Lingual tonsillectomy for refractory paroxysmal cough

Historically, the lingual tonsils are the most neglected members of Waldeyer's ring. They are often overlooked even in a thorough head and neck exam because of their anatomic location and the ambiguous constellation of symptoms which they produce when they are diseased or enlarged. The lingual tonsils have been reported to be associated with a variety of upper aerodigestive tract symptoms including odynophagia, dysphagia, otalgia, globus, halitosis, chronic cough, and dyspnea. Many patients with lingual tonsillar pathology may undergo extensive work-up for some of these non-specific upper airway complaints by their primary physician before referral to an otolaryngologist. Consequently, the diagnosis of lingual tonsillar disease requires a high index of suspicion and a thorough physical exam including evaluation of the tongue base and hypophaynx with indirect mirror or fiberoptic exam. In order to draw attention to this frequently unrecognized entity, we present a case report of a child with chronic cough resulting from lingual tonsillar hypertrophy.