What are the symptoms of kissing tonsils. How is hypertrophic tonsils diagnosed. What causes enlarged tonsils in children and adults. When is tonsillectomy recommended for enlarged tonsils. How does tonsillar hypertrophy affect sleep and daily functioning.

Understanding Hypertrophic Tonsils: The “Kissing Tonsils” Phenomenon

Hypertrophic tonsils, colloquially known as “kissing tonsils,” is a condition characterized by abnormally enlarged palatine tonsils. This enlargement can be so severe that the tonsils meet in the midline or overlap, hence the term “kissing.” While tonsils naturally vary in size, hypertrophic tonsils can lead to a range of symptoms and complications, particularly in children and young adults.

The condition often results from recurrent pharyngitis and local inflammation. In some cases, tonsilloliths (small, calcified deposits) may become lodged in the tonsillar crypts, further contributing to the enlargement. Understanding the symptoms, causes, and potential treatments for hypertrophic tonsils is crucial for proper management and prevention of complications.

Recognizing the Symptoms of Hypertrophic Tonsils

Hypertrophic tonsils can manifest through various symptoms, some of which may significantly impact an individual’s quality of life. Common signs and symptoms include:

• Difficulty in feeding (particularly in small children)
• Mouth breathing
• Noisy respiration
• Loud snoring
• Restless sleep
• Hypersomnolence (excessive daytime sleepiness)
• Secondary enuresis (bedwetting)
• Night terrors
• Behavior changes
• Poor school performance
• Dysphagia (difficulty swallowing)
• Weight loss
• Fatigue

In severe cases, massive tonsillar hypertrophy can lead to more serious complications, including:

• Chronic alveolar hypoventilation
• Pulmonary hypertension
• Cor pulmonale (right-sided heart failure due to lung disease)
• Right heart failure

Diagnosing Hypertrophic Tonsils: What to Look For

Diagnosing hypertrophic tonsils typically involves a combination of patient history, physical examination, and sometimes additional tests. During the physical examination, a healthcare provider will inspect the oral cavity for signs of tonsillar enlargement. In cases of “kissing tonsils,” the tonsils may meet in the midline or overlap.

Other signs that may be observed during the examination include:

• Noisy respirations with an open mouth
• Halitosis (bad breath)
• Visible tonsillar swelling

In some cases, additional tests may be necessary to rule out other conditions or assess the severity of the hypertrophy. These may include:

• Sleep studies to evaluate for obstructive sleep apnea
• Imaging studies such as X-rays or CT scans
• Blood tests to rule out infectious causes

The Link Between Hypertrophic Tonsils and Sleep Disorders

One of the most significant impacts of hypertrophic tonsils is on sleep quality and, consequently, daytime functioning. The enlarged tonsils can partially or completely obstruct the airway, particularly when the individual is lying down. This obstruction can lead to various sleep-related issues:

Obstructive Sleep Apnea in Children

Hypertrophic tonsils are the most common cause of obstructive sleep apnea in children. This condition is characterized by repeated episodes of partial or complete upper airway obstruction during sleep, leading to disrupted sleep patterns and potential long-term health consequences.

Sleep-Disordered Breathing

Even if full-blown sleep apnea is not present, children with hypertrophic tonsils may experience sleep-disordered breathing. This can manifest as snoring, mouth breathing, and restless sleep.

Daytime Consequences

The poor sleep quality resulting from hypertrophic tonsils can lead to various daytime symptoms, including:

• Excessive daytime sleepiness
• Poor cognitive performance
• Behavioral issues
• Decreased academic performance

Treatment Options for Hypertrophic Tonsils

The treatment approach for hypertrophic tonsils depends on the severity of symptoms and the impact on the individual’s quality of life. Options may include:

Watchful Waiting

In mild cases without significant symptoms, a period of observation may be recommended. This is because tonsils naturally tend to shrink as children grow older.

