What tonsils and adenoids do
Tonsils and adenoids are lymphoid tissue that help the immune system respond to germs entering through the mouth and nose. They grow during early childhood, when children meet many new infections, and usually shrink from around the age of 8 onwards. By adulthood, the adenoids have often almost disappeared.
Because children’s airways are small, even normal-sized tonsils and adenoids can take up a lot of space.
Signs of enlarged adenoids
- Blocked nose most of the time, without a cold.
- Breathing through the mouth, especially at night; see mouth breathing.
- Snoring and noisy breathing.
- A nasal, blocked-sounding voice.
- Runny nose and repeated sinus infections.
- Glue ear and repeated ear infections, with hearing problems; see fluid in ear.
Signs of enlarged or infected tonsils
- Large tonsils visible at the back of the throat, sometimes nearly touching.
- Loud snoring and restless sleep.
- Slow eating or difficulty swallowing solid foods.
- Frequent sore throats and tonsillitis; see swollen tonsils and tonsillitis treatment.
- Bad breath.
Sleep apnoea in children
When enlarged tonsils and adenoids narrow the airway during sleep, children can have obstructive sleep apnoea: loud snoring, pauses in breathing, gasping, very restless sleep, sweating, sleeping with the neck extended and bedwetting. During the day they may be tired, irritable, hyperactive or have difficulty concentrating, which can be mistaken for behaviour or attention problems.
Sleep apnoea in children affects growth, learning and behaviour, so it should be assessed. See child snoring.
How an ENT specialist assesses them
- History of snoring, sleep, infections, hearing and school or behaviour.
- Examination of the throat, nose and ears.
- Nasal endoscopy with a thin camera, or occasionally an X-ray, to see the adenoids.
- Hearing tests and tympanometry if glue ear is suspected.
- Sleep studies or oximetry in selected children.
Parents can help by recording a short video of the child’s breathing during sleep.
Non-surgical treatment
Many children improve as they grow and as the tonsils and adenoids shrink. A steroid nasal spray can reduce adenoid swelling and nasal blockage in some children. Treating allergies and using saline nose rinses also help.
Glue ear often clears on its own within 3 months, so it is usually monitored first. Hearing support may be needed while waiting.
When surgery is recommended
- Adenoidectomy: for persistent nasal blockage, recurrent ear infections or glue ear, often combined with grommets; see adenoid removal and ear tubes.
- Tonsillectomy: for recurrent tonsillitis meeting set criteria, such as 7 or more episodes in a year, 5 a year for 2 years or 3 a year for 3 years.
- Adenotonsillectomy: removing both is the main treatment for obstructive sleep apnoea in children.
Recovery from adenoidectomy usually takes a few days, and from tonsillectomy about 10 to 14 days.
Does removing them affect immunity?
Many parents worry that removing tonsils and adenoids will weaken their child’s immune system. Other immune tissues take over, and studies have not shown a meaningful long-term effect on immunity in children who have them removed for good reasons.
Effects on speech, eating and growth
Large adenoids give the voice a blocked, “hyponasal” quality, and mouth breathing can affect how the teeth and jaw develop over years, with a long face, open bite and crowded teeth in some children. Glue ear caused by blocked Eustachian tubes reduces hearing, which can delay speech and make children seem inattentive.
Very large tonsils can make eating slow, with children choosing soft foods, gagging on lumps or growing poorly. Poor sleep from sleep apnoea also affects growth hormone release, and some children catch up in growth after surgery. A speech and language therapist can help if speech or feeding have been affected.
When to seek help
- Pauses in breathing during sleep or gasping.
- Difficulty breathing or swallowing, or drooling.
- A one-sided, very swollen tonsil with severe pain and difficulty opening the mouth.
- Poor weight gain or daytime sleepiness.
- Hearing loss or speech delay.
Key points to remember
- Tonsils and adenoids are naturally large in young children and shrink with age.
- Enlarged adenoids cause nasal blockage, mouth breathing and ear problems.
- Snoring with pauses in breathing can be sleep apnoea and needs assessment.
- Surgery is considered for sleep apnoea, recurrent tonsillitis or persistent ear problems.
Questions about tonsils and adenoids in children
These answers are general information and do not replace an examination or individual medical advice.
What is the difference between tonsils and adenoids?
Tonsils are at the back of the throat and visible; adenoids are behind the nose and are not visible without instruments.
At what age do adenoids shrink?
They usually start shrinking from around age 8 and are small by the teenage years.
Can enlarged adenoids cause speech problems?
They can cause a blocked nasal voice and, through glue ear and hearing loss, affect speech development.
Is snoring normal in children?
Occasional snoring with colds is common, but regular loud snoring should be checked.
Do tonsils grow back after surgery?
Rarely, small amounts of tissue can regrow, but symptoms usually do not return.
How long is recovery after tonsil and adenoid surgery?
About 10 to 14 days for tonsillectomy and a few days for adenoidectomy alone.
Can enlarged adenoids cause bad breath?
Yes. Mouth breathing and mucus behind the nose can cause bad breath in children.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.