The palatine tonsils sit in the back of the throat and are made up of lymphatic tissue. Along with the pharyngeal, tubal, and the lingual tonsils, they act as a defence against possible infections.

The palatine tonsils are oval-shaped lymphatic tissue located at both sides of the back of the throat.

People can see their palatine tonsils by opening their mouths and looking in the mirror. When a person refers to tonsils, they usually refer to the palatine tonsils.

While they protect the body, complications such as infection and swelling can cause health problems.

Read on for conditions associated with the tonsils, symptoms, diagnostic tests, and treatments.

The palatine tonsils serve as a component of Waldeyer’s ring. It also consists of the pharyngeal (adenoids), tubal tonsil, and lingual tonsil.

The role of the palatine tonsils is to act as the first defense against pathogens and help stimulate an immune response to fight off infection. Small crypts cover the surface of the palatine tonsils. These crypts give them a large surface area to catch incoming pathogens that may cause infection.

The tonsil tissue also aids in developing B cells and T cells, white blood cells that help fight off infection.

The palatine tonsils play an important role in trapping bacteria and viruses as they enter the body. However, this can make them prone to infection.

Doctors refer to an infection in the tonsils as tonsillitis which is fairly common. This infection accounts for 1.3% of outpatient visits. Bacterial and viral infections can occur in the tonsils, but viral infections are the most common, with up to 70% of cases of tonsillitis being viral infections.

When there is a bacterial infection in the tonsils, group A Streptococcus is usually the cause. Doctors refer to these infections as strep throat.

Common symptoms of tonsillitis include:

  • a sore throat
  • difficulty swallowing
  • a high temperature
  • coughing
  • a headache or earache
  • nausea
  • fatigue
  • peritonsillar abscess

When the palatine tonsils become enlarged, it is called tonsil hypertrophy. This type of condition is particularly common in children. Tonsils can swell with infection but most have large tonsils without acute infection. For many, enlarged palatine tonsils do not cause any issues.

However, the swollen tissue caused by large tonsils and adenoids can begin to partially obstruct the throat and cause breathing problems. These symptoms are the most common cause of sleep apnea in children which is usually treated by removing the adenoids.

In adults, the cause of sleep apnea can result from the following:

  • obesity
  • having a large neck
  • smoking and drinking alcohol
  • having large tonsils or adenoids
  • sleeping on their back

Nasal positive airway pressure therapy is the main treatment of choice in adults.

Tonsil stones are a complication that can occur in the palatine tonsils, but they tend not to cause serious health issues. Tonsil stones are small white or yellow lumps that can form in the crypts of the palatine tonsils. The stones form when debris from things such as food, bacteria, and dead cells become trapped in the crypts of the tonsils and harden.

Tonsil stones may cause no symptoms, and a doctor may discover them during a routine examination of the mouth and throat. The most common symptom of tonsil stones is bad breath (halitosis), but they may also cause pain or a foreign body sensation in the throat and ear.

Another possible palatine tonsil complication is tonsil cancer. Tonsil cancer is oropharyngeal cancer that usually involves the palatine tonsils.

Symptoms can include:

  • a sore throat
  • ear pain
  • a painless lump in your neck
  • difficulty swallowing

The main risk factors for tonsil cancer are smoking, drinking alcohol, and infection with the HPV virus.

A doctor or specialist will ask for medical history and perform a physical exam to investigate issues with the palatine tonsils. A person can easily see their tonsils when they open their mouth, but a doctor may use a tongue depressor for a better view.

If there are signs of an infection, a doctor may perform a rapid strep test to see if bacteria called group A Streptococcus are causing it. A doctor will take a sample with a sterile swab by rubbing it along the tonsils and any red areas or sores.

A doctor may also perform a throat culture test to identify other causes for the infection that the rapid strep test misses, such as other bacteria or fungal infections. For this test, the doctor collects the sample in the same way, and they send the sample to a lab.

If a person experiences persistent infections in their tonsils, a doctor may order blood tests to test for infectious mononucleosis or glandular fever.

If a doctor suspects that a tonsil complication could be cancer, further tests may include imaging tests such as CT, MRI or PET scans to investigate abnormalities, and they may take biopsies of the tonsils.

Infections in the palatine tonsils are usually viral infections, such as tonsillitis. These typically resolve on their own, and a person can manage the symptoms at home.

Several ways a person can manage their symptoms include:

  • staying rested and hydrated
  • taking over-the-counter pain relievers to help relieve pain and manage their fever
  • taking lozenges that can numb and soothe the throat
  • gargling with salt water

Antibiotics

A doctor will usually treat a bacterial infection of the tonsils with antibiotics. Penicillins are a common treatment for bacterial tonsil infections. A doctor may prescribe other antibiotics such as azithromycin or cephalosporins if a person has a penicillin allergy.

Strep throat can also result in complications including:

It is important to treat strep throat with an antibiotic to prevent any complications from occurring.

Antibiotics for infections such as strep throat should begin to relieve symptoms after 48 hours. A full course is required to clear the infection and not breed resistant bacteria.

Tonsillectomy

A doctor may suggest removing tonsil tissue surgically, known as a tonsillectomy, for some tonsil complications.

A doctor may consider a tonsillectomy in cases of:

The infection criteria for having tonsils removed is:

  • seven bouts of infection in a row in one year
  • five in two years in a row
  • three for three years in a row

Doctors may consider less time if a person has an underlying medical condition or is allergic to antibiotics.

A tonsillectomy may help reduce tonsil complications but does have associated risks, including:

Some potential complications that could occur during or after a tonsillectomy include:

  • anesthetic reactions
  • bleeding at the surgical site
  • swelling
  • infection
  • fever
  • dehydration

Before a person has a tonsillectomy for themselves or a child, they should discuss any concerns with a doctor.

Laser resurfacing

For people with tonsil stones who do not qualify for a tonsillectomy, a doctor may suggest treating tonsil stones with laser resurfacing.

This procedure is also called coblation cryptolysis, smoothes the surface of the tonsils (crypts), reducing the number of crevices in which tonsil stones can grow.

A 2021 study claims this treatment may be more effective than other surgeries but it did in the United States (U.S.)., Tonsillectomy remains the most common treatment for tonsil stones in the U.S.

Cancer therapy

Treatment for tonsil cancer may involve surgical removal of cancerous tissue, radiotherapy of the affected area, chemotherapy, targeted therapy, or a combination of these treatments.

Surgery for tonsil cancer tends to involve the removal of both palatine tonsils. Surgery may also involve removing the lymph nodes in the neck, called a selective neck dissection. In cases where the cancer is small, surgery can be done through the mouth with a local anesthetic and may not require an overnight stay.

However, the vast majority of surgeries will be under general anesthesia in a hospital.

The surgery may be more complex for larger cancers, require a longer recovery and more aftercare.

The palatine tonsils play an important role in protecting the body from bacteria and viruses. However, this can make them prone to infection.

Complications with the palatine tonsils can arise for several different reasons, such as tonsillitis or tonsil stones.

A person experiencing discomfort may wish to see a doctor to rule out an underlying condition and promptly begin treatment to relieve symptoms.