Conservative Management

For less severe cases, conservative measures may be attempted, such as:

• Nasal steroid sprays to reduce inflammation
• Antibiotics for acute infections
• Lifestyle modifications to improve sleep hygiene

Tonsillectomy

In cases of massive tonsillar hypertrophy or when associated with significant symptoms, tonsillectomy (surgical removal of the tonsils) may be recommended. This is particularly true when the condition is associated with:

• Obstructive sleep-disordered breathing causing poor daily cognitive performance
• Severe dysphagia
• Failure to thrive
• Cor pulmonale

In the case study mentioned, the patient’s symptoms resolved two weeks after tonsillectomy, highlighting the potential effectiveness of this treatment in severe cases.

Differentiating Hypertrophic Tonsils from Other Tonsillar Conditions

While hypertrophic tonsils are a common condition, it’s important to differentiate them from other tonsillar disorders that may present with similar symptoms. Some of these conditions include:

Bilateral Tonsillar Abscesses

This severe, suppurative complication of tonsillitis or pharyngitis typically presents with:

• Intermittent odynophagia (painful swallowing)
• Voice changes (“hot potato voice”)
• High fever
• Bilateral swelling of the soft palate with a midline uvula displaced anteriorly

Infectious Mononucleosis

Often affecting patients between 15 and 30 years of age, this condition is characterized by:

• Fever
• Sore throat
• Malaise
• Pharyngeal injection with exudates
• Posterior cervical lymphadenopathy

Tonsillitis

One of the most common infections encountered by family physicians, tonsillitis presents with:

• Acute fever
• Sore throat
• Pain on swallowing
• Pharyngeal swelling
• Tonsillar erythema and exudates
• Tender anterior cervical lymphadenopathy

Long-Term Implications of Untreated Hypertrophic Tonsils

If left untreated, hypertrophic tonsils can lead to a range of long-term complications that extend beyond sleep disturbances. These potential consequences underscore the importance of proper diagnosis and management:

Cardiovascular Complications

Chronic obstruction of the airway can lead to increased strain on the heart, potentially resulting in:

• Pulmonary hypertension: Increased blood pressure in the arteries of the lungs
• Cor pulmonale: Right-sided heart enlargement and failure due to lung disease
• Right heart failure: The right side of the heart becomes unable to pump blood effectively

Respiratory Issues

Long-term airway obstruction can affect lung function, leading to:

• Chronic alveolar hypoventilation: Inadequate breathing that leads to increased carbon dioxide levels in the blood
• Increased risk of respiratory infections
• Potential for development of asthma or exacerbation of existing asthma

Developmental and Cognitive Impacts

Particularly in children, untreated hypertrophic tonsils can have significant developmental consequences:

• Failure to thrive: Poor physical growth and development
• Cognitive impairment: Chronic sleep disturbances can affect memory, attention, and learning abilities
• Behavioral problems: Sleep deprivation can lead to hyperactivity, irritability, and mood swings
• Academic underachievement: Poor sleep quality can significantly impact school performance

Craniofacial Development

Chronic mouth breathing due to nasal obstruction can affect facial growth and development:

• Changes in facial structure, including elongation of the face and retrognathia (receded lower jaw)
• Dental malocclusion: Misalignment of teeth due to altered oral posture
• Potential speech impairments

Prevention and Management of Recurrent Tonsillar Hypertrophy

While not all cases of tonsillar hypertrophy can be prevented, there are steps that can be taken to reduce the risk of recurrence or manage ongoing issues:

Lifestyle Modifications

• Maintain good oral hygiene to reduce bacterial load in the mouth and throat
• Stay hydrated to help flush out toxins and reduce inflammation
• Avoid irritants such as cigarette smoke and air pollution
• Practice good sleep hygiene, including maintaining a consistent sleep schedule

Dietary Considerations

• Consume a balanced diet rich in fruits and vegetables to support immune function
• Consider probiotic foods or supplements to promote a healthy oral and gut microbiome
• Limit consumption of dairy products if they seem to increase mucus production

Regular Check-ups

• Schedule regular follow-ups with healthcare providers to monitor tonsil size and overall health
• Address any recurring infections promptly to prevent chronic inflammation

