Enlarged tonsils and adenoids are common in children. They may enlarge due to an infection or can be large at birth itself.

Tonsils are round pieces of lymphoid tissue located on both sides of the throat in the back of the mouth. Adenoid is located above the roof of the mouth, behind the nasal cavity. Tonsils and adenoids are lymphoid tissue which fights against common infection but if infected continuously it can cause repeat infection in throat.  

There are multiple possible symptoms, but the most common is that a child may occasionally feel difficulty in breathing or swallowing. Enlarged tonsils and adenoids are particularly found in children between the ages of 3 and 6. Mouth breathing is a common symptom in adenoids.

* Symptoms:

Enlarged tonsils and adenoids can cause different symptoms. Few symptoms a child may experience for tonsils include:

• Cough

• Bad breath

• Sore throat

• Pain while swallowing

• Loss of appetite

• Fever

• Red tonsils

Symptoms for enlarged adenoids include:

• Breathing through the mouth

• Running nose

• Snoring, gasping while sleeping

• Nasal speech

• Nosebleed

• Sleep apnea

• Frequent ear infections


Consult a doctor or an ENT specialist if you face given symptoms frequently.


* Causes

Some children may have relatively large tonsils and adenoids without any problem.

Tonsils and adenoids enlarge due to many reasons such as exposure to bacteria, fungi viruses and parasite infections.

Enlarged tonsils and adenoids can be caused by:

Infection: Infections from viruses or bacteria.

Viruses: Viruses such as adenovirus, herpes simplex virus, influenza virus Epstein-Barr virus

Bacterial infection: Bacterial infections group A beta-hemolytic streptococci

Allergies: Any seasonal allergies may enlarge the tonsils.


The doctor may ask about the history of the throat problems to determine the cause of enlarged tonsils and adenoids.

The other method for diagnosis includes:

Physical exam: The doctor can ask about child symptoms and conduct a physical examination of your mouth, neck, and throat.

Endoscopy: Adenoids can be identified using a device called ‘endoscope’. It is a long thin flexible tube with light and camera attached to one end, inserted through the nose.

X-ray: The doctor may recommend an x-ray to diagnose tonsils and adenoids.

Blood test: Blood samples may be collected to identify infections.

Throat culture: A cotton-tipped stick is used to swap the back of the child’s throat to obtain samples to check for infections and bacteria.

Allergy testing: An allergy test inclcudes skin test and blood test to identify allergic reactions of the child to a variety of substances found in food and air.


* Treatment

Treatment options for enlarged tonsils and adenoids include multiple options depending on the bacterial or recurrent infection.

Treatment options available for bacterial infection include:

• Antibiotics (for bacterial infection)

• Acetaminophen

• Throat lozenges

• Nasal spray (spray is used to shrink the adenoids, making the breathing process easier)

• An increased amount of fluid intake

Treatment options available for recurrent infections include:

In case of frequent tonsils and adenoid infections, the doctor may recommend a tonsillectomy and adenoidectomy treatment to remove infected tissues.

Adenoidectomy is a surgical procedure which can be done in one sitting to remove the infected adenoid tissue. Tonsillectomy is a procedure of removing infected tonsils tissue. Depending on the infection, tonsil or adenoid can be removed partially or completely.

Risk factor

The risk factor for enlarged tonsils and adenoids increases with bacterial and viral infections.

Chronic infection of tonsils can cause streptococcal infection which can lead to rheumatic fever.

(Increase ASO titer)


* Prevention

Enlarged tonsils and adenoids can be prevented with regular checkups with an ENT (ear, nose & throat) doctor. Check out for the signs and symptoms if they appear frequently.


* Complication

Enlarged tonsils and adenoids can cause serious problems in children that may include:

Chronic ear infections: This infection occurs behind the eardrum. It is caused by an infection or virus that traps the fluid behind the eardrum resulting in swelling. It may lead to pain and discomfort. This can be treated with antibiotics.

Hearing loss: The blockage and fluid accumulation in the middle ear may cause a severe problem of hearing loss.

Speech problems: Unattended hearing loss can lead to speech problems.

Sinus infection: Enlarged tonsils can cause sinus infections and colds.

Obstructive sleep apnea: This may cause children to snore and labored breathing during sleep.

Prognosis or Outlook for patients

Enlarged tonsils and adenoids are easily curable. Many times, the enlarged part comes back to its original size without any treatments needed.

It can cause severe complications if left untreated. Early diagnosis and treatment reduce the risk for severe complications and increase the chances of complete recovery.



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