What Is Adenotonsillar Hypertrophy?
Adenotonsillar hypertrophy means that the tonsils and/or adenoids are enlarged. The tonsils are two areas of tissue located at the back of the throat, while the adenoids are located higher in the throat, behind the nose.
Tonsils and adenoids are part of the immune system and help the body recognize and respond to infections. They are naturally larger in children and often become smaller with age.
When the tonsils or adenoids become significantly enlarged, they can obstruct normal breathing through the nose or throat. This may contribute to snoring, mouth breathing, disrupted sleep, recurrent infections and obstructive sleep apnea.
Symptoms of Adenotonsillar Hypertrophy
Enlarged tonsils and adenoids may cause one or more of the following:
- Loud or persistent snoring
- Mouth breathing, especially during sleep
- Difficulty breathing through the nose
- Chronic nasal congestion
- Restless or disrupted sleep
- Pauses in breathing or gasping during sleep
- Daytime tiredness or difficulty concentrating
- Sleeping in unusual positions to help with breathing
- Difficulty swallowing
- A muffled or altered voice
- Frequent sore throats or tonsil infections
- Recurrent ear infections or fluid behind the eardrum
- Persistent postnasal drainage
- Bad breath
In children, poor-quality sleep due to airway obstruction may sometimes present as daytime irritability, hyperactivity, behavioral changes or difficulty paying attention rather than obvious sleepiness.
Diagnosing Enlarged Tonsils and Adenoids
Diagnosis typically begins with a medical history and examination of the nose, mouth, throat and neck. Your provider will ask about snoring, sleep quality, breathing difficulties, infections, swallowing problems and other symptoms.
During the examination, your provider may evaluate:
- The size of the tonsils
- The appearance of the throat
- Nasal airflow and congestion
- The nasal septum and nasal passages
- Signs of chronic inflammation or infection
- The ears and middle-ear space
- Breathing patterns and other signs of airway obstruction
Because the adenoids are located behind the nose and cannot usually be seen during a routine mouth examination, your provider may use a small flexible camera (nasal endoscopy) to evaluate their size and determine whether they are obstructing the nasal airway.
If sleep-disordered breathing or obstructive sleep apnea is suspected, a sleep study (polysomnography) may be recommended. This can help determine the severity of nighttime breathing problems and guide treatment.
When Is Surgery Considered?
Not everyone with enlarged tonsils or adenoids needs surgery. Treatment depends on the size of the tissue, the severity of symptoms, the frequency of infections, the effects on sleep and breathing and overall health.
Tonsillectomy, adenoidectomy or removal of both tonsils and adenoids (tonsillectomy and adenoidectomy) may be considered when enlarged tissue is causing significant airway obstruction, sleep apnea, recurrent infections, swallowing difficulties or other persistent problems.
Your provider will discuss whether observation, medical treatment, further testing or surgery is the most appropriate option based on your individual symptoms and examination.
When Should You Be Evaluated?
An evaluation is recommended if you or your child has persistent loud snoring, mouth breathing, witnessed pauses in breathing during sleep, recurrent tonsillitis, chronic nasal obstruction or other symptoms affecting sleep, breathing, swallowing or daily activities.
A thorough evaluation can determine whether enlarged tonsils or adenoids are contributing to the symptoms and help identify the most appropriate treatment.