Sore Throat 102: Waldeyer’s Ring and Defending the Fort

Following is a continuation of the topic on sore throats.  You all probably know that docs like me need to be very specific, using nifty words from our medical repertoire, impressing upon you that our six figure student loan was totally worth it.  Fortunately, I paid off mine after 10 years of practice.   Read on and be totally impressed...or not.

Anyway, whenever you see or hear the suffix “–itis” attached to the back of a word, think of “inflammation.”  Thus, tonsillitis = “inflammation of the tonsils.”  Inflammation is a rather broad term, referring to a response of the body part or organ to some insult such as trauma, foreign objects, chemicals, adverse effects of medications, or microorganisms such as bacteria, viruses and fungi.  An infection is a type of inflammation caused by microorganisms (which lay people often call “germs”) invading that specific organ or bodily part.

Sore Throat 101 talked about pertinent anatomy; you can look back at that discussion for a refresher and review those awesome drawings (imagine me patting myself on the back right now). 

So when someone has a sore throat caused by inflammation, it could be described as:
Pharyngitis:  a broader topic referring to the structures of the oropharynx as defined and shown in Sore Throat 101, but often referred to oropharynx structures other than the palatine tonsils, or in patients who’ve had their tonsils previously removed.
Tonsillitis: involving the palatine tonsils, but also can involve the lingual tonsils and adenoids, all of which are similar in makeup and part of a family called Waldeyer’s Ring—more on this later.
Laryngitis: often mild soreness but more so voice changes such as hoarseness or loss of voice, and it’s more critical subtype, epiglottitis, a potentially life threatening condition especially in children.

Of course there are other causes of sore throats, such as tumors or cancers, which is an entirely different topic altogether.  Most causes of sore throats deal with infections of Waldeyer’s Ring.

“What the…?”  you might ask.
"The Ring"

Tonsils, adenoids, lingual tonsils are collective called Waldeyer’s Ring.  I’ll refer to these tissues simply as “The Ring,” not to confuse them with the horror movie about a hideously, super-scary girl with long dark hair creeping out of the T.V. screen on all fours, killing everyone in her path.  Sorry about the aside.  Anyway, The Ring is a sentry, so to speak, a protective part of the portal of entry into the body from the nose and mouth.  Think of The Ring as border guards or the TSA (Transportation Security Administration) at the airport.  The Ring is part of the lymphoproliferative system, a fancy term for the immune system of the body’s defense against foreign invaders.  It allows direct exposure of immunologically active cells to foreign antigen (such as bacteria, viruses, fungi etc.) and when these lymphoid tissues get exposed to the antigen, they produce antibodies against those antigens, microscopic proteins that attach to the antigen.  They also signal other defense-cells to divide and grow, aiding to rid the body of those bad foreign invaders.

The palatine tonsils are what we often refer to as “the tonsils”: they are the largest of the lymphoid tissue in The Ring and are visible to most people.  They also tend to have more “crypts”—deep canyons or spaces within the tissue lined by specialized cells.  This increases the surface area to maximize exposure to antigens.  These very crypts however can be the source of problem when they trap debris and bacteria.  Thus, those palatine tonsils often are major source of infection in The Ring.

The Ring is more active during childhood, typically up until 10 years of age.  That’s the reason kids often have large tonsils since their immune system is being primed by all those germs in their environment.  Afterwards, they do not have a major function since other aspects of the immune system takes over and often shrink, oftentimes withering away to mere fraction of their former selves.  The adenoids and lingual tonsils can also be involved, but the symptoms are typically not as bad as when those palatine tonsils are involved.  But all these guys can become the source of problems, still trapping nasty invaders and creating problems for their host, which is the person holding these tissues, and potentially you and me.

Yes I know, you're itching to see the sequels, so hold onto your pants and when time permits there'll be more on specific causes of sore throats and how they relate to The Ring.

©Randall S. Fong, M.D.