Table of ContentsView AllTable of ContentsCausesSymptomsComplicationsWhen to Seek Medical CareDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Complications
When to Seek Medical Care
Diagnosis
Treatment
Tonsillar hypertrophy, a condition in which thetonsilsare enlarged, is more common in children than adults. Large tonsils usually don’t cause symptoms or only cause minimal symptoms. But they can cause health problems, includingsnoringandsleep apnea—which can affect daytime behavior and long-term growth in children.
If you have any concerns about your child’s tonsils, their healthcare provider can assess whether enlarged tonsils could be causing adverse health effects and whether your child needs treatment.
This article takes you through the causes, symptoms, diagnosis, and treatment of enlarged tonsils, plus possible complications to be aware of.
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What Causes Enlarged Tonsils in Kids?
Children can have large tonsils for a number of reasons. The back of the mouth and throat are proportionately smaller in children. The lymphoid tissue of the tonsils and adenoids grows in most children between the ages of two and six years.
For children who do not have room to spare, tonsil growth may cause a narrowing that prevents adequate passage of air. Additionally, muscle tone is firmer in children than adults, potentially shrinking the airway opening in the back of the throat.
The tonsils can become swollen and inflamed when tonsillitis results from allergies or infections, and sometimes these issues can become chronic.
What Causes Chronic Tonsillitis?
What Are the Symptoms of Enlarged Tonsils?
Many children who have large tonsils never develop symptoms. When symptoms do occur, they tend to be more common during sleep, when the muscles are more relaxed.
Children with enlarged tonsils might snore during sleep, and some can develop sleep apnea, which could be noticed if someone else is in the room.
The most common symptoms of enlarged tonsils include:
If your child has enlarged tonsils due to an acute and short-lived infection, the symptoms may include a fever, sore throat, and cough. Prolonged symptoms indicate a chronic issue.
Tonsillar hypertrophy is more common in children, but adults can have swollen tonsils andassociated complicationsas well.
Complications of Enlarged Tonsils
Sometimes enlarged tonsils can cause problems. Many of these complications can contribute to and worsen each other. For example, large tonsils can predispose your child to recurrent infections, which in turn can lead to chronically inflamed tonsils.
Obstructed Breathing
Enlarged tonsils can interfere with breathing. This is more common during sleep, but it can occur while awake.
Children who have tonsillar hypertrophy might develop mouth breathing, which can lead to dental issues such as periodontal disease,halitosis (bad breath), and tooth decay.
Sleep Problems
Sleep problems due to enlarged tonsils include waking up frequently at night, usually falling back asleep right away. Interrupted sleep and oxygen deficiency can prevent a child from getting enough restorative sleep.
Untreated snoring and sleep apnea can have a significant impact on a child’s health.Inadequate sleepmay disturb the release of growth hormones and interfere with adequate growth.
Eating Difficulty
Children who have tonsillar hypertrophy can have trouble swallowing food.Additionally, oral health and dental issues can interfere with eating.
Behavior Changes
A lack of restorative sleep and oxygen deprivation can cause symptoms of daytime fatigue, but it can also manifest with irritability, trouble concentrating, hyperactivity, and behavioral changes.
Treatment of enlarged tonsils can improve symptoms ofattention-deficit/hyperactivity disorder(ADHD), and may reduce some children’s need for ADHD medication.
Heart and Pulmonary Disorders
When to See a Healthcare Provider
Contact your child’s healthcare provider if your child has enlarged tonsils with:
Seek immediate medical care if your child experiences:
Diagnosing Enlarged Tonsils
Enlarged tonsils can be diagnosed with a physical examination. Anatomic variations that may be associated with a narrowed airway, such as large adenoids, a short neck, or a small jaw, may worsen the effects.
The degree of enlargement is assessed with the Brodsky scale, which grades the size of the palatine tonsils from 1+ to 4+.At the largest classification, the tonsils are touching in the midline of the throat.
Your child may have additional tests to assess their oxygen level and breathing ability. These may include:
Your child might also need a thorough dental examination, and in some cases, asleep studyto determine whether they are experiencing sleep apnea.
