Tonsils and Adenoids

Tonsils are the two round lumps in the back of your throat. Adenoids are high in the throat behind the nose and the roof of the mouth (referred to as your soft palate). They are not visible through the mouth or nose without special instruments.

Tonsils and adenoids are part of the immune system and help protect the body from disease. They “sample” bacteria and viruses that enter through the mouth or nose. Unfortunately, sometimes they can get infected or cause problems by being too large.

What Are the Symptoms of Tonsil and Adenoid Difficulty?

Tonsillitis is an infection of the tonsils. Symptoms may include:

• Swelling of the tonsils
• Redder than normal tonsils
• A white or yellow coating on the tonsils
• A slight change in the voice due to swelling
• Sore throat sometimes accompanied by ear pain
• Uncomfortable or painful swallowing
• Swollen lymph nodes (glands) in the neck
• Fever
• Bad breath

If your or your child’s tonsils or adenoids are enlarged, it may be hard to breathe through the nose, or cause difficulty while sleeping. Other signs of adenoid and/or tonsil enlargement include:

• Breathing through the mouth instead of the nose most of the time
• Nose sounds “blocked” when the person speaks
• Chronic runny nose
• Noisy breathing during the day
• Recurrent ear infections
• Snoring at night
• Restlessness during sleep, or pauses in breathing for a few seconds at night (this may indicate sleep apnea, or other sleeping disorder)

You should see your ENT (ear, nose, and throat) specialist, or otolaryngologist, when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.

What Causes Difficulties in Tonsils and Adenoids?

The two most common problems of the tonsils and adenoids are caused by infection. Tonsil swelling can block the airway, or a person can experience repeated bacterial infections. These infections can contribute to breathing problems, nasal obstruction and swallowing difficulties, and sleep problems.

Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.

What Are the Treatment Options?

Your physician will ask about problems of the ear, nose, and throat, and examine the head and neck. They may use a small mirror or a flexible lighted instrument to see these areas. Other methods used to check tonsils and adenoids are:

• Throat cultures or strep tests to identify infections in the throat
• A small, flexible scope to visualize the size of the adenoids; an X-ray may also be ordered
• Blood tests to diagnose infections such as mononucleosis
• Sleep study, or polysomnogram, to help decide whether sleep apnea is present and if sleep disturbance may be due to enlarged tonsils and adenoids

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Tonsillectomy, removal of the tonsils and/or adenoids (adenoidectomy), can be an option when infections return frequently even after antibiotic therapy or there is difficulty breathing with the enlarged tonsils and/or adenoids.

Frequent infections of the adenoids can affect other areas such as the ear’s passage between the back of the nose and the inside of the ear, known as the eustachian tube. This can lead to frequent ear infections and collection of fluid in the middle ear that may cause temporary hearing loss. Removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (called otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., prednisone) is sometimes helpful.

What Questions Should I Ask My Doctor?

1. Are my tonsils or adenoids enlarged?
2. Could my snoring, sleep difficulty, or daytime sleepiness be related to sleep apnea?

Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.