created and secretory antibody (IgA) is produced.
CLINICAL SIGNIFICANCE
 The palatine tonsils can become enlarged
(adenotonsillar hyperplasia) or inflamed (tonsillitis).
The most common way to treat tonsillitis is with 
anti-inflammatory drugs such as ibuprofen, or if
bacterial in origin, antibiotics, e.g. amoxicillin and 
azithromycin.
 Surgical removal (tonsillectomy) may be advised if
the tonsils obstruct the airway or interfere with
swallowing, or in patients with severe or recurrent 
tonsillitis.
Contd….
 However, different mechanisms of pathogenesis for
these two subtypes of tonsillar hypertrophy have
been described, and may have different responses
to identical therapeutic efforts. In older patients,
asymmetric tonsils (also known as asymmetric
tonsil hypertrophy) may be an indicator of 
virally infected tonsils, or tumors such as 
lymphoma or squamous cell carcinoma.
Contd….
 A tonsillolith (also known as a “tonsil stone”) is
material that accumulates on the palatine tonsil.
This can reach the size of a peppercorn and is white
or cream in color.
 The main substance is mostly calcium, but it has a
strong unpleasant odor because of hydrogen sulfide
 and methyl mercaptan and other chemicals.
Contd….
 Palatine tonsil enlargement can affect speech,
making it hypernasal and giving it the sound of 
velopharyngeal incompetence (when space in the
mouth is not fully separated from the nose's air
space).
  Tonsil size may have a more significant impact on
upper airway obstruction for obese children than
for those of average weight.
Contd….
 As mucosal lymphatic tissue of the aerodigestive
tract, the palatine tonsils are viewed in some
classifications as belonging to both the 
gut-associated lymphoid tissue (GALT) and the 
mucosa-associated lymphoid tissue (MALT).
 Other viewpoints treat them (and the spleen and
thymus) as large lymphatic organs
contradistinguished from the smaller tissue loci of
GALT and MALT.