Tonsils are small, oval-shaped tissue pads located on each side at the back of the throat. They serve as a part of the body’s immune system, acting as a first line of defense against bacteria and viruses entering through the mouth or nose. While tonsils are present in everyone, their size can vary significantly from person to person, and a “tonsil size chart” is a tool healthcare professionals use to assess this variation.
Understanding Tonsil Grading
Healthcare providers use a standardized tonsil grading scale, known as the Brodsky grading scale, to visually assess tonsil size. This scale, ranging from Grade 0 to Grade 4, describes how much the tonsils extend into the throat. Assessment involves observing their projection relative to the tonsillar pillars, the arches of tissue at the back of the throat. This grading helps determine if tonsil size is typical or indicates enlargement. It also clarifies how much of the oropharynx, the space between the two tonsillar pillars, is occupied by the tonsils.
What Each Tonsil Size Indicates
Each grade on the tonsil size scale offers a general interpretation of tonsil health and potential implications.
Grade 0 indicates tonsils have been surgically removed or are entirely within the tonsillar pillar and not visible.
Grade 1 tonsils are normal, barely visible, or occupy less than 25% of the oropharyngeal airway, typically not obstructing the throat.
Grade 2 tonsils show mild enlargement, extending beyond the tonsillar pillars but occupying 26% to 50% of the oropharyngeal airway. While slightly larger, they generally do not cause significant obstruction or discomfort.
Grade 3 tonsils are moderately enlarged, extending to the midline of the throat and occupying 51% to 75% of the oropharyngeal airway. This size can indicate significant enlargement and may lead to issues such as snoring or difficulty swallowing.
Grade 4 tonsils represent severe enlargement, where they nearly touch or are actually touching each other, a condition sometimes called “kissing tonsils.” These tonsils occupy more than 75% of the oropharyngeal airway. This level of enlargement can cause substantial breathing difficulties, especially during sleep, and may be associated with obstructive sleep apnea, snoring, and swallowing problems.
When to Consult a Doctor
It is advisable to consult a doctor if you or a family member experience symptoms related to tonsil size, regardless of the perceived grade.
Difficulty breathing, particularly at night, accompanied by loud snoring or pauses in breathing, can suggest obstructive sleep apnea and warrants medical attention. Persistent difficulty swallowing or eating, especially solid foods, also indicates a need for evaluation.
Recurrent or frequent tonsil infections, such as strep throat, are a common reason to seek medical advice. Other symptoms that should prompt a doctor’s visit include a persistent sore throat that does not improve within 24 to 48 hours, unexplained fevers, or chronic fatigue. Consult a medical professional if one tonsil appears noticeably larger than the other, or if there is excessive drooling in a young child.