What Is Tonsillar Hypertrophy?

Written by Bethany Afshar
Medically Reviewed by Shruthi N, MD on June 19, 2025
5 min read

‌Tonsillar hypertrophy is when your or your child’s tonsils become swollen. Enlarged tonsils are a common condition that is more likely to happen in children. Surgery to remove the tonsils might be required depending on how large they become. This is called a tonsillectomy.

Tonsils are a pair of glands, one on each side, at the back of your throat. They are important for keeping bacteria out of your throat and esophagus. Their main purpose is to protect you from bacterial and viral infections. If they’re swollen, they can be harmful to your health.

‌Tonsils are important organs in your body. They protect your body from unknown bacteria and viruses. They play an important part in helping your immune response stay consistent. They work on their own and are made of mucosal-associated lymphoid tissue.

‌When your tonsils block bacteria and viruses, they also use them to make antibodies. Tonsils work with adenoids to keep you healthy. Your adenoids are further back and higher than your tonsils. They rest where your nasal passage connects to your throat. Typically, when enlarged tonsils are removed, the adenoids are taken out.

‌When your tonsils become swollen, you have tonsillar hypertrophy. This can cause infection and inflammation in your body. Tonsillar hypertrophy can be simple, which means you only have enlarged tonsils, or it can be hypertrophy with chronic inflammation. Your treatment plan and health effects will depend on how tonsillar hypertrophy affects your body.

Tonsillar hypertrophy can have harmful effects on your health. If left untreated, other conditions can occur. These include the following: 

  • Hearing loss and ear infection that keep coming back
  • Chronic sinus infections
  • Obstructive sleep apnea can happen in children, causing them to snore or stop breathing for periods when asleep, which could affect their oxygen levels. 
  • Weight loss or no weight gain can happen when the pain in your tonsils makes it too hard to eat. 

‌‌When your enlarged tonsils begin to make your daily tasks difficult, you may need medical treatment.

‌Tonsillar hypertrophy is typically marked by swollen, enlarged tonsils. But it also causes other symptoms. Knowing these signs can help you understand whether you or your child has this condition. Symptoms include the following: 

‌In small children, tonsillar hypertrophy may be harder to identify. However, its symptoms show up more often when your child is asleep. Here are some signs to look for: 

  • Mouth breathing
  • Noisy breathing
  • Loud snoring
  • Inability to sleep well
  • Night terrors
  • Excessive sleepiness
  • Bedwetting after potty training
  • Change in behavior

‌‌Other symptoms in children with enlarged tonsils and adenoid problems include the following: ‌

  • Sore throat
  • Trouble swallowing
  • Inner ear infection
  • Bright red tonsils
  • Bad breath
  • White or yellow film on tonsils
  • Fever (in some cases of infection)

‌There’s no exact cause of tonsillar hypertrophy. However, some doctors believe that secondhand smoke from cigarettes and air pollution could cause enlarged tonsils.

‌Some potential causes of tonsillar hypertrophy include viruses such as adenovirus, influenza virus, and herpes simplex virus. Another cause could be bacterial infections, including Neisseria gonorrhoeae, mycoplasma, and Haemophilus influenzae type B. 

‌Enlarged tonsils can also result from fungal or parasitic infections, but these are less common.

‌Treatment for tonsillar hypertrophy is a common, easy procedure. In some cases, your doctor may prescribe antibiotics to get rid of a bacterial infection, which may shrink your swollen tonsils. However, this will depend on the severity of the enlarged tonsils. If they are troublesome and limit your or your child’s daily activities, such as eating, sleeping, and breathing, they may need to be removed.

If your doctor suggests removing your tonsils, a tonsillectomy will be scheduled to get rid of them. They may remove your adenoids as well. This depends on the type of tonsillar hypertrophy you have and whether the adenoids are affecting your quality of life. 

Any child over the age of 4 years can get a tonsillectomy. It is a simple surgery that takes very little time. It’s a common procedure that has been done on many children and adults. The recovery can take about one to two weeks. The first week will involve throat pain. Your doctor will allow you to eat certain foods as your throat heals over the two weeks.

Typically, your tonsils are pink, round, fleshy mounds on both sides of the back of your throat, behind your soft palate. When you have enlarged tonsils, your tonsils become red and swollen, partially blocking your airway.

Your tonsils are glands located at the back of your throat. They are meant to protect you from bacterial and viral infections. When your tonsils become enlarged, it is called tonsillar hypertrophy, a condition that affects mostly children. This can lead to infections, inflammation, and sleep problems. Your doctor may first treat you with antibiotics to fight any associated infection. But if your enlarged tonsils continue to interfere with your daily activities and sleep, they may recommend a tonsillectomy, a surgery that removes your tonsils.

Is tonsillar hypertrophy an indication for surgery? 

Yes, if your enlarged tonsils are causing breathing or sleep issues or generally interfering with your daily life, your doctor may suggest a tonsillectomy. 

How serious are enlarged tonsils?

Tonsillar hypertrophy can either be mild or severe. It can have a serious impact on your daily life and cause issues such as sleep apnea, worsened asthma, frequent infections, and poor growth. Your doctor can best determine if or when a tonsillectomy is needed.

What grade is hypertrophy tonsils?

Doctors grade tonsillar hypertrophy on a scale from 0 to 4. Grade 0 means that the tonsils are in their normal resting place. Grades 1-4 are measured by how much of the oropharynx (the space between the two resting places) is covered by the enlarged tonsils:

  • Grade 1: Less than 25%
  • Grade 2: Less than 50%
  • Grade 3: Less than 75%
  • Grade 4: More than 75%

Can enlarged tonsils be cancerous?

Enlarged tonsils can be a sign of cancer, but that’s usually a concern when it’s present only on one side in adults. Other symptoms include a persistent sore throat that is not helped by antibiotics and a painless lump on the neck. Talk to your doctor if you have any concerns.