Tonsils & Adenoids

Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are located in the back of the throat. Adenoids are located behind the nose and soft palate, therefore, are not visible without special instruments.

The tonsils and adenoids function as part of the body’s first line of defense against invaders. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections.

WARNING: The following video contains medical imagery and/or illustrations which may be sensitive for some viewers.

Medical Concerns

Recurrent infections in the nose and throat can negatively affect the health of your tonsils and adenoids. Significant enlargement of these structures can also cause nasal obstruction, mouth breathing, trouble swallowing, and difficulty sleeping.


Tonsillitis is an infection of the tonsils and is associated with the following symptoms:

  • Swelling of the tonsils
  • Extremely red tonsils
  • White or yellow coating on tonsils
  • Slight voice change due to swelling
  • Sore throat, sometimes with ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Large Tonsils or Adenoids

Those who have large tonsils or adenoids often find it difficult to breathe through their nose which results in trouble breathing while asleep. Enlarged tonsils or adenoids can also lead to the following symptoms:

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

Evaluation & Treatment

It is important to seek medical evaluation if you are experiencing the common symptoms of infected or enlarged tonsils or adenoids.

Doctors can use the following assessment tools to determine if medical treatment is needed:

  • Patient medical history
  • Physical examination
  • Throat cultures/Strep tests – helpful in determining infections in the throat
  • X-rays are able to pinpoint the size and shape of the adenoids
  • Blood tests – helpful in diagnosing infections such as mononucleosis
  • Sleep studies can be helpful to determine whether sleep disturbance is occurring as a result of large tonsils and adenoids

Bacterial Infection of the Tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness and may even cause behavioral or school performance problems in some children.

Chronic infections of the adenoids can lead to frequent ear infections and fluid buildup in the middle ear. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids.

Preparing for Surgery


  • Talk to your child about his/her feelings and provide strong reassurance and support
  • Encourage the idea that the procedure will make him/her healthier
  • Be with your child as much as possible before and after the surgery
  • Tell him/her to expect a sore throat after surgery, and that medicines will be used to help the soreness
  • Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward
  • It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy
  • Your otolaryngologist can answer questions about the surgical procedure


For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.

  • Tell your surgeon if the patient or patient’s family has had any problems with anesthesia or clotting of blood. If the patient is taking medications, has sickle cell anemia, has a bleeding disorder, is pregnant, or has concerns about the transfusion of blood, the surgeon should be informed
  • A blood test may be required prior to surgery
  • A visit to the primary care doctor may be needed to make sure the patient is in good health at surgery
  • You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important, as anything in the stomach may be vomited when anesthesia is induced

When the patient arrives at the hospital or surgery center, the anesthesiologist and nursing staff will meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After Surgery

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique, and recovery time may vary.

Your ENT specialist will provide you with the details of preoperative and postoperative care and answer your questions.

There are several postoperative problems that may arise such as swallowing difficulty, vomiting, fever, throat pain, and ear pain.

Occasionally, bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.

Any questions or concerns you have should be discussed openly with your surgeon.