Tuberculosis involving the tonsil is very rare. These days it is still rare because of better milk processing techniques like pasteurization which eradicates the bovine strain of tuberculosis. Even though tonsils are situated in an exposed area where infected material like sputum and food stuffs come into contact this lesion is rare because of the following features:
1. Antiseptic and cleansing action of saliva (first and foremost)
2. Presence of saprophytic organisms in the oral cavity which prevents growth of tubercle bacilli
3. The stratified squamous epithelial lining of the tonsil also offers some degree of protection
Tuberculosis of tonsils may be:
Primary - Due to ingestion of infected milk (Bovine strain)
Secondary - Due to pulmonary infection. The coughed out infected sputum finds its way to the throat to involve the tonsils.
Diagnosis of tuberculosis of tonsil is not straight forward. It needs high degree of suspicion.
Pointers for the diagnosis of tuberculosis tonsil:
1. Asymmetric enlargement of tonsil
2. Tonsillar enlargement without exudate
3. Obliteration of crypts
4. Painful deglutition
5. Presence of enlarged mobile jugulodigastric nodes
Clinical photograph of a patient with Tuberculosis tonsil
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