The tonsils are two masses of lymphoid tissue located at the back of the throat, one on each side. They are part of the body’s immune system, acting as a first line of defense against pathogens that enter through the mouth or nose. These tissues contain white blood cells that help filter out germs and produce antibodies to fight infections, protecting the respiratory and digestive tracts from illness. Tonsils play a role in developing specific white blood cells, B cells and T cells, particularly in early childhood.
Why Tonsils Enlarge
Tonsils can become enlarged due to various factors, most commonly infections. Bacterial infections like Streptococcus pyogenes, which causes strep throat, are frequent culprits. Viral infections, including the common cold, influenza, mononucleosis (Epstein-Barr virus), and adenoviruses, can also lead to tonsil enlargement. Allergies, chronic irritation from environmental factors like smoke or polluted air, and even gastroesophageal reflux can contribute to tonsil enlargement.
When tonsils become inflamed, they can present with several symptoms. Difficulty swallowing, often accompanied by a sore throat, is a common complaint. Enlarged tonsils can also obstruct the airway, leading to snoring, noisy breathing, and disturbed sleep, sometimes progressing to obstructive sleep apnea where breathing repeatedly stops and starts during sleep. Symptoms can also include bad breath, fever, and a white or yellow coating or patches on the tonsils.
At-Home Strategies for Relief
Several self-care strategies can help alleviate the discomfort and swelling associated with enlarged tonsils. Gargling with warm salt water is a widely recommended practice, as it can help reduce inflammation and soothe the throat.
Maintaining adequate hydration is also beneficial, as it helps keep the throat moist and aids the body in fighting off infection. Consuming warm liquids like tea with honey, broths, and soups can provide soothing relief, while cool options such as popsicles or ice chips can help numb the throat and provide fluids. Using a cool-mist humidifier can add moisture to the air, which helps relieve a dry, scratchy throat, particularly during sleep. Getting plenty of rest allows the body to conserve energy and focus on healing, and avoiding irritants like cigarette smoke can prevent further aggravation of the tonsils.
Medical Treatments Beyond Home Care
When enlarged tonsils persist or are caused by specific infections, medical interventions become necessary. For bacterial infections, such as strep throat caused by Group A Streptococcus, healthcare providers prescribe antibiotics. These medications are typically taken for 10 to 14 days to fully eliminate the infection. Completing the entire course of antibiotics is important to prevent complications.
Anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen, can be used to manage pain and reduce swelling associated with enlarged tonsils. These over-the-counter options help alleviate symptoms like sore throat, headache, and fever. If allergies are identified as a contributing factor to tonsil enlargement, a doctor may recommend allergy medications, including nasal steroids or saline sprays, to reduce inflammation in the nasal passages and surrounding tissues.
When Surgery Becomes an Option
Tonsillectomy, the surgical removal of the tonsils, is considered when conservative treatments are insufficient or when enlarged tonsils cause health problems. One common indication is chronic or recurrent tonsillitis, typically defined as seven or more infections in one year, five or more per year for two consecutive years, or three or more per year for three consecutive years. These infections are often accompanied by symptoms such as fever, swollen neck glands, or pus on the tonsils.
Another reason for tonsillectomy is when enlarged tonsils cause breathing difficulties, particularly during sleep. This can manifest as loud snoring or obstructive sleep apnea, where breathing repeatedly pauses. Difficulty swallowing that impacts nutrition or persistent pain also warrants consideration for surgery. The tonsillectomy procedure is performed as an outpatient surgery under general anesthesia, lasting about 20 to 30 minutes. Recovery takes 10 to 14 days, with throat pain and possible ear pain being common during this period.