Enlarged Tonsils and Adenoid

Tonsils are small, round pieces of tissue located in the back of the mouth on both sides of the throat. The adenoid is a clump of tissue located behind the nasal cavity above the roof of the mouth. Tonsils and the adenoid fight infection and can become enlarged when they get infected.

Enlarged tonsils and adenoid are also referred to as tonsil and adenoid hypertrophy. A child with enlarged tonsils and adenoid may have a sore throat, trouble swallowing, snoring and sleep disturbance, such as sleep apnea. A child with an enlarged adenoid may have nasal obstruction, mouth breathing, and increased risk of ear infection.

Symptoms of enlarged tonsils and adenoid can vary depending on the cause and severity of infection. They can occur suddenly or develop gradually.

Symptoms of tonsillitis

• Sore throat
• Painful swallowing
• Snoring and sleep disturbance such as sleep apnea (when the child repeatedly stops breathing for a few seconds while asleep)
• Bad breath

Symptoms of an enlarged adenoid

• Breathing through the mouth instead of the nose
• Constantly running nose
• Nasal speech
• Recurring ear infections
• Snoring

A child’s tonsils and adenoid can become enlarged for many different reasons, most commonly a viral infection.

Common viruses that can cause tonsil and adenoid enlargement include:

• Adenovirus
• Influenza virus
• Epstein-Barr virus
• Coronavirus

A clinician will ask about your child’s symptoms and medical history and do a physical examination of their ears, neck, mouth, and throat. A throat culture can help determine if the infection is bacterial or viral.

A clinician can see if the tonsils are enlarged by looking inside your child’s mouth, however, the adenoid is harder to see. Your child’s doctor may use an endoscope, a long, flexible tube with a light at the end to observe the adenoid. Other diagnostic tests could include an X-ray, blood test, or sleep study.

Antibiotics are only effective in treating bacterial infections. Therefore, if the enlarged tonsils and/or adenoid are due to a viral infection, treatment will focus on your child’s comfort.

Treatment options to reduce pain and swelling include:

• Acetaminophen or ibuprofen
• Increased fluid intake
• Throat lozenges
• Nasal spray

If your child’s symptoms persist, their doctor may recommend a further treatment. Depending upon your child’s symptoms and the diagnostic findings, this may include a tonsillectomy, tonsillotomy, or adenoidectomy.

Boston Children’s Department of Otolaryngology and Communication Enhancement is the oldest, largest and one of the most recognized centers for pediatric otolaryngology in the U.S. Our team specializes in caring for infectious and inflammatory conditions of the ear, nose, and throat, including enlarged tonsils and adenoid. Because our focus is children, we have the experience and expertise to offer the very best treatment.