Tonsils are lymphoid tissues at the back of the throat, part of the body’s immune system. They act as a first line of defense, trapping pathogens like bacteria and viruses entering through the mouth and nose. These oval-shaped masses contain immune cells that identify and fight infections.
Normal Tonsil Size and Appearance
Healthy tonsils appear as two oval, pinkish masses on either side of the back of the throat. Their color matches surrounding tissue, and they should not protrude or obstruct the airway. In adults, each palatine tonsil measures up to 2.5 cm in length, 2.0 cm in width, and 1.2 cm in thickness.
Tonsil size varies with age, often appearing larger in children than adults. Children’s developing immune systems are frequently exposed to new pathogens, making tonsils more active. After puberty, tonsils tend to shrink, becoming smaller in adulthood. The Brodsky scale categorizes normal tonsil size as Grade 1 or 2, meaning they occupy less than 50% of the oropharyngeal airway and do not extend beyond the tonsillar pillars.
Understanding Enlarged Tonsils
Enlarged tonsils, or tonsillar hypertrophy, are swollen beyond their typical size. This enlargement often indicates an active immune response or chronic irritation. Frequent infections from common viruses (e.g., adenovirus, influenza, Epstein-Barr virus) are a primary cause of swelling. Bacterial infections, like Streptococcus pyogenes (strep throat), also commonly lead to significant enlargement.
Chronic inflammation also contributes to persistent tonsil enlargement. Environmental irritants like secondhand smoke and air pollution, allergies, and gastroesophageal reflux can cause swelling. While some individuals naturally have larger tonsils, persistent enlargement often signals an underlying condition.
When Enlarged Tonsils Require Attention
While some tonsil enlargement is normal, especially in children, medical evaluation is warranted if it causes persistent symptoms. Significantly enlarged tonsils can obstruct the airway, leading to noisy breathing, loud snoring, and pauses in breathing during sleep (obstructive sleep apnea). This obstruction can cause restless sleep, frequent awakenings, and daytime fatigue.
Other symptoms requiring medical attention include recurrent tonsillitis, difficulty or pain swallowing (dysphagia), especially with solid foods. Enlarged tonsils can also contribute to chronic ear infections, bad breath, or a muffled voice. Seek medical consultation if one tonsil appears significantly larger than the other, or if breathing difficulties, extreme trouble swallowing, or excessive drooling are present.