Can only one tonsil be enlarged?Yes, tonsil swelling can affect only one side, or it may be more prominent on one side than the other. This can happen with hypertrophy or tonsillitis. While uneven tonsils can be one sign oftonsil cancer, this is rare in children.Talk to your child’s healthcare provider if tonsil enlargement is confined to one side.
Can only one tonsil be enlarged?
Yes, tonsil swelling can affect only one side, or it may be more prominent on one side than the other. This can happen with hypertrophy or tonsillitis. While uneven tonsils can be one sign oftonsil cancer, this is rare in children.Talk to your child’s healthcare provider if tonsil enlargement is confined to one side.
Yes, tonsil swelling can affect only one side, or it may be more prominent on one side than the other. This can happen with hypertrophy or tonsillitis. While uneven tonsils can be one sign oftonsil cancer, this is rare in children.
Talk to your child’s healthcare provider if tonsil enlargement is confined to one side.
Treating Enlarged Tonsils in Kids
Enlarged tonsils that aren’t causing symptoms often don’t need any treatment.However, if you are concerned about the effects of enlarged tonsils, or if your child has been snoring or having recurrent infections, your child’s healthcare provider will discuss treatment options with you.
Treatments can depend on the cause of the enlargement:
Can Your Tonsils Grow Back After a Tonsillectomy?
Summary
Enlarged tonsils are common in children and may not cause symptoms. When symptoms occur, you may notice snoring, daytime drowsiness, and difficulty swallowing. Other symptoms such as pain and fever may also be present, depending on the cause of tonsil swelling. Complications can include obstructed breathing, sleep problems, and heart and pulmonary issues.
Diagnosis is usually based on a physical exam, but other tests may also be needed. Treatment addresses the cause of the enlargement (e.g., allergies, viral or bacterial infection). Contact a healthcare provider if symptoms include fever, significant pain, difficulty swallowing, or noticeable daytime fatigue that persists for more than a couple of days. Seek immediate medical attention for breathing difficulties, extreme difficulty swallowing, or if a red rash develops.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Pediatrics.Sleep apnea detection.İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D.Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children.Biomed Res Int.2021 Apr 2;2021:5550267. doi:10.1155/2021/5550267Keskin N, Keskin S.Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children.Auris Nasus Larynx. 2021;48(2):248-254. doi:10.1016/j.anl.2020.08.002Perez A, Hunter K.Adenotonsillectomy as a treatment for sleep-disordered breathing in children with ADHD.JAAPA. 2020 Oct;33(10):34-39. doi:10.1097/01.JAA.0000697248.35685.c6Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA.Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy.Pediatr Cardiol.2014 Jun;35(5):785-92. doi:10.1007/s00246-013-0853-7American Academy of Pediatrics.Tonsillitis: Symptoms & Treatment.Nemours KidsHealth.Scarlet Fever.Kumar DS, Valenzuela D, Kozak FK, et al.The reliability of clinical tonsil size grading in children.JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034-7. doi:10.1001/jamaoto.2014.2338Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S.Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature.Int J Pediatr Otorhinolaryngol.2018 Jul;110:57-60. doi:10.1016/j.ijporl.2018.04.027Nationwide Children’s Hospital.Enlarged tonsils.Huang Q, Hua H, Li W, Chen X, Cheng L.Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children.J Otolaryngol Head Neck Surg. 2020 Jun 1;49(1):35. doi:10.1186/s40463-020-00428-3Mitchell RB, Archer SM, Ishman SL, et al.Clinical practice guideline: Tonsillectomy in children (update)-executive summary.Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi:10.1177/0194599818807917
