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What Are Tonsils?

Everybody's heard of tonsils, but not everybody knows what tonsils do or why they sometimes need to be taken out. I'm Dr. Cindy Gellner and we'll discuss that today on The Scope.

So tonsils are the small glands on either side of the back part of the throat. Their main job is to help stop bacteria from getting farther down the throat. Some people have large tonsils and some people have small tonsils. Tonsils are graded on a scale from 0 to 4. Zero means you've had them removed, 1 means they're barely visible, 2 means they're normal, 3 means they're large and just about touching that thing that hangs down at the back of your throat called the uvula, and 4 means they're ginormous. They're touching or overlapping the uvula or kissing each other.

When Do Tonsils Need to Be Taken Out?

Enlarged tonsils can be an ongoing problem or a temporary result of an infection. Your tonsils are part of your immune system, so they do get bigger as your body fights off illnesses. Doctors aren't sure what causes chronically enlarged tonsils, but secondhand smoke and air pollution can make them larger. If your child's tonsils are very large, they may snore really loud, called "heroic snoring," or have trouble swallowing certain foods, mainly breads and meats.

Sleep Apnea

Some kids with enlarged tonsils have obstructive sleep apnea, where they stop breathing for a few seconds and then snort loudly to restart breathing. This is because the tonsils partially block the airway. A test done overnight in the hospital called a sleep study can help determine if someone has sleep apnea by looking at these pauses. Occasionally, a child with sleep apnea may need to wear a special mask at night that helps with breathing.

Strep

Then there's strep, the dreaded infection parents worry about with large tonsils and a sore throat. The ear, nose, and throat specialists, those ENT doctors, don't remove large tonsils with strep after only two or three infections a year or if your child only gets it once a year. But if they get it four times in one year or six times in two years, then the ENT doctors are much more likely to say it's time for them to come out.

Tonsils enlarged from an infection, whether strep or otherwise, usually return to normal size when the infection gets better. Chronically enlarged tonsils may also shrink as children get older. Most of the time, treatment is not necessary. Sometimes, your pediatrician might recommend a nose spray to try to shrink the tonsils or refer them to an ENT specialist when it is possible your child may need surgery to remove them, called a tonsillectomy.

Remember, enlarged tonsils are common. Treatment depends on the size of the tonsils and whether or not they interfere with eating, sleeping, or breathing.

_{updated: September 24, 2024
originally published: March 18, 2016}