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Enlarged Tonsils and Adenoids | Overview

What are enlarged tonsils and adenoids?

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 adenoids fight infection and can become enlarged when they get infected.

Enlarged tonsils and adenoids are also referred to as tonsillitis, adenoiditis, or tonsil and adenoid hypertrophy. A child with enlarged tonsils and adenoids may have a sore throat, trouble swallowing, sleep apnea or an inner ear infection.

What causes enlarged tonsils and adenoids?

Tonsils and adenoids can become enlarged for many different reasons, including exposure to viruses, bacteria, fungal, parasitic infections and cigarette smoke.

Common viruses include:

  • adenovirus
  • influenza virus
  • Epstein-Barr virus
  • herpes simplex virus

Common bacteria include:

The risk for tonsil and adenoid infections increase when children are in close contact with other children who have viral or bacterial infections.

What are the symptoms of enlarged tonsils and adenoids?

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

Symptoms of tonsillitis

  • sore throat
  • painful swallowing
  • lost appetite
  • bright red tonsils
  • white or yellow film on the tonsils
  • fever
  • bad breath

Symptoms of enlarged adenoids

  • breathing through the mouth instead of the nose
  • constantly running nose
  • nasal speech
  • recurring ear infections
  • snoring
  • sleep apnea, when the child repeatedly stops breathing for a few seconds while asleep

How we care for enlarged tonsils and adenoids

The 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 adenoids. Because our focus is children, we have the experience and expertise to offer the very best treatment. 

Enlarged Tonsils and Adenoids | Diagnosis & Treatment

How are enlarged tonsils and adenoids diagnosed?

A clinician will ask about the child’s symptoms and medical history and do a physical examination of the child’s 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 a child’s mouth, however, adenoids are harder to see. The clinician 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.

What are the treatment options for enlarged tonsils and adenoids?

If diagnostic testing determines that the cause of the infection is bacterial, not viral, the clinician may prescribe antibiotics.

Because antibiotics are only effective in treating bacterial infections, treatment will focus on the child’s comfort if a virus is causing the inflammation.

Treatment options to reduce pain and swelling include:

  • acetaminophen
  • increased fluid intake
  • throat lozenges
  • nasal spray

If the child has frequent tonsil and adenoid infections, the health care provider may recommend a procedure called a tonsillectomy and adenoidectomy (T&A) in which chronically infected tissues are removed. Often, both the tonsils and adenoids are removed at the same time, but sometimes only one or the other is removed.

Enlarged Tonsils and Adenoids | Programs & Services