Hypertrophy of the lingual tonsil: causes, symptoms, diagnosis, treatment

Hypertrophy of the lingual tonsil is a frequent anomaly of the development of this organ, which is often accompanied by hypertrophy and other solitary lymphadenoid formations of the pharynx. Mucous membrane of the upper surface of the root of the tongue, unlike the rest of its part, does not have papillae, but contains a large number of follicles of different sizes (folliculi linguales), which protrude on the surface of the root of the tongue in the form of rounded tubercles and together constitute the lingual tonsil.

In children, this amygdala is considerably developed and occupies the entire root of the tongue. After 14 years, the middle part of the lingual tonsil undergoes a reverse development, and the amygdala is divided into two symmetrical halves - the right and the left. Between them remains a narrow smooth strip, covered with a flat epithelium, which extends from the blind opening of the tongue to the middle lingual-epiglottis fold. However, in some cases, the lingual tonsil does not undergo reverse development, but continues to increase, occupying the entire space between the root of the tongue and the posterior wall of the larynx, filling also the lingual-epiglottic fossa, causing the sensation of a foreign body and provoking various reflex feelings and acts disturbing the patient. Usually hypertrophy of the lingual tonsil ends between 20 and 40 years of life, is more common in women. The cause of hypertrophy of the lingual tonsil should be sought first of all in an innate predisposition to this developmental anomaly, which is activated by the anatomical position of the IV amygdala lying on the airway and the food path, the constant traumatization of coarse, spicy food.

Pathological anatomy. There are two forms of hypertrophy of the lingual tonsil - lymphoid and vascular-glandular. The first of them arises as a result of the influence of the chronic inflammatory process in the palatine tonsils, which extends to the lingual tonsil, often manifested by its inflammation. Hypertrophy of the lymphoid tissue of the lingual tonsil occurs in the same way as the compensatory process after removal of the palatine tonsil. The second form of hypertrophy occurs when the venous vascular plexuses proliferate and the number of mucous glands increases. Simultaneously, the volume of lymphadenoid tissue decreases. This form of hypertrophy of the lingual tonsil often occurs in patients with diseases of the digestive system, as well as in individuals whose professional activity necessitates an increase in intrathoracic pressure (singers, speakers, musicians on wind instruments, glass blowers).

Symptoms and clinical course of hypertrophy of the lingual tonsil. Patients complain about the sensation of a foreign body in the throat, difficulty in swallowing, change in voice, snoring at night, periodic apioes. With physical exertion, the breathing of such persons becomes noisy, bubbling. Particularly worried sick chronic "causeless" cough - dry, sonorous, without phlegm, sometimes leading to laryngospasm and stridoroznomu breath. This cough does not respond to any treatment and continues to bother the patient for many years. Often, this cough leads to a violation of the integrity of the enlarged veins of the root of the tongue and bleeding. Cough is due to the fact that the hypertrophic lingual tonsil presses on the epiglottis and irritates the nerve endings of the upper laryngeal nerve that innervate it, which indirectly through the vagus nerve sends pulses to the bulbar cough center. In the cough reflex can take part and glossopharyngeal nerve, the branches of which reach the final groove of the tongue. Patients suffering from cough syndrome caused by lingual tonsils and palatine tonsils often visit doctors of various specialties who can not determine the cause of this syndrome, and only an ENT specialist who is familiar with reflex disorders caused by tonsillar hyperplasia can establish the true cause of this ailment.

Treatment of hypertrophy of the lingual tonsil should pursue the goal of reducing its volume, which is achieved by various means. The use of various "caustic" agents in the old times did not bring any significant results. Surgical excision of the lingual tonsil is fraught with formidable bleeding, often resulting in a ligation of one or both of the external carotid arteries with known consequences. Currently, the most effective methods of choice can be diathermocoagulation (4-6 sessions) and cryosurgical treatment (2-3 sessions). With the relapse of hypertrophy, especially of the vascular type, radiation therapy is used to ensure the final recovery.

[1], [2], [3], [4], [5], [6]