Environmental Control

• Use air purifiers to reduce exposure to allergens and irritants
• Maintain optimal humidity levels in living spaces to prevent dryness of the throat

Post-Tonsillectomy Care

For those who have undergone tonsillectomy, proper post-operative care is crucial:

• Follow all post-operative instructions provided by the surgeon
• Maintain a soft diet during the recovery period
• Stay hydrated to promote healing and prevent complications
• Avoid strenuous activities as advised by the healthcare provider
• Complete any prescribed course of antibiotics or pain medications

The Role of Immunology in Tonsillar Hypertrophy

Understanding the immunological aspects of tonsillar hypertrophy can provide insights into its development and potential management strategies:

Tonsils as Immune Organs

The tonsils play a crucial role in the immune system, particularly in children:

• They are part of the mucosa-associated lymphoid tissue (MALT)
• Act as a first line of defense against inhaled or ingested pathogens
• Produce antibodies and immune cells to fight infections

Immune Response and Hypertrophy

Tonsillar hypertrophy often results from repeated or chronic immune responses:

• Recurrent infections lead to persistent activation of immune cells in the tonsils
• Chronic inflammation can cause tissue hyperplasia and enlargement
• In some cases, autoimmune processes may contribute to tonsillar hypertrophy

Immunological Considerations in Treatment

Understanding the immune function of tonsils influences treatment decisions:

• The potential impact of tonsillectomy on overall immune function, especially in young children
• The role of immunomodulatory therapies in managing chronic tonsillar inflammation
• The importance of supporting overall immune health in preventing recurrent tonsillar issues

By considering these immunological aspects, healthcare providers can develop more comprehensive and personalized approaches to managing tonsillar hypertrophy, balancing the need to address symptoms with the importance of maintaining immune function.

Enlarged Tonsils and Fatigue | AAFP

MALCOLM LEMYZE, MD, AND FAVORY RAPHAEL, MD, Calmette Hospital, Lille, France

Am Fam Physician. 2010;82(6):669-670

Author disclosure: Nothing to disclose.

A 16-year-old girl presented with fatigue, weight loss, and dysphagia that began several months earlier. She had restless sleep leading to daytime somnolence and poor school performance, and her family reported loud snoring. Her medical history was unremarkable, except for recurrent upper respiratory tract infections.

Physical examination revealed noisy respirations with an open mouth, halitosis, and tonsillar swelling (see accompanying figure). She had no fever or lymphadenopathy.

Question

Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?

A. Bilateral tonsillar abscesses.

B. Hypertrophic tonsils.

C. Infectious mononucleosis.

D. Tonsillitis.

Discussion

The answer is B: hypertrophic tonsils. Hypertrophic tonsils can be caused by recurrent pharyngitis and local inflammation, especially in children and young adults. Inspection of the oral cavity may reveal hypertrophy of the palatine tonsils, which is sometimes called “kissing tonsils” when tonsils meet in the midline or overlap. Tonsilloliths may be lodged in the crypts. Although tonsillar enlargement may be asymptomatic, massive tonsils sometimes fall back and occlude the oropharynx, particularly when the patient is recumbent. Most cases of obstructive sleep apnea in children are associated with hypertrophic tonsils.

Symptoms suggestive of tonsillar hypertrophy include difficulty in feeding with small children, mouth breathing, noisy respiration, loud snoring, restless sleep, hypersomnolence, secondary enuresis, night terrors, behavior changes, and poor school performance. Tonsillar hypertrophy may also lead to respiratory and cardiac complications, such as chronic alveolar hypoventilation, pulmonary hypertension, cor pulmonale, and right heart failure.¹ Massive tonsillar hypertrophy may require tonsillectomy, especially when associated with obstructive sleep-disordered breathing that causes poor daily cognitive performance, dysphagia, failure to thrive, and cor pulmonale.^2,3 This patient’s symptoms resolved two weeks after tonsillectomy.