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Pediatrics.Sleep apnea detection.İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D.Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children.Biomed Res Int.2021 Apr 2;2021:5550267. doi:10.1155/2021/5550267Keskin N, Keskin S.Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children.Auris Nasus Larynx. 2021;48(2):248-254. doi:10.1016/j.anl.2020.08.002Perez A, Hunter K.Adenotonsillectomy as a treatment for sleep-disordered breathing in children with ADHD.JAAPA. 2020 Oct;33(10):34-39. doi:10.1097/01.JAA.0000697248.35685.c6Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA.Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy.Pediatr Cardiol.2014 Jun;35(5):785-92. doi:10.1007/s00246-013-0853-7American Academy of Pediatrics.Tonsillitis: Symptoms & Treatment.Nemours KidsHealth.Scarlet Fever.Kumar DS, Valenzuela D, Kozak FK, et al.The reliability of clinical tonsil size grading in children.JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034-7. doi:10.1001/jamaoto.2014.2338Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S.Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature.Int J Pediatr Otorhinolaryngol.2018 Jul;110:57-60. doi:10.1016/j.ijporl.2018.04.027Nationwide Children’s Hospital.Enlarged tonsils.Huang Q, Hua H, Li W, Chen X, Cheng L.Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children.J Otolaryngol Head Neck Surg. 2020 Jun 1;49(1):35. doi:10.1186/s40463-020-00428-3Mitchell RB, Archer SM, Ishman SL, et al.Clinical practice guideline: Tonsillectomy in children (update)-executive summary.Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi:10.1177/0194599818807917
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Pediatrics.Sleep apnea detection.İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D.Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children.Biomed Res Int.2021 Apr 2;2021:5550267. doi:10.1155/2021/5550267Keskin N, Keskin S.Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children.Auris Nasus Larynx. 2021;48(2):248-254. doi:10.1016/j.anl.2020.08.002Perez A, Hunter K.Adenotonsillectomy as a treatment for sleep-disordered breathing in children with ADHD.JAAPA. 2020 Oct;33(10):34-39. doi:10.1097/01.JAA.0000697248.35685.c6Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA.Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy.Pediatr Cardiol.2014 Jun;35(5):785-92. doi:10.1007/s00246-013-0853-7American Academy of Pediatrics.Tonsillitis: Symptoms & Treatment.Nemours KidsHealth.Scarlet Fever.Kumar DS, Valenzuela D, Kozak FK, et al.The reliability of clinical tonsil size grading in children.JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034-7. doi:10.1001/jamaoto.2014.2338Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S.Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature.Int J Pediatr Otorhinolaryngol.2018 Jul;110:57-60. doi:10.1016/j.ijporl.2018.04.027Nationwide Children’s Hospital.Enlarged tonsils.Huang Q, Hua H, Li W, Chen X, Cheng L.Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children.J Otolaryngol Head Neck Surg. 2020 Jun 1;49(1):35. doi:10.1186/s40463-020-00428-3Mitchell RB, Archer SM, Ishman SL, et al.Clinical practice guideline: Tonsillectomy in children (update)-executive summary.Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi:10.1177/0194599818807917
American Academy of Pediatrics.Sleep apnea detection.
İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D.Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children.Biomed Res Int.2021 Apr 2;2021:5550267. doi:10.1155/2021/5550267
Keskin N, Keskin S.Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children.Auris Nasus Larynx. 2021;48(2):248-254. doi:10.1016/j.anl.2020.08.002
Perez A, Hunter K.Adenotonsillectomy as a treatment for sleep-disordered breathing in children with ADHD.JAAPA. 2020 Oct;33(10):34-39. doi:10.1097/01.JAA.0000697248.35685.c6
Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA.Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy.Pediatr Cardiol.2014 Jun;35(5):785-92. doi:10.1007/s00246-013-0853-7
American Academy of Pediatrics.Tonsillitis: Symptoms & Treatment.
Nemours KidsHealth.Scarlet Fever.
Kumar DS, Valenzuela D, Kozak FK, et al.The reliability of clinical tonsil size grading in children.JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034-7. doi:10.1001/jamaoto.2014.2338
Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S.Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature.Int J Pediatr Otorhinolaryngol.2018 Jul;110:57-60. doi:10.1016/j.ijporl.2018.04.027
Nationwide Children’s Hospital.Enlarged tonsils.
Huang Q, Hua H, Li W, Chen X, Cheng L.Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children.J Otolaryngol Head Neck Surg. 2020 Jun 1;49(1):35. doi:10.1186/s40463-020-00428-3
Mitchell RB, Archer SM, Ishman SL, et al.Clinical practice guideline: Tonsillectomy in children (update)-executive summary.Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi:10.1177/0194599818807917
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