The tonsils are examined using direct visualization. You will observe rough, lobular, and coral to light pink tissue of varying amounts between the anterior and posterior pharyngeal pillars (Figure 25). Atypical presentations include excessively large or asymmetrical tonsils, cratered surfaces without evidence of erythema or exudates. Occasionally, individuals have large crypts in the tonsils that collect food debris, bacteria and hardened material. Patients with this type of cryptic tonsil often complain of halitosis. Careful inspection is needed to evaluate the tonsils for serious diseases. Since increases have been reported in tonsillar cancer it is important to fully evaluate, refer if necessary and follow-up on any suspicious areas seen. Early stages of this cancer may not be very suspicious looking so it is essential to be vigilant. After a tonsillectomy one may observe residual tonsil tissue or a regrowth of lymph tissue in the area. Pathologic findings include:
Dysphagia (painful or difficult swallowing)
Swelling, asymmetry, erythema and/or surface exudates (Figure 26)
Erythema and/or dysphagia may also be associated with mouth breathing and may indicate a nasal obstruction.
Figure 25. Normal anatomy of the oropharyngeal area.
Figure 26. Streptococcal infection of the tonsils.