Tonsillar abscess is a severe, suppurative complication of tonsillitis or pharyngitis. It usually presents with intermittent odynophagia, voice changes (“hot potato voice”), and high fever in a young adult.⁴ Most cases are unilateral with contralateral displacement of the uvula. In patients with bilateral abscesses, examination reveals bilateral swelling of the soft palate with a midline uvula displaced anteriorly. Group A streptococci and anaerobic bacteria of the oral flora are common causes of this condition. Surgical treatment and parenteral antibiotics may be required.

Infectious mononucleosis usually affects patients 15 to 30 years of age. The most common symptoms include fever, sore throat, and malaise. Examination shows pharyngeal injection with exudates. Patients often have posterior cervical lymphadenopathy. ⁴

Tonsillitis is one of the most common infections encountered by family physicians. Patients have sore throat, acute fever, and pain on swallowing. Physical examination reveals pharyngeal swelling, tonsillar erythema and exudates, and tender anterior cervical lymphadenopathy. Viruses are the most common causes of tonsillitis, although group A beta-hemolytic streptococcus accounts for 5 to 30 percent of cases. Streptococcal infection requires an antibiotic regimen.⁴

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors’ Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to [email protected].

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz. 

Enlarged Tonsils: Symptoms, Diagnosis and Treatment

Nationwide Children’s Hospital

Overview

Signs & Symptoms

Diagnosis

Treatment

What Are the Tonsils?

The tonsils are paired tissue in the back of the throat and are part of the immune system. The function is to help identify and fight infections caused by viruses or bacteria. Although they can be beneficial, they can cause problems if they are enlarged or become infected.

What Are the Symptoms of Enlarged Tonsils?

When the tonsils are enlarged, they can cause a variety of symptoms. Sometimes they cause no problems at all. In other cases, they can cause or contribute to snoring and sleep problems. Common problems are partial airway obstruction during sleep that results in restless sleep, frequent awakening from sleep or even sleep apnea. In some cases, they can also cause trouble swallowing foods due to obstruction.

How Are Enlarged Tonsils Evaluated?

Your doctor or ENT surgeon can visualize the tonsils directly by having your child open his or her mouth widely. Sometimes a tongue depressor must be used to see the area fully. If the symptoms are unclear, your doctor may recommend a sleep study to better determine how severe sleep problems are.

What Is the Treatment for Enlarged Tonsils?

If the tonsils are enlarged but are not causing symptoms, often no treatment is recommended. This is because as your child gets older, most of the time enlarged tonsils will become smaller and smaller. If the tonsils are causing problems with sleep, your ENT surgeon may recommend tonsillectomy. This is needed for patients who have Obstructive Sleep Apnea with enlarged tonsils. If your child is having disturbed sleep that results in problems with sleepiness or behavior in the daytime, tonsillectomy may also be recommended. Commonly, when the tonsils are enlarged, the adenoids are also enlarged and will be removed (called an adenoidectomy) during the same surgery.

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Treatment of tonsillitis in Pyatigorsk

Publication date: 12/28/2020 22:21

Clinic “Lor-KMV” in Pyatigorsk offers a service for the treatment of tonsillitis in adults and children. You have probably already encountered this disease, because tonsillitis (specifically, its acute form) is a sore throat!

What is tonsillitis: definition and causes of the disease

The word “tonsillitis” comes from the Latin tonsillae – tonsils. This disease is an inflammation in the palatine tonsils (in other words – tonsils), which is provoked by certain viruses.

Tonsils are an extremely important part of our immune system. They are the first barrier to bacteria and viruses that enter our body through the respiratory tract. If the tonsils are healthy, they easily cope with incoming infections and the body does not get sick. However, if for some reason the tonsils are weakened, they begin to fail to cope with the “pressure” of bacteria and viruses. As a result, inflammatory processes begin, which are called tonsillitis.

Weakening of the tonsils and development of tonsillitis lead to:

• general hypothermia or hypothermia of the throat, weak adaptation of our body to a cold climate
• dusty and gassy air
• monotonous diet, vitamin deficiency
• constant stress, chronic fatigue
• disturbances in the work of the nervous system
• injuries and injuries of the tonsils
• chronic inflammation of the upper respiratory tract (sinusitis, sinusitis)

Tonsillitis is an infectious disease. How can you get infected?

