Tonsils are lymphoid tissue. There is a ring of such tissue around the throat. They are called the Waldeyer’s tonsillar ring. It includes two tonsils at the back of the throat (pharyngeal tonsils), two tonsils on either side of the root of the tongue (lingual tonsils), two tonsils on either sides of the oropharynx behind the uvula (palatine tonsils), and two tonsils on the roof of the pharynx (tubal tonsils). Enlarged pharyngeal tonsils are referred as adenoids while the two palatine tonsils are referred as tonsils. This article will talk about both types of tonsils and the differences between them in detail, highlighting their clinical features, symptoms, causes, investigation, prognosis, and the course of treatment they require.
Tonsils
People usually refer to the two palatine tonsils as tonsils. Tonsillitis is usually the inflammation of the two palatine tonsils. It presents as nasal speech, sore throat, painful swallowing, enlarged lymph node just below the angle of the jaw. On examination, reddened, swollen palatine tonsils are visible. There may be pus formation. If untreated, it can lead to peri-tonsillar abscess due to spread of infection into the deep tissue around the palatine tonsils. When palatine tonsils are inflamed and enlarged, they do not obstruct the airway, but in children, because the Eustachian tube is more horizontal, middle ear infections can accompany tonsillitis.
Commonly tonsillitis is viral, but it also can be bacterial. Adenovirus, streptococcus, staphylococcus, heamophilus and well known culprits. Drinking warm water, steam inhalation, and antibiotics can effectively cure tonsillitis. It can recur. When cellular debris accumulates inside a tonsillar crypt, a small stone forms. This is called a tonsillolith. This presents as tonsillitis, bad breath, or tonsillar abscess. These stones mainly contain calcium salts. These can be removed under direct vision in the office.
Adenoids
People usually refer to pharyngeal tonsils as adenoids. These are situated at the back wall of the throat where the nose meets the throat. In children, these are more prominent as two soft tissue mounds just posterior and superior to the uvula. The adenoids are made up of lymphoid tissue. It does not contain crypts like other tonsillar tissues. It is lined by a pseudo-stratified columnar epithelium. Adenoids can enlarge to a point that they completely block the air flow through the back of the nose. Even if they do not block the airway completely, a large amount of effort is needed to breathe through the nose. Enlarged adenoids affect the speech by limiting the air flow and resonance of voice as in sinuses. When adenoids are enlarged, they give rise to typical facial features. Elongated face, uplifted nostrils, short upper lip, high arched palate, and mouth breathing are characteristic of adenoid faces.
Adenoids can get infected by the same organisms that infect other tonsils. When they get infected, they get inflamed, produce mucus excessively, and block the air flow. Usually children grow out of adenoids, but troublesome, frequent infections are treated and prevented by removing adenoids. Antibiotics, steam inhalation, and drinking warm water help a lot.
What is the difference between Adenoids and Tonsils?
• “Tonsils” usually refers to enlarged palatine tonsils while adenoids are enlarged pharyngeal tonsils.
• Tonsils present as sore throat while adenoids present as altered speech.
• Tonsils do not block the air flow through nasal passages while adenoids do.
• Tonsils can be treated with antibiotics only, but adenoids need to be removed, to stop frequent infection.