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

Hypertrophy of the lingual tonsil is a common developmental anomaly of this organ, which is often accompanied by hypertrophy of other solitary lymphadenoid formations of the pharynx. The mucous membrane of the upper surface of the root of the tongue, unlike the rest of it, does not have papillae, but contains a large number of lymphatic follicles of various sizes (folliculi linguales), which protrude on the surface of the root of the tongue in the form of rounded tubercles and together form the lingual tonsil.

In children, this tonsil is significantly developed and occupies the entire root of the tongue. After 14 years, the middle part of the lingual tonsil undergoes reverse development, and the tonsil is divided into two symmetrical halves - right and left. Between them there remains a narrow smooth strip covered with flat epithelium, which extends from the blind opening of the tongue to the median lingual-epiglottic 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 laryngopharynx, also filling the lingual-epiglottic fossa, causing a sensation of a foreign body and provoking various reflex sensations and acts that bother the patient. Usually, hypertrophy of the lingual tonsil ends between 20 and 40 years of life, and is more common in women. The cause of hypertrophy of the lingual tonsil should be sought primarily in the congenital predisposition to this developmental anomaly, which is activated due to the anatomical position of the fourth tonsil, lying on the air and food tract, and constant trauma to it from coarse, spicy food.

Pathological anatomy. There are two forms of hypertrophy of the lingual tonsil - lymphoid and vascular-glandular. The first of them occurs as a result of the influence of the chronic inflammatory process in the palatine tonsils, which also spreads to the lingual tonsil, often manifested by its inflammation. Hypertrophy of the lymphoid tissue of the lingual tonsil occurs in the same way as a compensatory process after removal of the palatine tonsil. The second form of hypertrophy occurs with the proliferation of venous vascular plexuses and an increase in the number of mucous glands. At the same time, there is a decrease in the volume of lymphadenoid tissue. This form of hypertrophy of the lingual tonsil is most often found in patients with diseases of the digestive system, as well as in people whose professional activities require an increase in intrathoracic pressure (singers, speakers, wind instrument players, glassblowers).

Symptoms and clinical course of hypertrophy of the lingual tonsil. Patients complain of a sensation of a foreign body in the throat, difficulty swallowing, changes in the timbre of the voice, snoring at night, periodic apioe. During physical exertion, breathing in such individuals becomes noisy and gurgling. Patients are especially bothered by chronic "causeless" cough - dry, sonorous, without sputum, sometimes leading to laryngospasm and stridor breathing. This cough does not respond to any treatment and continues to bother the patient for many years. Often, this cough leads to damage to the dilated veins of the root of the tongue and bleeding. The cough is caused by the fact that the hypertrophied lingual tonsil presses on the epiglottis and irritates the nerve endings of the superior laryngeal nerve that innervate it, which indirectly sends impulses to the bulbar cough center through the vagus nerve. The glossopharyngeal nerve, whose branches reach the terminal groove of the tongue, can also participate in the cough reflex. Patients suffering from cough syndrome caused by the lingual tonsil and palatine tonsils often visit doctors of various specialties for a long time, who cannot determine the cause of this syndrome, and only an ENT specialist familiar with reflex disorders caused by hyperplasia of the tonsils 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 past did not bring significant results. Surgical excision of the lingual tonsil is fraught with severe bleeding, often ending in ligation of one or both external carotid arteries with known consequences. At present, the most effective methods of choice may be diathermocoagulation (4-6 sessions) and cryosurgical exposure (2-3 sessions). In case of relapse of hypertrophy, especially of the vascular type, radiation therapy is used, ensuring final recovery.

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