Enlarged Tonsils

“Tonsillar hypertrophy” is the medical term for enlarged tonsils. Your tonsils are two small fleshy mounds on both sides of the back of your throat. Part of your immune system, they trap and kill germs that come in through your mouth and nose. They sometimes swell when this happens. Then, they return to their normal size.

But sometimes, tonsils stay enlarged. This is especially the case in children between ages 3 and 7. These are the prime years when kids fight off childhood illnesses.

Enlarged tonsils usually don’t need treatment unless they cause problems. If they’re blocking your child’s airway and interrupting their sleep, it’s time to see a healthcare provider.

Symptoms of enlarged tonsils

Enlarged tonsils look bigger than normal. They may look red and irritated. Sometimes, they happen alongside symptoms like a sore throat or fever. If they’re big enough to block your child’s airway, they can cause:

• Mouth breathing
• Bad breath
• Painful swallowing
• Trouble eating or feeding
• Losing weight or not gaining enough weight
• Trouble sleeping or loud snoring

Tonsillar hypertrophy causes

Many factors can cause enlarged tonsils. Possibilities include:

• Frequent upper respiratory infections (usually from a virus or bacteria)
• Inflammation from repeated exposure to pollution or irritants (like secondhand smoke)
• Chronic acid reflux, or GERD
• Genes (some people are born with large tonsils)

Enlarged tonsils in adults

Causes of tonsillar hypertrophy in adults can be the same as in children. Other causes include more serious infections (like HIV), cysts, benign tumors and cancer (uncommon). Tonsil cancer can cause one tonsil to be bigger than the other.

How to lower your child’s risk

Not all causes of tonsillar hypertrophy are avoidable. But you can reduce your child’s risk of enlarged tonsils by helping them avoid getting sick. Teach them proper handwashing technique. Make sure they’re getting the right nutrition and enough sleep.

Complications of this condition

The most common complication of enlarged tonsils is obstructive sleep apnea (OSA). About 8 out of 10 children with OSA have enlarged tonsils. The lack of sleep can lead to irritability, behavioral changes and poor school performance. Not getting the sleep they need can increase your child’s risk for several conditions, including heart disease.

Over time, mouth breathing because of a blocked airway can lead to a misaligned bite. It can affect how the bones in your child’s face and jaw develop.

Enlarged tonsils can also increase your child’s risk of frequent or ongoing upper respiratory and ear infections.

How doctors diagnose this condition

Your child’s healthcare provider will ask about their symptoms. Then, they’ll examine their tonsils. They’ll likely use a wooden tongue depressor to get a clearer view of your child’s throat. They may check for swollen lymph nodes in their neck. Swelling usually means an infection.

Your child may need a throat culture to see if a bacteria is causing their tonsils to swell.

Tonsillar hypertrophy grading

Your child’s healthcare provider may also assign a grade based on how much space your child’s tonsils take up in relation to their throat:

• Grade 1: Tonsils cover less than 25% of their airway.
• Grade 2: Tonsils cover less than 50% of their airway.
• Grade 3: Tonsils cover less than 75% of their airway.
• Grade 4: Tonsils cover more than 75% of their airway.

While much depends on your child’s symptoms, higher grades are more likely to require treatment.

How is tonsillar hypertrophy treated?

Healthcare providers only treat hypertrophy of the tonsils that’s causing symptoms. Treatments include:

• Antibiotics for bacterial infections
• Antihistamines or nasal sprays to treat allergies
• Medicine, like NSAIDs, to reduce swelling
• Changes to your child’s environment, if the cause is an irritant like secondhand smoke

Surgery

Your child may need a tonsillectomy to remove enlarged tonsils. This is the most common treatment for children with obstructive sleep apnea. Often, their provider will remove their adenoids, too. Adenoids, like tonsils, are part of the immune system. They’re also prone to swelling and can cause issues.

Not having tonsils or adenoids won’t prevent your child’s body from fighting germs. Other parts of their immune system will step up to fight illnesses.

When should I see my healthcare provider?

Let your child’s provider know if your infant is having trouble eating and gaining weight. Let them know if your child is struggling to get enough sleep or is showing other signs of enlarged tonsils.

What can I expect if my child has this condition?

Usually, tonsils get smaller as children reach adolescence. So, enlarged tonsils may improve without treatment. But if your child is having symptoms, there are treatments that can help. Depending on the cause, your child may need over-the-counter or prescription medicine. If their tonsils are blocking their airway and interrupting their sleep, a tonsillectomy can usually fix the issue.