Tonsils and adenoids are both made of lymphoid tissue similar to the glands in our neck and are
situated in the throat (tonsil -one on each side inside the mouth) and the adenoidal tissue is situated at the back of the nose where our mouth meets the back of the nose which is known as the
nasopharynx. Both adenoids and tonsillar tissues can enlarge as we grow through infancy and
childhood. They large to cause obstruction in the back of the nose or in the mouth (oropharynx) or
cause enlargement due to infection/inflammation or combination of both.
There are made up of lymphoid tissue, therefore, produced lymphocytes to fight against both
bacterial and viral infections, however large proportion of this work is done by the liver spleen and
bone marrow which usually takes over producing lymphocytes following early infancy.
Tonsillar enlargement causes difficulty with breathing, eating, swallowing and speaking in particular
can cause snoring, apnoea’s, drooling, gagging, and poor sleep. Tonsillar infections on the other
hand courses fevers ,headaches, abdominal cramps and pains, nausea vomiting, febrile convulsion,
frequent sore throats, drooling, halitosis (bad breath) and adjacent neck gland enlargement.
Tonsillar and adenoidal enlargement can cause obstructive symptoms especially at night with sleep
disturbance, apnoea’s, snoring and result in the reduction of oxygen and elevation of carbon dioxide.
These children often suffer from poor quality sleep, lethargy, hyperactivity, poor concentration, poor
school performance and behaviour behavioural abnormalities.
Tonsil infections are predominantly viral (70%), remainder by bacteria. Group A -beta haemolytic
streptococcus (GABHS) particular bacteria also normal as strep throat is implicated with rheumatic fever and subsequent heart valve disease as well as glomerulonephritis of the kidneys. Persistent
sore throat with throat culture when positive for GABHS would require antibiotic treatment to
prevent above complication. Recurrent GABHS infection in children especially between ages 6 and
14 would require treatment with penicillin antibiotic. Chronic tonsillar infections can cause chronic
cellulitis of tonsil and the surrounding tissue and can give rise to peritonsillar abscess (Quinsy) which
is a serious complication of chronic tonsillar infection with abscess formation around the tonsillar
Adenoidal enlargement often causes nasal obstruction with blocked nose/runny nose, snoring or
mouth breathing, hypo nasal speech, ear pain and recurrent ear infections. Persistent adenoidal
infection can cause sinusitis-like symptoms, sore throat and facial pain.
How adenoidal enlargement is diagnosed
Adenoidal tissue is difficult to examine in children unless we place a nasal endoscope which ENT surgeon can perform under local anaesthesia to visualise the adenoidal tissue. This is a simple procedure done performed in-office with the video endoscope. In children who whom, we are unable to perform this can obtain a lateral neck x-ray which can show adenoidal enlargement although this is not very accurate.