Tonsils

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.

Massive Tonsillar Hypertrophy in a Singer

This approximately 30-year-old man is a serious classical singer experiencing symptoms of sleep apnea. While he has not yet been officially diagnosed, he has an upcoming sleep study. His more immediate concern is vocal strain following extensive singing during an illness. At the time of evaluation, his voice and vocal cords appear relatively normal, validating his sense that he has recovered. However, his tonsils are significantly hypertrophied, making a tonsillectomy likely in his future.

There is no indication of a short palate issue (palatal insufficiency), so a tonsillectomy that preserves the muscles of the palate and pharynx should not negatively impact his voice. In fact, some singers report that their voice “grows” after a period of healing and adjustment while he adapts to the changes in his throat post-surgery.