Tonsillar hypertrophy is the medical term for the persistent enlargement of the tonsils, the two small masses of lymphoid tissue located at the back of the throat. The tonsils function as part of the immune system, acting as a first line of defense to trap and neutralize germs entering through the mouth and nose. Hypertrophy refers to a state where this enlargement is long-lasting, often without an active infection. This condition affects people of all ages but is most frequently observed in children between the ages of three and seven.
What Causes Tonsils to Become Enlarged?
The primary reason for tonsil enlargement relates to their function in fighting off pathogens, which increases their size as they process repeated exposures to germs. Recurrent upper respiratory infections, whether caused by viruses or bacteria such as Group A Streptococcus, stimulate the lymphoid tissue to grow. Repeated or chronic infections can cause the tonsils to remain permanently enlarged.
Chronic inflammation, even without an active infection, also contributes to tonsillar hypertrophy. Exposure to environmental irritants, such as secondhand smoke or air pollution, can trigger a prolonged inflammatory response leading to sustained enlargement. Allergic reactions and chronic acid reflux are recognized factors that contribute to the swelling of these tissues. Some individuals, particularly children, may simply have naturally larger tonsils due to genetics or developmental factors.
Recognizing the Signs of Enlarged Tonsils
When the tonsils grow large enough, they can physically obstruct the upper airway, resulting in noticeable symptoms. A common sign is chronic, loud snoring, which indicates restricted airflow during sleep. This obstruction often leads to mouth breathing, especially at night.
A more serious manifestation of this blockage is obstructive sleep apnea (OSA), characterized by repeated pauses in breathing during sleep. This sleep-disordered breathing can result in restless sleep, daytime sleepiness, and behavioral changes due to poor sleep quality. Enlarged tonsils can also interfere with swallowing, causing dysphagia or difficulty eating. Other signs include persistent bad breath, a muffled or nasal-sounding voice, and frequent throat clearing.
Diagnosis and Treatment Approaches
A medical evaluation for tonsillar hypertrophy typically begins with a physical examination of the throat, where a healthcare provider visually assesses the size of the tonsils. Physicians often use a grading scale, such as the Brodsky scale, to objectively document the degree of enlargement. If an active infection is suspected, a throat swab or culture may be taken to determine if bacteria are the cause.
For cases where the primary concern is sleep-related breathing issues, a sleep study, known as polysomnography, may be recommended to measure the severity of the obstruction. Management varies depending on the cause and symptom severity. If the enlargement is mild and causes no functional issues, a “watchful waiting” approach with routine monitoring is appropriate. Non-surgical management involves treating underlying causes, such as prescribing antibiotics for bacterial infections or using antihistamines and nasal sprays for chronic allergies. When the enlargement causes significant airway obstruction, such as severe sleep apnea, or leads to frequent, recurrent infections, surgical removal (tonsillectomy) is often considered.