Many children have enlarged tonsils or tonsillitis . These can narrow the airways and cause a child to snore and breathe slowly while sleeping. If the child in question sleeps poorly in the long term, this can lead to various problems and sometimes illness. Therefore, in many cases an operation is recommended in case of enlarged tonsils.

The temporary hypertrophy of the tonsil first degree is, therefore, a variant of the standard for the acute period of an infectious disease. Elevation of the amygdala to grade 2 and 3 leads to symptoms of the disease and requires treatment. This is a common pathology in children.

The hypertrophy of the glands can develop in parallel with an increase in the pharyngeal or lingual tonsils. Often an enlarged gland is diagnosed against the background of the adenoids and vice versa.

In some children, the palatine tonsils are enlarged (technical terms: tonsillar hyperplasia or tonsillar hypertrophy), in others – the apple of the throat (technical terms: adenoids). There are even children in which both are enlarged.

There is often confusion when it comes to the apple. For example, pharyngeal tonsils are commonly mistakenly referred to as polyps. However, nasal polyps are understood to be benign growths of the nasal mucosa, which generally only occur in adults.

In addition, it is important to distinguish a prolonged enlargement of the apple from an inflammation of the tonsils (tonsillitis). These are two different diseases.

Symptoms of hypertrophy in the tonsils

The following symptoms and complaints may indicate an enlarged tonsils:

  • Ronquidos.
  • Breathing with pauses during sleep.
  • Predominance of mouth breathing.
  • Forced breathing
  • Restless sleep, frequent waking, night sweats.
  • Unusual sleeping positions (head stretched excessively, legs prone).
  • Difficulty to swallow.
  • Common cold.

The main symptoms, among other things, depend on what type of inflammation is occurring. For one thing, the pharyngeal tonsil makes nasal breathing difficult. In contrast, breath murmurs are caused primarily by enlarged palatine tonsils.

When a child sleeps poorly, they are not sufficiently rested during the day. Despite this, children generally do not seem tired after a sleepless night, but rather fidgety or fired up. However, tiredness can literally make it more difficult for them to rest, for example in the car seat while you are driving. Only older children and adolescents show strong fatigue.

Parents tend to attribute changes in the child’s body to the inflammation process during a cold. However, if the infection clears and the breathing is heavy and with nasal difficulty, this is an opportunity to consult a doctor.

If there is regular respiratory failure and the child wakes up several times at night, obstructive sleep apnea (OSA) can be a great nuisance. In this situation, children can barely get into a deep sleep, making the night’s rest little more than relaxing.

Causes of enlarged tonsils in children

It is not possible to say exactly why the gland is hypertrophied. It is safe to say, however, that this is a protective response of the body to the action of an adverse factor .

Why the tonsils increase in size in some children and not in others is not clear. However, swollen tonsils are often a normal accompaniment to growth. Over the years, they can also get smaller again. The strength of the symptoms does not always have to do with the size of the tonsils.


Enlarged tonsils can remain without consequences in many children. About 7% of all children snore permanently, about 2% breathe slowly, and suffer from obstructive sleep apnea at rest. In children, these problems are often caused by enlarged tonsils, especially between the ages of 3 and 6.

Consequences of inflammation of the tonsils

The possible effects of swollen tonsils can be:

  • Respiratory infections such as colds: These are favored by constant mouth breathing with inflamed tonsils.
  • Middle ear infections and tympanic effusion: This occurs when enlarged tonsils obstruct the ventilation of the middle ear. Chronic persistence of this problem can cause hearing and speech problems.
  • Deformities in the jaw, open bite and altered position of the tongue: can also be the result of permanent mouth breathing.
  • Strong and long-lasting sleep apnea due to enlarged tonsils can affect physical development and increase the risk of cardiovascular disease.

The consequences of having enlarged tonsils depend mainly on how severely the airways narrow, whether there are respiratory distress syndromes, and how long a child has had these problems.

The risk of complications is higher with obstructive sleep apnea than with snoring alone. But loud snoring and frequent mouth breathing can also have consequences. In contrast, it is harmless if a child snores only silently or occasionally, for example, when he has caught a cold.

How hypertrophy in the tonsils is diagnosed

If the child has any discomfort, the first thing parents do is go to a pediatrician. For further examinations, the procedure usually refers to a treatment with medications for the ear, nose, and throat.

First, the doctor asks about the existing symptoms. Then the medical professional examines the throat and checks how big the tonsils are and how much they narrow the airways .

In addition, the ears are examined and it is seen if, for example, there is a tympanic effusion. It also checks if the child hears and speaks well. On the other hand, it is important to clarify other possible causes of discomfort, such as allergies or deformities in the jaw.

On rare occasions, a sleep test is proposed in the laboratory. It can be helpful in suspected obstructive sleep apnea, in very young children, or when other diseases or disabilities may be involved.

To reliably detect obstructive sleep apnea, a laboratory examination is necessary. However, it is often not possible to do it just for swollen tonsils because it is an elaborate procedure and there are only limited places available.


You can’t always be completely sure when enlarged tonsils are a health problem. It is not easy, for example, to decide to operate the tonsils when we notice that snoring becomes problematic. Therefore, it may be that different doctors give different recommendations. However, there is agreement that persistent sleep apnea has negative consequences for a child and should be treated.

Before deciding on treatment, you should review the results of the diagnosis. In particular, it is necessary to consider the degree of growth of the lymphoid tissue, the presence of infection and inflammation.

If a child snores only occasionally, rather silently, or usually only during a cold, treatment is not necessary.

There are the following treatment options:

  • Waiting to see symptoms develop – This is helpful for minor ailments that may improve on their own. Parents need to see if snoring is increasing and it is about interruptions in breathing. In addition, it is important that the child is examined by a doctor who specializes in the ear, nose and throat.
  • Cortisone Nasal Spray : Can be used to reduce throat inflammation, improving nasal breathing. However, it has no influence on enlarged palatine tonsils.
  • Operation of the pharyngeal tonsil : to remove most of it (adenotomy).
  • Palatine tonsil surgery : These are usually partially removed (tonsillotomy), rarely completely (tonsillectomy).

If the tonsils and palatine tonsils are enlarged, they can also be operated on in a single operation (adenotonsillectomy or adenotonsillotomy).

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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