An encyclopedia about voice, swallowing, airway, coughing, & other head + neck disorders.

Tonsils are accumulations of lymphoid tissue found in the upper aerodigestive tract. Lymph nodes are also part of the lymphatic system, but are encapsulated and found buried in tissue of the neck, chest, abdomen, etc.

When one refers to “tonsils” the usual reference is to the palatine tonsils, comprised of semi-encapsulated lymphoid tissue located on the lateral walls of the pharynx. These are often easily seen by opening the mouth widely and shining a light towards the posterior wall of the pharynx while saying “ah.”

Adenoid tissue is very similar but found in the extreme back of the nose, above the palate. They can be referred to as the “nasopharyngeal tonsils.”

A third main location for similar lymphoid tissue is the base of the tongue, where they are called “lingual tonsils.”

We sometimes refer to “micro-tonsils” which are the small salmon-colored bumps seen on the wall of the throat, especially during/after pharyngitis.

“Kissing” Tonsils

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Tonsils enlarged (1 of 3)

A singer with very large tonsils seen on either side of the photo as she sings A3 (220 Hz). The line of sight is looking straight down from the nasopharynx.

Higher pitch (2 of 3)

At an octave above, A4 (440 Hz), a slight pharynx contraction brings the tonsils closer together.

Tonsils in contact (3 of 3)

At nearly an octave higher again, G5 (784 Hz), the pharynx has contracted more (upper arrows), causing the tonsils to come into contact just out of the view (lower arrows)--hence the term “ kissing tonsils.” This phenomenon can often be seen by looking at the tonsils through the mouth on an “ah” vowel.

Scarring Diverts Swallowed Materials Directly into the Larynx

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Post tonsillectomy (1 of 4)

A young woman struggles to swallow after extensive cauterization of severe bleeding after tonsillectomy elsewhere. The arrows here show the path food and liquid should follow to get into the esophagus (opening indicated by flat oval).

Closer view (2 of 4)

Closer view shows that the epiglottis is tethered to base of tongue at the dotted line. Furthermore, the "ski jump" scar appears to be ready to divert swallowed material directly into the larynx ( arrow) rather than into the pyriform sinus at *.

The "chute" (3 of 4)

A closer view shows even better the "chute" into the larynx.

Abnormal diversion (4 of 4)

While swallowing blue-colored water, arrows indicate the normal path on the left (right of photo) and the abnormal diversion into the larynx on the right (left of photo). The patient manages, but must swallow carefully, especially since the epiglottis cannot invert since it is scarred to the base of tongue as shown in photo 2.
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