1. Airborne – through close contact with sick people, coughing and saliva (for example, during a conversation if you stand too close).
2. Contact path – through common household items (toothbrushes, dishes, cutlery) or kisses.
3. Endogenous route – internal infection when the virus enters the tonsils from our own other foci of inflammation along with blood or lymph. Tonsillitis can develop against the background of sinusitis, sinusitis, otitis, periodontitis, caries.

Symptoms of tonsillitis

General symptoms of tonsillitis are:

• severe swelling and redness of the tonsils
• reddening of palatine arches
• inflammation of the lymph nodes (enlargement and possible pain on palpation)
• pain, discomfort, dryness and itching in the throat, difficulty swallowing solid food with painful sensations
• fever (chills), sudden or prolonged low-grade fever
• general weakness and malaise, headache, apathy, loss of strength

Other symptoms of the disease vary depending on which type of tonsillitis (angina) occurs in a particular patient:

1. Catarrhal tonsillitis is the mildest type of tonsillitis, not accompanied by the appearance of pus or white plaque on the tonsils. The classic symptoms are swelling and redness of the palatine tonsils.
2. Follicular angina – in addition to the above symptoms, accompanied by the formation of pus in the tonsil follicles – they are visually visible through the epithelium and look like yellow grains.
3. Lacunar tonsillitis – accumulations of pus in lacunae – recesses in the tonsils, responsible for the removal of pathogenic bacteria to the outside. Outwardly, it looks like grains of a whitish curd-like mass with a possible unpleasant odor. A white coating forms around the purulent plugs.
4. Ulcerative membranous angina is an atypical form of inflammation of the palatine tonsils, in which ulcers form on them. Patients experience pain, discomfort when swallowing, a putrid odor and increased salivation.

Types of tonsillitis

It is also customary to subdivide tonsillitis into chronic and acute. Often these two types of the disease are at the same time its stages, following one after the other.

Acute tonsillitis is a primary disease, a sharp onset of angina with pronounced symptoms: high fever, fever, weakness, swelling and redness of the tonsils. The disease can end in two ways: either pathogenic bacteria are destroyed, the inflammatory process is stopped with the help of medical treatment, or the acute form of the disease becomes chronic, that is, long-term and sluggish. This happens when part of the bacteria remains in the folds or follicles of the tonsils, that is, a focus with a “dormant” infection remains. In the future, these bacteria can permanently suppress the immune system and cause complications in the upper respiratory tract.

Variants of chronic tonsillitis:

• compensated;
• decompensated;
• recurrent;
• toxic-allergic.

Compensated chronic tonsillitis proceeds secretly: the patient does not feel pain and discomfort, there is no fever, but the tonsils are reddened and enlarged. In the decompensated variant, on the contrary, pain and sore throat are felt. Recurrent tonsillitis periodically disturbs the patient with new acute diseases (tonsillitis). The toxic-allergic form of chronic tonsillitis can spread infection from the tonsils to all body systems – as a result, a person experiences pain in the joints, problems in the work of the heart, kidneys, liver, urogenital area, increased fatigue and reduced performance.

Chronic tonsillitis is more difficult to treat, so it is advisable not to bring it to this stage, but to consult a doctor and engage in treatment immediately after the onset of primary symptoms.

Diagnosis is carried out using:

• pharyngoscopy – examination of the oral cavity using direct lighting, a forehead reflector, mirrors and other medical instruments.
• bacteriological examination of the contents of lacunae and a throat swab (from the surface of the tonsils or the posterior pharyngeal wall)
• laboratory blood test

Tonsillitis is treated with:

• drugs – antibiotics, painkillers and anti-inflammatory drugs, antiseptics for rinsing, antihistamines and antipyretics
• physiotherapeutic procedures – washing the lacunae, filling them with an antiseptic, lubricating with solutions, UV therapy, etc.
• lifestyle modification

Clinic Lor-KMV provides a complete and high-quality treatment of any form of tonsillitis in adults and children. We carry out diagnostics, prescribe drugs, carry out medical procedures – everything so that your immunity completely and permanently copes with pathogenic bacteria. Sign up for an examination with our ENT doctor at the specified phone number or through the website.

