Prevalence of Gerlach tonsil: a mucosa associated lymphoid tissue aggregation in the nasopharynx
Keywords: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.
Cesta MF. Normal structure, function, and histology of mucosa-associated lymphoid tissue. Toxicol Pathol. 2006;34(5):599-608.
Dai ZY, Huang DY, Zhou CY. Effects of partial tonsillectomy on the immune functions of children with obstructive sleep apnea-hypopnea syndrome at early stage. Genet Mol Res 2014;13:3895-902.
Huang SW, Giannoni C. The risk of adenoid hypertrophy in children with allergic rhinitis. Ann Allergy Asthma Immunol. 2001;87(4):350-5.
Zhang, X, Sun, B, Li, S, Jin, H, Zhong, N, Zeng, G. Local atopy is more relevant than serum sIgE in reflecting allergy in childhood Adeno tonsillar hypertrophy. Pediatr Allergy Immunol. 2013:24:422-6.
Acar GÖ, Cansz H, Duman C, Öz B, Ciğercioğullar E. Excessive reactive lymphoid hyperplasia in a child with persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy. J Craniofac Surg. 2011;22(4):1413-5.
Çoban K, Köycü A, Aydın E. Lingual Tonsil Hypertrophy in Patients With Allergic Rhinitis. Am J Rhinol Aller. 2020; 34(1):87-92.
Moneret-Vautrin DA. Le MALT nasal. Rev Aller Clinic Immunol. 1994;34(2):165-70.
Masieri S, Trabattoni D, Incorvaia C, De Luca MC, Dell’Albani I, Leo G, Frati F. A role for Waldeyer’s ring in immunological response to allergens. Curr Medic Res Opin. 2014;30(2):203-5.
Schilder AG, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, et al. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clinic Otolaryngol. 2015;40(5):407.
Emerick KS, Cunningham MJ. Tubal tonsil hypertrophy: a cause of recurrent symptoms after adenoidectomy. Arch Otolaryngol Head Neck Surg. 2006;132(2):153-6.
Monroy A, Behar P, Brodsky L. Revision adenoidectomy--a retrospective study. Int J Pediatr Otorhinolaryngol. 2008;72(5):565-70.
Honda K, Tanke M, Kumazawa T. Otitis media with effusion and tubal tonsil (video). Acta Oto-Laryngologica. 1988;105(sup454):218-21.
Hazem A. Tubal tonsil hypertrophy: a cause of recurrent otitis media with effusion. Egypt J Otolaryngol. 2010:26.
Hong SC, Min HJ, Kim KS. Refractory sleep apnea caused by tubal tonsillar hypertrophy. Int J Pediat Otorhinolaryngol. 2017;95:84-6.