Tubal tonsil

Tonsilla tubaria

  • Latin eponym: Eustachian amygdala
  • Eponym: Gerlach's tonsil

Definition

Antoine Micheau

The tubal tonsil (Eustachian amygdala; Gerlach's tonsil) is a lymphoid tissue located in the nasopharynx, around the pharyngeal opening of auditory tube (eustachian tube). It is part of the Waldeyer's ring, which includes other tonsillar tissues such as the palatine, lingual, and pharyngeal tonsils.

The tubal tonsil is lined by pseudostratified columnar ciliated epithelium and contains areas of follicle-associated epithelium (FAE) that are heavily infiltrated by lymphocytes.[1-2]

Histologically, the tubal tonsil is characterized by the presence of lymphoid follicles, which are generally organized as solitary lymphoid follicles without germinal centers, in contrast to the nasopharyngeal tonsil.[1] The epithelium overlying these lymphoid follicles is modified into FAE, which lacks goblet cells and cilia, and is involved in the immune response by facilitating the transport of antigens to the underlying lymphoid tissue.[2] The tubal tonsil plays a role in the mucosal immune system of the upper respiratory tract, acting as an inductive and effector site for immune responses against inhaled or ingested pathogens.[3] It is also implicated in certain clinical conditions such as tubal tonsil hypertrophy, which can cause symptoms like nasal obstruction, obstructive sleep disorders, and recurrent otitis media.[4-6]

References

1.Histology, Immunohistochemistry and Ultrastructure of the Equine Tubal Tonsil.Kumar P, Timoney JF.Anatomia, Histologia, Embryologia. 2005;34(3):141-8. doi:10.1111/j.1439-0264.2005.00582.x.

Histology and Scanning Electron Microscopy of the Tubal Tonsil of Goats.Indu VR, Lucy KM, Chungath JJ, Ashok N, Maya S.Veterinary World. 2015;8(8):1011-4. doi:10.14202/vetworld.2015.1011-1014.

Functions of Tonsils in the Mucosal Immune System of the Upper Respiratory Tract Using a Novel Animal Model, Suncus Murinus.Suzumoto M, Hotomi M, Fujihara K, et al.Acta Oto-Laryngologica. 2006;126(11):1164-70. doi:10.1080/00016480600681593.

Tubal Tonsil Hypertrophy: A Cause of Recurrent Symptoms After Adenoidectomy.Emerick KS, Cunningham MJ.Archives of Otolaryngology--Head & Neck Surgery. 2006;132(2):153-6. doi:10.1001/archotol.132.2.153.

Partial Resection of Hypertrophic Torus Tubarius for Recurred Snoring: Case Series.Kim JW, Rhee CS, Jung HJ.Medicine. 2020;99(10):e19329. doi:10.1097/MD.0000000000019329.

Refractory Sleep Apnea Caused by Tubal Tonsillar Hypertrophy.Hong SC, Min HJ, Kim KS.International Journal of Pediatric Otorhinolaryngology. 2017;95:84-86. doi:10.1016/j.ijporl.2017.02.010.