T he pharynx is the common entry pathway of our body, for respiration and digestion. The natural guards to protect our body from disease entry are tonsils. The tonsils are oval lymph glands situated on the sidewalls of the pharynx. There are two tonsils for a human, sitting at the back end of the throat on both sides and projecting out as masses. They drain lymphocytes containing lymph into the tonsilar lymph node situated behind and below the lower jaw. The tonsils gradually enlarge in size from birth and reach their maximum size in 6-8 years and atrophies in 12-14 years. Tonsils also tend to enlarge in size during puberty and shrink thereafter.

Function of tonsils

In this modern scientific era, we try to answer each question with scientific explanation. But nature never exposes itself with complete answers. Nature never puts anything as a waste nor does a thing uselessly. Till now, we know the functions of tonsils as follows:

• It monitors the quality of the air, food and water which enter our body
  
• It plays a major role in body immunity mechanism and antibody reaction most probably in childhood
  
• It is helpful in forming lymphocytes (white blood cells) which protect our body as a defence mechanism.
  
• It becomes as red swollen inflamed mass (danger light) indicating any infection entering our body
  
• It traps the germs that enter the body by its antibodies and drains it into the lymph node for elimination
  
• It is also supposed to kill bacteria that enter into the tonsil through the blood stream.

If we ignore the red light of tonsil, the infection might spread in the throat, mouth, sinuses and upper respiratory tract. If we delay, the infection spreads further to the lower respiratory tract (lungs), digestive tract and other parts of the body (joints, heart, etc.) With repeated attack of infection, the tonsils may get fibrosis and scarred and lose its protective function.

Tonsillitis

The inflammation of the tonsils is called tonsillitis. The infected tonsils become red and swollen, to work better to trap or stop the disease force - bacteria or virus. They also get coated (either partly or entirely) with yellow, grey, or white substance, depending upon the type of infection and pus formation. Tonsillitis begins with a sudden sore throat and painful swallowing. The tonsils infection is common in children and teenagers but rare in adults.

Types of tonsillitis:

Tonsillitis can be classified as acute and chronic.

• Acute tonsillitis is a sudden onset inflammation that lasts for about 4 to 6 days. It is an uncomplicated form which commonly affects children of ages 5-10.


• Chronic tonsillitis occurs when there is recurrent infection. They remain infected and do not respond to treatment. They are usually a complicated form which are seen in maltreated or untreated children and teenagers.

Further tonsillitis types are classified as

• Membranous - which is most common in children


• Follicular - having follicles in the outer layer which appears as yellow dots on the tonsil surface. It is common in young adults.

Causes:

The most common cause for tonsillitis is

• Bacterial or viral infection - Bacteria, specifically beta-hemolytic streptococci, is the main offender. Virus can also cause tonsillitis. The source of infection may be food or water or droplet infection from coughing or mucous secretions of an infected person.
  
• It also occurs as an allergic reaction to allergens, for example pollens, cold things, food preservatives, drugs, mechanical injury, etc.

In patients with auto-immune disorders, who suffer from immunodeficiency, tonsillitis may occur due to multiple infections. For example HIV, psoriasis, SLE, etc.

Symptom - differ from patient to patient depending upon the size and involvement of sides (single or both)

• Red swollen tonsils - felt or visualised as a lump in throat
  
• Sore throat which induces constant hawking and choking
  
• Difficulty and pain during swallowing - due to obstruction. Sore throat is felt as tight constricted area, so there is delay in eating, which further produces aversion to food and weight loss.
  
• Difficulty in breathing - due to the blockage of air way by enlarged tonsil. This may lead to snoring, mouth breath and restlessness at night due to sleep apnea (large pauses between two breaths). Due to sleeplessness at night, there will be excessive tiredness in daytime.
  
• Poor growth and development due to air hunger and lack of appetite or aversion.
  
• Excess salivation and dribbling of saliva when mouth breath predominates
  
• Ear ache and bad breath (halitosis) due to infection and pus formation
  
• White spots or yellow or grey coating over the tonsils
  
• Painful or painless lymph node enlargement below the angle of lower jaw
  
• Constitutional disturbances like fever with chill and tiredness
  
• Recurrent or repeated attack of cold and cough.
  
• Constipation

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