How Do You Treat Hypertrophic Tonsils?

The medical term for enlarged tonsils is hypertrophic tonsils or tonsillar hypertrophy. Hypertrophic tonsils are a common condition in children, though it can also affect adults. The tonsils are masses of lymph tissue located in the back of the throat. They are part of the body’s immune system that helps the body fight off infection. 

Enlarged tonsils (hypertrophic tonsils) may be a sign of infection or irritation. Enlarged tonsils may not cause symptoms but if they do, symptoms may include:

• Problems breathing
  • Noisy breathing
  • Mouth breathing 
• Sleep problems
  • Snoring
  • Restless sleep
  • Obstructive sleep apnea
  • Daytime sleepiness
• Trouble swallowing 
• Runny nose
• Repeated ear or sinus infections
• Difficulty eating in young children
• Bad breath (halitosis) 

If viral or bacterial infections are the cause of the enlarged tonsils, symptoms that accompany the enlarged tonsils may also include:

• Sore throat
• Fatigue
• Swollen glands in the neck
• Fever
• Bad breath
• Pain with swallowing
• Cough
• Neck stiffness

Some people are born with larger tonsils, and there may be a genetic link, since enlarged tonsils (hypertrophic tonsils) can run in families. 

Enlarged tonsils may also be a sign of an infection, such as:

• Strep throat
• Common cold 
• Influenza
• Mononucleosis 
• Peritonsillar abscess
• Sinusitis
• Coronavirus (COVID-19)

Other causes of enlarged tonsils may include:

• Allergies
• Throat irritation from exposure secondhand smoke and air pollution 
• Gastroesophageal reflux disease (GERD)
• Throat cancers

Enlarged tonsils (hypertrophic tonsils) are diagnosed with a physical examination of the tonsils in the back of the throat. 

Tests that may be used to help diagnose the cause of enlarged tonsils include:

• Throat culture
• Blood tests
• X-rays
• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI)
• Sleep study to check for sleep apnea (polysomnography)

Treatment for enlarged tonsils (hypertrophic tonsils) depends on the cause. If a person has naturally large tonsils that do not interfere with their ability to breath, sleep, or eat, no treatment is needed. 

If tonsillar hypertrophy is caused by a bacterial infection it may be treated with antibiotics. Antibiotics commonly used for tonsillar infections (tonsilitis) include:

• Penicillins (including amoxicillin)
• Macrolides (including azithromycin and erythromycin)
• Cephalosporins (including cefoxitin and cefuroxime)
• Tetracyclines
• If enlarged tonsils are due to allergies, nasal corticosteroid sprays or oral antihistamines may be recommended. Oral steroids such as prednisone or prednisolone may also be used.
• If hypertrophic tonsils are due to environmental irritants such as secondhand smoke, avoiding the irritants may resolve the problem. 
• If there is no underlying medical condition but the large tonsils interfere with breathing, sleeping, or eating, then surgical removal of the tonsils (tonsillectomy) may be indicated. 
  • Frequently people who have enlarged tonsils also have enlarged adenoids, and those may need to be removed as well (adenoidectomy). 

Complications of enlarged tonsils (hypertrophic tonsils) may include: 

• Chronic ear infections 
• Hearing loss
• Recurring sinus infections
• Obstructive sleep apnea
• Bad breath
• Weight loss (or lack of weight gain in children) due to difficulty swallowing or difficulty breathing

Depending on the cause, enlarged tonsils (hypertrophic tonsils) may be prevented. 

• To prevent bacterial or viral infection that may cause enlarged tonsils: 
• Wash hands frequently with soap and water for at least 20 seconds. 
• If soap and water are not available, use hand sanitizer with at least 60% alcohol and use a sufficient amount to rub in for 20 seconds.

Do not touch your mouth, nose, or eyes with unwashed hands.

If enlarged tonsils are the result of allergies, avoid known allergens or take allergy medicine as recommended by your doctor to help prevent symptoms. 

If hypertrophic tonsils are caused by gastroesophageal reflux disease (GERD), avoiding food triggers or taking acid reducing medications as recommended by your doctor may prevent symptoms.