Lingual Tonsils

Catarrhal symptoms are strongly related to the presence of lingual tonsils. These are lumps of lymphoid tissue, like the palatine tonsils (which we know simply as “the tonsils”) which sit at the very back of the tongue, above the voice box. The lingual tonsils, like the palatine tonsils, the adenoids and the posterior pharyngeal wall lymphoid aggregates, make up a ring of glandular tissue around the throat, called Waldeyer’s ring.

Site of the lingual tonsils

Glandular tissue in the throat, number 1 is the adenoids, 2 the palatine tonsils, 3 the lingual tonsils. 4 is the larynx (voice box) which shows the close relation of the lingual tonsils to this area, hence catarrhal symptoms due to the lingual tonsils are symptoms such as lump in the throat when swallowing, tightness in the throat, cough.

Causes of lingual tonsil problems The lingual tonsils are often enlarged in cases where the palatine tonsils have been removed, ie “tonsillectomy”. It seems there is a reactive hyperplasia of the lingual tonsils in response to the loss of lymphoid tissue in the palatine tonsils. Lingual tonsillar hypertrophy may also be due to the irritative effects of acid in cases of gastro-oesophageal reflux. Lingual tonsil problems may also be set off by ingestion of a foreign body, such as a fish bone, which often lodges in the back of the tongue. These forms of lingual tonsillitis can be more serious, leading to abscess formation.

Diagnosis
Lingual tonsillitis is a relatively common condition that can be very hard to diagnose. Patients go to the doctor with recurrent throat pains, but on examination all is normal. It is not until an ENT surgeon looks down with mirrors and/or flexible endoscopes, that the disease becomes apparent. In these cases patients are often thought to be making it up, the throat always looking completely normal to the GP.

Complications
Severe lingual tonsillitis with abscess formation – a potentially life-threatening condition.

Treatment of lingual tonsillitis
In the acute phase, powerful anti-inflammatories and antiseptic gargles should be used. Antibiotics are of unknown use. Longer term, some form of local therapy is often required. Simple dissection, as with palatine tonsillectomy, is not possible due to the site of these organs. Therefore a more indirect technique is required. Laser vapourisation, either with the Holmium YAG or CO2 laser can be effective at least in reducing their size. More definitive removal is only realistically achieved by approaching the tongue base through the neck – a lateral pharyngotomy – major surgery that is generally reserved for cancer cases only. Thus there is no good way of curing this condition, although it can be ameliorated to a significant degree by laser treatment.