Tonsillar enlargement is often in response to the child having had viral or bacterial infections of the tonsils or may be an allergic lymphoid response in those children with significant allergies.

Tonsillar enlargement may be surprisingly asymptomatic and one often sees children with very large tonsils who don’t snore or have very few others symptoms however some children with smaller tonsils but with lax and floppy tissues of the lining of the throat or pharynx can have significant symptoms with snoring, struggling to breathe and even apnoea (see Obstructive Sleep Disorder). If the tonsils are enlarged and causing significant symptoms as described in the obstructive sleep disorder section or the child has quality of life issues such as difficulty swallowing meat and apple peel and is living on a fairly liquid or soft diet then there may well be an indication for removal of tonsils. If the tonsil enlargement is one sided and there is a significant difference between the size of the tonsils then we will, particularly if there are any other systemic symptoms, remove the tonsil to ensure there is no abnormal tissue present in the tonsil.Lymphoma is rare in children but it is something that we need to keep in the back of our mind as a possible cause or unilateral or one sided tonsillar enlargement.

Enlarged tonsils

Further Reading

In some cases if your cases if your observations indicate that your child has quite significant obstructive sleep apnoea or in cases where we are not 100% certain for the severity we may obtain a sleep study with a paediatric sleep medicine expert. These are either done at Princess Margaret Hospital for Children or St John of God Subiaco utilizing one of the paediatric sleep medicine experts after consultation with them. Sleep studies or polysomnography is the “gold standard” for seeing whether or not a child has significant obstructive sleep disorder and if in fact in the more severe cases a child might require special nurses postoperatively (usually tonsillectomy or adenoidectomy) or in uncommon circumstances an intensive care ward at Princess Margaret Hospital particularly in children with co-morbidities such as cerebral palsy, Down Syndrome or other neuralgic conditions.

In some cases the airway obstruction causing obstructive sleep disorder and apnoea is quite obvious and rather than wait several months for the sleep study to be performed we go ahead with the surgical intervention. There are also instances where the child may not have all the classical features of obstructive sleep disorder but have quality of life issues such as being unable to swallow solids such as meat apple peel and similar food causing gagging, vomiting or even failure to thrive. For further more detailed information on obstructive sleep disorder I would direct you towards the attached website of the Joint Committee of the Paediatric Section of the Royal Australasian College of Paediatrics and the Committee from the Australian Society of Otolaryngology Head and Neck Surgery with the position statement on tonsillectomy. Professor Coates was a member of this Committee