Sure, you might know vaguely where your tonsils are (hint: two round lumps in the back of your throat). But do you know what your tonsils do—and would you recognize if they were causing you problems? Tonsil issues are actually somewhat common: In fact, close to 300,000 people over the age of 15 have theirs removed each year, according to research published in JAMA Otolaryngology–Head & Neck Surgery. Here's what you need to know about your tonsils—and what you should do if they're causing issues like dragon breath or snoring.
This story was originally published by our partners at WomensHealthMag.com.
According to the U.S. National Library of Medicine, the tonsils are part of your body's lymphatic system, which helps fight off infection. Since they are located in the back of your throat, tonsils are often the first line of defense against germs like viruses and bacteria that enter the body through the nose or mouth. Your tonsils are designed both to trap and prevent germs from getting farther into your body as well as to sound the alarm to the immune system to produce antibodies when there is an invader.
But if they get overworked or overwhelmed, tonsils themselves can get infected, causing them to swell and get irritated, a condition called tonsillitis. Often caused by allergies, bacteria, or viruses like streptococcus or Epstein-Barr, you'll likely know something is wrong because the back of your throat will be sore and painful. However, tonsils can also play a supporting role in a number of other surprising conditions you may be suffering from, including the following:
Minty gum not cutting the mouth funk? According to the National Institutes of Health, half the world's population suffers from halitosis or bad breath. While 90% of cases are caused by issues in the mouth such as poor oral hygiene or saliva flow, it is possible to get dragon breath from tonsil stones, also known as tonsoliths. "Tonsil stones are created when trapped debris in the tonsils calcifies," says Murray Grossan, MD, founder of the Grossan Sinus & Health Institute and author of The Whole Body Approach to Allergy and Sinus Health. "The tonsils are filled with nooks and crannies where bacteria, dead cells, and mucus become clogged. The trapped materials then form a debris, which accumulates in white formations in the pockets." These tonsoliths often contain volatile sulphur compounds that lead to stinky breath. The treatment? "Good oral hygiene like brushing your teeth and gargling with an antiseptic can help dislodge trapped debris," suggests Jeffrey Gallups, MD, CEO and medical director of The ENT Institute.
While many tonsil stones are small and don't cause any discomfort, when larger calcifications form, they can make swallowing painful. "When [the tonsil stones] are rock hard, they can act as a foreign body and cause localized discomfort," says Murray. "When you swallow, it is like you have a pin in your throat." If you are experiencing swallowing discomfort and don't have allergies or a virus like strep throat, the pain may be caused by large tonsil stones. Sometimes you can dislodge the tonsil stones at home by vigorously gargling salt water or even coughing. However, larger tonsoliths may require a consultation with an ear, nose, and throat specialist to discuss professional removal options such as laser tonsil cryptolysis. According to the New York Head and Neck Institute, during this procedure, which is done under local anesthesia (meaning you're awake), a doctor inserts a tube containing a laser through your nostrils and down your throat to blast through tonsil stones. (Want to pick up some healthier habits? Sign up to get healthy living tips and more delivered straight to your inbox!)
Sawing logs giving you or your partner a sleepless night? According to the American Academy of Otolaryngology, enlarged tonsils can be a cause of snoring. "When tonsils are enlarged, the size interferes with the air passage," says Murray. While the snoring may be annoying, it isn't exactly harmful (except to your goal of 8 hours of shut-eye) unless it is accompanied by sleep apnea, in which the body gets reduced oxygen during sleep due to breathing pauses or airway blockages.
While enlarged tonsils are more often a cause of snoring in children, an estimated 4 of every 100 middle-age men and 2 of every 100 middle-age women have obstructive sleep apnea that can be caused by enlarged tonsils. "The tonsils may be enlarged due to a congenital condition or recurrent infection or other factors," says Gallups. If the condition is severe, removing the tonsils may be recommended. "It's a last resort, but it is the most common treatment for this kind of snoring because few people want to wear a continuous positive airway pressure device every night to keep the airway open," he says.
The surgical removal of the tonsils (known as a tonsillectomy) is a fairly standard operation performed by an ENT and often also includes removal of the andenoids—patches of tissue that sit in the back of the nasal cavity and work in conjunction with the tonsils—as well. But the surgery itself has been on the decline. According to the American Academy of Otolaryngology, the number of tonsillectomies has dropped significantly since the 1970s, as has the central reason doctors recommend the treatment. Thirty years ago, approximately 90% of tonsillectomies were performed for recurrent infection; now it is about 20% for infection and 80% for obstructive sleep problems.
While some studies show modest benefits for kids suffering from recurrent tonsil issues, the surgery has mixed results in its effectiveness for adults. "Tonsillectomies should be a last treatment resort for all tonsil issues because there can always be complications with surgery," says Gallups. Plus, he says, surgery isn't always a guaranteed solution to your problems. If you're suffering from regular sore throats or these other tonsil problems, find a board-certified ENT who is willing to explore all non-surgical options first.