The hidden tonsils of Waldeyer's ring

The visible and the hidden tonsils of Waldeyer's ring merit attention from specialists in allergy and clinical immunology not only because they are sites of antigen recognition and synthesis of antibody, including IgE, but also because they may produce a wide range of symptoms in the upper airway. Ordinarily, such symptoms may be differentiated from those of classic allergic rhinitis, but allergists commonly see patients with a variety of upper airway complaints that on investigation prove not to have an allergic basis. Use of flexible fiberoptic upper airway endoscopy, a simple office procedure that permits direct inspection of the recessed areas of the upper airway, will result in timely evaluation and treatment of pathology of these upper airway lymphatic structures, and identification of patients requiring referral to another specialis.