The main prevention of tonsillitis is a healthy lifestyle

Let’s talk about throat diseases today. The topic is relevant, against the backdrop of the recent epidemic and quarantine in educational institutions. Our guest is Vadim Gennadyevich Kotelnikov, otorhinolaryngologist, specialist of the children’s clinic “Health 365” on Bazhova, 68.

Vadim Gennadievich, we often hear the wording “chronic tonsillitis”, what does it mean?

– This disease occurs in the upper respiratory regions, with prolonged inflammation in the palatine tonsils, or tonsils.

That is, when the throat hurts in the truest sense of the word? And the throat is red, if you look?

– Yes, the main complaint is a sore throat. At the same time, the redness is not all over the throat, according to localization – these are precisely the palatine tonsils, a kind of sacs on the sides of the throat.

What are the main causes of tonsillitis?

– The main causes are frequent colds. Also concomitant pathology, for example, pathology of teeth, gums.

So caries can lead to tonsillitis?

– That’s right. This is a secondary focus of infection, which leads to an overstrain of immunity with the subsequent formation of pathology already in the amygdala itself.

“Chronic” in this case means permanent tonsillitis?

– Yes, a prolonged inflammatory process.

What are the main symptoms of tonsillitis? What to pay attention to? Can the development of the disease be prevented?

– It is possible to adhere to certain rules, but there are no guaranteed methods that would absolutely prevent the disease. Unfortunately, there are no magic pills.

And you should pay attention to frequent colds, diseases that lead to the defeat of nasal breathing – the so-called rhinosinusitis. Frequent problems in childhood associated with adenoids. Also, I repeat, the pathology of the oral cavity. Pathologies of the gastrointestinal tract, tk. tonsils are at the crossroads of breathing and food intake.

It turns out, can it be “covered” from above, or from below?

– Yes. Due to gastroesophageal reflux, there is a reflux from the stomach, including acid, which causes a mucosal burn. And the flora that is present in the gastrointestinal tract is conditionally pathogenic, under certain conditions it can cause respiratory diseases.

Vadim Gennadievich, let’s talk about treatment methods. They say that it is straight for life, incurable.

– There are several ways. The first is a medical, conservative method. Tablets, using local methods: rinsing, drugs with antiseptic properties of local action in the form of sprays.

The second method – with the use of physiotherapy: UHF, UV irradiation of the oropharyngeal mucosa, washing the tonsils. Such procedures are part of the combined treatment.

Well, the radical method is surgical. For him there are strict indications. Still, these organs are given to man for a reason.

This must be some kind of completely neglected case?

– Yes, when there are very frequent relapses, almost monthly – and even against the background of ongoing preventive treatment. That is, if conservative treatment does not work, you have to use this method. And also to avoid possible complications.

And the complications are quite serious. Rheumatic affections: heart, kidneys, joints. Septic lesions of the blood and the spread of infection to the internal organs.

Is it contagious? If in the family, for example, there is a person with chronic tonsillitis?

– There is a genetic predisposition, but the sluggish process itself is not contagious. But there is a risk of flora transmission. In the acute period, you can get infected through a kiss, for example. The infection will manifest itself in the form of acute tonsillitis, but the human body can cope on its own. It all depends on the characteristics of the immune system.

Let’s move on to prevention then. You can’t kiss someone who’s sick, at least. What other preventive measures are there?

– The main thing is a healthy lifestyle. It is necessary to exclude tobacco smoking, alcohol abuse. Do not even so much sports, but physical education. Because professional sport is also a kind of extreme.

You need to follow the daily routine. People who are constantly working, constantly stressed, tired, are more prone to this disease.