Tonsils are paired organs at the back of the throat and their main purpose is to act as the body's first line of defense against external agents. They are full of white blood cells, the type of cells that help fight infections. Though known as the tonsils, they are in fact the "Palatine Tonsils", a part of the upper respiratory tract's defense mechanism, the other two being the Adenoids (behind the nose), and the Lingual Tonsils (the tonsils at the back of the tongue). 

Sometimes, on account of an infection, the tonsils become enlarged and painful. In some instances, like infection with streptococcal bacteria, they become covered with white pus points (strep throat). In this case, the patient, usually a child, will experience high-grade fever, pain in the throat, difficulty in swallowing, swelling in the neck, and a foul odor from the mouth. 

Apart from symptomatic relief, these patients sometimes need an antibiotic to treat the infection.

Though tonsillectomy (surgical removal of the tonsils) was commonly advised in the past, it is a much less performed operation now.

Clear Indications for Tonsillectomy

- Repeated infections: 6 or more per year, for at least once 2 years

- Tonsillar enlargement causing sleep apnoea or sleep-disordered breathing

- Suspected tumour/ neoplasm of the tonsil

- Removal of tonsilloliths (also known as tonsil stones)

Tonsillitis vs Covid-19 Infection

An attack of acute tonsillitis is quite different from the coronavirus infection. In Covid-19, the primary infection is in the nose, leading to the lungs. The throat may sometimes be involved. The patient usually displays common symptoms of Covid-19 including loss of sense of smell and taste, cough, breathlessness, etc. 

A simple throat swab will help the physician make a correct diagnosis - if results are positive for bacteria, it will be treated as acute tonsillitis.


Tonsil Stones

To increase its surface area, the tonsils have deep crypts and recesses. Food particles and infected material sometimes lodge in these crypts. These are attacked by the white blood cells and they gradually become harder and are called tonsilloliths or tonsil stones. They sometimes cause halitosis (foul oral odor) and appear unsightly. Maintaining good oral hygiene, doing a thorough mouth wash after every meal sometimes takes care of them. They are harmless, but if they bother the patient, the only permanent solution is the removal of the tonsils.