Prevalence of Gerlach tonsil: a mucosa associated lymphoid tissue aggregation in the nasopharynx


  • Ramesh Varadharajan Department of Otorhinolaryngology and Head and Neck Surgery, Aarupadai Veedu Medical College and Hospital, Kirumampakkam, Puduchery
  • Sonee Thingujam Department of Otorhinolaryngology and Head and Neck Surgery, Aarupadai Veedu Medical College and Hospital, Kirumampakkam, Puduchery



Tubal tonsil, Gerlach tonsil, Mucosa-associated lymphoid tissue


Background: The major aggregate of mucosa associated lymphoid tissue located in the nasopharynx is the adenoid. The minor aggregate located in the nasopharynx is the Gerlach tonsils or tubal tonsils. The Gerlach tonsils are well described in the text books. But unlike the adenoids they are rarely visualized during routine endoscopic examination. Several studies conducted in children for recurrence of adenoids or serous otitis media after surgery; have reported tubal tonsil hypertrophy widely. This study in adults aims to see the prevalence of Gerlach or tubal tonsils visible during nasal endoscopy.

Methods: The case records of 155 adult patients, aged between 18-50 years, who underwent pre-operative diagnostic nasal endoscopy for the management of septal deviations, chronic Sinusitis, nasal polyposis or eustachian dysfunction between Jan. 2019 to March 2020 are retrospectively reviewed and the endoscopy findings analyzed and presented.   

Results: Gerlach tonsil hypertrophy is reported to be more prevalent in children than in adults.  When hypertrophied, the Gerlach tonsils can cause symptoms in adults also and can be visualized during nasal endoscopy. In this adult study, we report a 0.6% incidence of Gerlach tonsil hypertrophy.  

Conclusions: The possibility of a Gerlach tonsil hypertrophy is to be remembered during nasal endoscopy in adult patients presenting with symptoms of eustachian dysfunction and past history of allergic rhinitis and adeno tonsillectomy. Comparing the size of the contra lateral torus tubaris and the eustachian tube opening during the act of swallowing is helpful in diagnosis.

Author Biography

Ramesh Varadharajan, Department of Otorhinolaryngology and Head and Neck Surgery, Aarupadai Veedu Medical College and Hospital, Kirumampakkam, Puduchery



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Original Research Articles