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Tonsils are those two small balls of tissue found on either side of the mid-line uvula. Tonsils are most active in children. They shrink somewhat after puberty. In bygone days, they were removed the second time a child complained of a sore throat. In those days, it often worked, and the complaining stopped. This propagated a myth amongst some grandparents today who still cling to the belief that unwarranted removal enhances health. We now know that tonsils are organs filled with lymphocytes which are cells that can produce thousands of anti-bodies the moment an invading organism is detected. Therefore, they are involved in producing immunity and can regulate the production of certain immunoglobulins. A closer look reveals the surface to be studded with crypts. These crypts will trap foreign material and present it to the deeper tissue as a way of checking for infection. When this system is turned on, the tonsils appear swollen and red. They can be tender and painful. "Strep-throat" refers to the large swollen tonsils covered with pus as a result of invasion by Streptococcal bacteria species. It requires treatment to prevent the more serious sequel of rheumatic fever. Cold viruses can also cause a response, but generally less so. The Epstein-Barr virus of mononucleosis has a hallmark of making the tonsils appear large, dull and grey. Tonsilar crypts will attract yeast infection producing white cheesy spots. I also see the occasional crypt filled with benign white material that requires no treatment.
Examining tonsils is an artform. They come in many shapes and sizes. There are children in my practice who have larger tonsils while they are growing. Without this baseline knowledge, walk-in clinics often confuse these benign signs with illness, and cautiously prescribe medication. Deciding on when to remove the tonsils is even a bigger artform. Despite their function, it is difficult to demonstrate a deficiency when tonsils are removed. One theory suggests that the residual tissue left in the throat continue to exert some function. If the patient's chart demonstrates more than six genuine and recurrent sore throats in a year, then a second opinion about removal is generally sought. Tonsillectomy sometimes helps in children with resistant ear infections. Other times, the tonsils can be naturally large and obstruct breathing. Some people develop a severe abscess called a Quincy. A Quincy requires drainage, aggressive treatment and expert care.
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