Most of us only become aware of our tonsils if they become swollen or infected. But these masses of lymphatic tissue in the mouth and throat are important immunological gatekeepers at the start of the airways and digestive tract, grabbing pathogens and warding off diseases before they reach the rest of your body. Here are some essential answers about these often-overlooked tissues—like what to do when your tonsils are swollen, and whether you should get your tonsils removed.
The term tonsils usually refers to your palatine tonsils, the ones that can be seen at the back of your throat. But tonsillar tissue also includes the lingual tonsil (located in the base of the tongue), tubal tonsils, and the adenoid tonsil (often just called adenoids). “Collectively, these are referred to as Waldeyer’s ring,” says Raja Seethala, the director of head and neck pathology at the University of Pittsburgh Medical Center and a member of the College of American Pathologists Cancer Committee.
The tonsils are a key barrier to inhaled or ingested pathogens that can cause infection or other harm, Seethala tells Mental Floss. “These pathogens bind to specialized immune cells in the lining—epithelium—to elicit an immune response in the lymphoid T and B cells of the tonsil,” he says. Essentially, they help jumpstart your immune response.
If the adenoid tonsils are swollen, they can block breathing and clog up your sinus drainage, which can cause sinus and ear infections. If adenoids are too big, it forces a person to breathe through their mouth. In children, frequent mouth breathing has the potential to cause facial deformities by stressing developing facial bones. “If the tonsils are too large and cause airway obstruction, snoring, or obstructive sleep apnea, then removal is important,” says Donald Levine, an ear, nose, and throat specialist in Nyack, New York. Fortunately, the adenoids tend to get smaller naturally in adulthood.
Even though your tonsils are part of your immune system, Levine tells Mental Floss, “when they become obstructive or chronically infected, then they need to be removed.” The rest of your immune system steps in to handle further attacks by pathogens. Another reason to remove tonsils besides size, Levine says, is “chronic tonsillitis due to the failure of the immune system to remove residual bacteria from the tonsils, despite multiple antibiotic therapies.”
Tonsil removal is believed to have been a phenomenon for three millennia. The procedure is found in ancient Ayurvedic texts, says Seethala, “making it one of the older documented surgical procedures.” But though the scientific understanding of the surgery has changed dramatically since then, “the benefits versus harm of tonsillectomy have been continually debated over the centuries,” he says.
The first known reported case of tonsillectomy surgery, according to a 2006 paper in Otorhinolaryngology, is by Cornélio Celsus, a Roman “encylopaediest” and dabbler in medicine, who authored a medical encyclopedia titled Of Medicine in the 1st century BCE. Thanks to his work, we can surmise that a tonsillectomy probably was an agonizing procedure for the patient: “Celsus applied a mixture of vinegar and milk in the surgical specimen to hemostasis [stanch bleeding] and also described his difficulty doing that due to lack of proper anesthesia.”
The same paper reveals that among some of the more outlandish reasons for removing tonsils were conditions like “night enuresis (bed-wetting), convulsions, laryngeal stridor, hoarseness, chronic bronchitis, and asthma.”
As early practitioners struggled to perfect techniques for removing tonsils effectively, another early physician, Aetius de Amida, recommended “ointment, oils, and corrosive formulas with frog fat to treat infections.”
A common technique today for removing the tonsils, according to Levine, is a far cry from the painful early attempts. Under brief general anesthesia, Levine uses a process called coblation. “[It’s] a kind of cold cautery, so there is almost no bleeding, less post operative pain, and quicker healing. You can return to normal activities 10 days later,” Levine says.
The incidence of tonsillar cancers is increasing, according to Seethala. “Unlike other head and neck cancers, which are commonly associated with smoking and alcohol, tonsillar cancers are driven by high-risk human papillomavirus (HPV),” he says. “HPV-related tonsillar cancer can be considered sexually transmitted.”
