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Most of us only notice our tonsils when they’re swollen or infected. However, these lymphatic tissues located in the mouth and throat serve as key immune system gatekeepers, positioned at the start of the airways and digestive tract. They capture harmful pathogens and protect the body from diseases before they spread. Here’s a deeper look into these often-overlooked tissues, including the question of what happened to the practice of tonsillectomies?
There are four distinct types of tonsils in the human body.
The term 'tonsils' typically refers to the palatine tonsils, which are visible at the back of the throat. However, tonsillar tissue also includes the lingual tonsil (at the base of the tongue), tubal tonsils, and the adenoid tonsil (commonly known as adenoids). Collectively, these are referred to as Waldeyer’s ring,” explained Raja Seethala, an anatomical pathologist at the University of Pittsburgh Medical Center, during an interview with Mytour in 2019.
Tonsils are among the body's first line of defense against harmful pathogens.
Tonsils act as a critical barrier against inhaled or ingested pathogens that could cause infections or other damage, according to Seethala. 'These pathogens attach to specialized immune cells in the lining—epithelium—which triggers an immune response in the tonsil’s lymphoid T and B cells.' Essentially, they help initiate your immune defense.
Swollen adenoid tonsils can obstruct airflow and lead to facial deformities.
When the adenoid tonsils are enlarged, they can block breathing and interfere with sinus drainage, leading to sinus and ear infections. Enlarged adenoids can also force individuals to breathe through their mouths. In children, chronic mouth breathing may result in facial deformities due to the pressure on growing facial bones. 'If the tonsils are too large and cause airway blockage, snoring, or obstructive sleep apnea, removal becomes necessary,' said Donald Levine, an ear, nose, and throat specialist in Nyack, New York, in a 2019 interview with Mytour. Luckily, adenoids naturally shrink as a person matures into adulthood.
There are times when tonsils need to be surgically removed.
Although tonsils are part of your immune system, Levine noted, 'when they become obstructive or are chronically infected, they must be removed.' The rest of your immune system steps in to fight off further attacks by pathogens. Another reason for tonsil removal, besides their size, is 'chronic tonsillitis caused by the failure of the immune system to clear lingering bacteria from the tonsils, even after multiple rounds of antibiotics,' Levine explained.
Tonsillectomies have been practiced for thousands of years...
The practice of removing tonsils dates back over three millennia. The procedure is referenced in ancient Ayurvedic texts, Seethala said, 'making it one of the oldest documented surgical practices.' However, despite changes in the scientific understanding of the surgery over time, 'the debate over the benefits and risks of tonsillectomy has persisted throughout the centuries,' he added.
... and it was likely very painful.
The earliest known account of a tonsillectomy, as recorded in a 2006 paper published in the journal Otorhinolaryngology, was by Cornélio Celsus, a Roman physician who authored a medical encyclopedia titled Of Medicine in the 1st century BCE. Based on his writings, it’s clear that tonsillectomy was probably a painful procedure: 'Celsus used a mixture of vinegar and milk to slow the bleeding, describing the difficulty of doing so due to the lack of proper anesthesia.'
Tonsillectomies were often performed for surprising reasons.
The same study also reveals some of the more unusual reasons for tonsil removal, including conditions like 'night enuresis (bed-wetting), convulsions, laryngeal stridor, hoarseness, chronic bronchitis, and asthma.'
Doctors once turned to frog fat to treat inflamed tonsils.
In their attempts to improve tonsil removal techniques, early practitioners like Aetius de Amida recommended the use of 'ointments, oils, and corrosive concoctions with frog fat to treat infections.'
Today’s tonsillectomies are far more advanced and precise.
A modern technique for tonsil removal, as explained by Levine, is a far cry from the painful methods of the past. Using brief general anesthesia, Levine employs a process known as coblation, 'a form of cold cautery that results in minimal bleeding, less post-operative discomfort, and faster recovery. Patients can resume their usual activities within 10 days,' he explained.
HPV, a sexually transmitted virus, can lead to tonsil cancer.
The rate of tonsillar cancers is on the rise, according to Seethala. 'Unlike other head and neck cancers, which are often linked to smoking and alcohol use, tonsillar cancers are primarily caused by high-risk human papillomavirus (HPV),' he said. 'HPV-related tonsillar cancer can be considered sexually transmitted.'
