The tonsils and adenoids are part of the immune system. They help protect the body by ‘sampling’ the bacteria and viruses that enter through the nose and mouth. The same sampling role is what makes them prone to infection, inflammation and enlargement, which can affect breathing, sleep and hearing.
What are tonsils?
The tonsils are the two round, fleshy masses at the back of your throat — collections of lymphoid tissue that form part of the immune system. Their main role is to filter out germs entering through the nose or mouth. They contain many white blood cells that help kill germs. (Tonsils are also called the palatine or faucial tonsils.)
What are adenoids?
The adenoids are fleshy lumps of lymphoid tissue at the back of the nose, out of sight when your child opens their mouth. They are part of the lymphatic and immune system, trapping and destroying germs and producing antibodies that help fight infection.
A normal adenoid is around 6.2 mm; an enlarged adenoid averages 11.6 mm. They can become enlarged due to infection, allergies or other irritants. Adenoids reach their maximum size between ages 3 and 5 and begin to shrink around ages 7–8, usually disappearing by adulthood.
Common conditions
Tonsillitis
Tonsillitis occurs when the tonsils become infected. Common symptoms include:
- Enlarged, reddened tonsils, often with a white or yellow coating
- Painful or uncomfortable swallowing
- Slight vocal change due to swelling
- Sore throat, sometimes with referred ear pain
- Bad breath
- Fever
- Swollen lymph nodes in the neck
- Tonsil stones and associated bad breath
Hypertrophy of the adenoids
Chronic or recurrent inflammation can lead to enlargement (hypertrophy) of the adenoids. This makes nasal breathing difficult and can cause sore throat or ear problems.
Adenoiditis
When the adenoids become inflamed — usually from persistent bacterial infection or allergy — it’s called adenoiditis. Symptoms depend on the cause and can come on gradually or suddenly. They often include:
- Snoring
- Nasal speech
- Runny nose
- Noisy breathing
- Mouth breathing
- Brief pauses in breathing at night
Ear infections
When the adenoids enlarge or become inflamed, they can block the Eustachian tube — which equalises pressure in the middle ear. This causes fluid to build up in the middle ear (glue ear / otitis media with effusion), leading to infections and hearing problems. Bacteria can also spread directly from infected adenoids to the middle ear via the Eustachian tube.
How are tonsil and adenoid issues diagnosed?
If your doctor suspects a tonsil or adenoid problem, they’ll ask about your child’s symptoms and perform a physical examination. They may order blood tests, refer your child for x-rays or other imaging, or arrange a nasal endoscopy — a thin, flexible tube with a small camera that examines the nasal passages and adenoids. If sleep is affected, a sleep study may be recommended.
When to see an ENT surgeon
Tonsil and adenoid issues are typically managed first by your GP. If problems continue, with difficulty breathing during sleep, recurrent infections, or hearing concerns, surgery may be recommended.
When surgery is considered
Frequent or persistent adenoid inflammation can cause a blocked nose, leading to breathing or sleep difficulties, mouth breathing, frequent ear infections and glue ear. In older children and adolescents, tonsil problems are more often related to recurrent or persistent infections. If these issues persist, surgery may be considered.
The relevant procedures are Tonsillectomy (removal of the tonsils) and Adenoidectomy (removal of the adenoids). The two can be combined as an adenotonsillectomy when both tissues are causing problems.
