Palatine Tonsils: Anatomy and Function

Medically reviewed by John Carew, MD

The palatine tonsils are solid masses of lymphatic tissue, part of the body that exposes the immune system to potential invaders. Palatine tonsils are also sometimes called “faucial tonsils” and are one of three sites of tonsils in the body. When people use the term “tonsils,” they usually mean the palatine tonsils.

This article focuses on palatine tonsil anatomy and problems such as tonsillitis and enlarged tonsils.

Location of Palatine Tonsils Relative to Waldeyer’s Ring

Multiple sites of tonsil tissue lie behind your nose and in the back of your throat. Together they make up a collective lymphatic structure known as Waldeyer’s ring and include the following:

• Adenoid or pharyngeal tonsil: Located in the back of the nose, above the throat (pharynx)

• Tubal tonsils: Located where the pharynx connects with the tube leading to the ear (the Eustachian tube) and are a subsite of the adenoid tonsils

• Palatine tonsils: Located in your throat, near the roof of your mouth, which a healthcare provider can see when shining a light into your throat

• Lingual tonsils: Located at the base of the tongue

Function: Why Do We Have Palatine Tonsils?

All the tonsils, including the palatine tonsils, impact immune function. They are part of the lymphatic system, which channels fluid through the body and exposes it to immune cells. The lymphatic system is a component of the more extensive immune system.

What Is the Immune System?

The immune system is a group of cells and cellular components dedicated to identifying and eliminating possible sources of infection.

The body has these defense mechanisms at the openings to the throat to protect against potential bacteria or viruses entering the body through the air or food. Cells in the tonsils can identify invaders and help alert the rest of your body to a possible infection.

However, partly because of this function, palatine tonsils can become infected or enlarged.

Disease, Illness, and Infections of the Palatine Tonsils

The most common problems from palatine tonsils are related to infection or enlargement.

Tonsillitis

"Tonsillitis" refers to inflammation or infection of the palatine tonsils, not other tonsils in Waldeyer's ring. Children and teenagers have a higher risk of tonsillitis than adults.

Tonsillitis can be caused by viruses or bacteria, typically group A beta-hemolytic streptococcus, which causes strep throat. These infections pose a higher risk of complications from tonsillitis.

Tonsilitis can cause symptoms like:

• Fever

• Sore throat

• Pain with swallowing or difficulty swallowing

• Tender and swollen lymph nodes in the neck

• Tonsils that appear bright red or whitish or yellowish

If you're experiencing these symptoms, follow up with a healthcare provider. Many cases of tonsillitis go away without treatment, but it's important to rule out other causes or get antibiotics to treat a bacterial infection.

Enlarged Tonsils

Sometimes the palatine tonsils become enlarged during an episode of tonsillitis. However, they can also enlarge when you don’t have tonsillitis (tonsillar hypertrophy). It is more common among kids who get a lot of colds and other respiratory illnesses.

Up to one-third of children may have enlarged palatine tonsils, though many don’t experience problems with them.

However, enlarged palatine tonsils sometimes lead to the following:

• Difficulty swallowing, especially solid foods

• Vocal changes

• Sleep disruption

Enlarged tonsils can contribute to obstructive sleep-disordered breathing (obstructive sleep apnea is a subtype). It can cause pauses in breathing during sleep and other symptoms. This can lead to fatigue. In children, it can also lead to impaired learning and growth.

Palatine Tonsils Pain: What to Do

A combined approach is often most helpful in addressing tonsillitis.

Medical Treatment

You might need antibiotics if a healthcare provider diagnoses tonsillitis from a bacterial infection. However, antibiotics aren’t helpful for viral infections. So your healthcare provider may not prescribe them unless they’ve determined that a bacterial infection is to blame.

Pain Relievers

Certain over-the-counter (OTC) medications can help reduce your symptoms. You can use Advil (ibuprofen) to help relieve inflammation or Tylenol (acetaminophen) for pain relief. Follow the dosing instructions and don't exceed the recommended dose, especially in children.

Home Remedies

Some people turn to home remedies to help soothe their symptoms. Consider trying these options:

• Eat cold foods like Popsicles, or warm liquids, like broth.

• Gargle with salt water.

• Suck on a lozenge.

• Use a humidifier when you sleep.

It's also crucial to stay hydrated when you're sick.

Severe Palatine Tonsil Symptoms

Though rare, people with severe tonsillitis symptoms may require hospitalization. Severe symptoms are things like tonsil swelling so extreme that it is difficult to breathe or pain from swallowing that leads to serious dehydration.

Severe complications are rare and typically occur in people with tonsillitis from a strep infection. Some risks include:

• Pus-filled infection of nearby tissue (peritonsillar abscess), which may cause severe throat pain, lockjaw, or a muffled voice

• Kidney infection (glomerulonephritis), which can cause swelling, high blood pressure, and decreased urine (pee) output

• Rheumatic fever, which can lead to joint pain and heart problems

If your child has been diagnosed with tonsillitis, follow up with a medical provider for any potentially serious symptoms such as:

• A very severe throat that can’t be managed with pain relievers

• Joint pain

• Swelling of the arms or legs

• Decreased urination

Seek emergency medical attention for potentially life-threatening symptoms like severe difficulty breathing, sudden chest pain, or decreased consciousness. 

Palatine Tonsils Removal

Some people with repeated tonsillitis may need a tonsillectomy (surgery to remove the tonsils). Guidelines from the American Academy of Otolaryngology—Head and Neck Surgery Foundation advise that children might benefit from tonsillectomy if they’ve had:

• Seven bouts of tonsillitis in one year

• Five episodes annually for two years

• Three episodes annually for three years

Some children who have experienced severe symptoms or tonsil-related complications may benefit from having their tonsils removed.

A healthcare provider may recommend a tonsillectomy for children or adults with obstructive sleep-disordered breathing. Sometimes this is done alongside surgical adenoid removal (adenoidectomy).

Adenoidectomy and Ear Infections

The American Academy of Otolaryngology does not recommend tonsil removal for recurrent ear infections. However, if surgery to put in ear tubes (myringotomy or tympanostomy tubes) hasn’t been successful, they may consider an adenoidectomy along with a second placement of new tympanostomy tubes.

Summary

The palatine tonsils are located at the back of your mouth. They are made up of lymphatic tissue that is important for fighting infections. Most of the time, when people say “tonsils,” they mean the palatine tonsils. Tonsillitis is tonsil inflammation that leads to a sore throat or painful swallowing, usually caused by infection.

If bacteria are causing the infection, like in the case of strep throat, you may need antibiotics to treat it and prevent complications. Some people with recurrent tonsillitis or enlarged tonsils may benefit from surgical removal of the tonsils.