Tonsils & Adenoids

Tonsils and adenoids are a part of the immune system and act as the body’s first line of defense against ingested and inhaled viruses and bacteria. Tonsils are two visible, round lumps in the throat located on either side of the tongue at the back of the mouth. The adenoids are similar masses that sit in the back of the nose and throat and cannot be seen without special instruments.

Tonsils and adenoids are most commonly affected by chronic infection of the ears, nose or throat. This can lead to an infection in the tonsils or adenoids; while this can occur at any age, it is more common in children. This is called tonsillitis or adenoiditis.

When the tonsils are infected, common symptoms include swollen tonsils, white or yellow patches on the tonsils, sore throat, fever, painful swallowing, enlarged glands, scratchy voice, bad breath, stomachache, stiff neck and headache. Common symptoms of infected adenoids include sore throat, stuffy nose, swollen glands in the neck and ear pain.

After diagnosing tonsils or adenoids as infected, antibiotics are commonly used to treat the infection. If medication is not successful, they may need to be removed through a tonsillectomy or adenoidectomy.

If you or someone you care for have symptoms of tonsillitis or adenoiditis, contact us at (503) 257-3204 to schedule an appointment.

Tonsillitis is inflammation of the tonsils. Adenoiditis is inflammation of the adenoids.

Tonsillitis: Overview

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Tonsillitis and Adenoiditis Causes:

  • Viral
  • Bacterial
    • “Strep” throat

Acute Tonsillitis Symptoms Include:

  • Fever
  • Sore throat
  • Foul breath
  • Difficulty swallowing
  • Painful swallowing
  • Neck lymph nodes become enlarged, painful
  • Airway obstruction due to swollen tonsils and adenoids
    • mouth breathing
    • snoring, nocturnal breathing pauses – apnea
  • Lethargy and malaise are common.
  • On examination, the tonsils may appear
    • Enlarged
    • Red
    • White or yellow coating
    • White debris in the crypts
    • Swollen uvula
  • These symptoms usually resolve in three to four days, but may last up to two weeks despite therapy.

Recurrent tonsillitis:

  • multiple episodes of acute tonsillitis in a year

Chronic tonsillitis

  • chronic sore throat, bad breath, tonsil stones (tonsilloliths), and frequent tender cervical nodes

Peritonsillar abscess

  • A pus pocket (abscess) forms under the tonsil. The tonsil will be pushed to the middle.
  • Symptoms include: severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and muffled voice quality, such as the hot potato voice (as if talking with a hot potato in his or her mouth).
  • This is a serious infection and is treated by drainage and antibiotics.

Enlarged Adenoids: Overview

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Enlarged Adenoids / Tonsils and Chronic Adenoid Infection Symptoms:

  • Nasal obstruction
  • Frequent nasal drainage, even when not sick
  • Chronic mouth breathing
    • This can cause improper alignment of the teeth
    • Can affect development of the jaw and facial bones
  • Noisy breathing during the day (stertor)
  • Frequent ear infections or persistent middle ear fluid
  • Snoring at night
    • Nightly snoring in a child is not normal and is a relative indication for tonsillectomy and adenoidectomy.
  • Stopping breathing at night – obstructive sleep apnea
    • Poor quality sleep can cause daytime sleepiness, irritability, poor concentration, hyperactivity, ADHD type symptoms and behavioral problems
    • Bed wetting, delayed growth, heart problems
    • Obstructive sleep apnea in children due to enlarged tonsils and adenoids is an absolute indication for tonsillectomy and adenoidectomy
    • In select cases, an overnight sleep study is indicated.


  • Complete history and physical examination to obtain accurate diagnosis
  • Diagnostic testing if indicated:
    • Rapid strep test, throat culture
    • Blood tests
  • Epstein Barr virus testing if mononucleosis is suspected

Recurrent/Chronic Adenotonsillitis Treatment Options Include:

  • Conservative treatment, symptom relief for most viral infections.
  • Antibiotics if bacterial
  • Surgery
    • Tonsillectomy and/or adenoidectomy if indicated.

Enlarged Tonsil and Adenoids Treatment Options Include:

  • Mild obstructive symptoms
    • Close observation
  • Chronic, severe upper airway obstructive symptoms
    • In select cases, an overnight sleep study is indicated
    • Tonsillectomy and adenoidectomy

Tonsillectomy: Overview

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Dr. Barlow operates on pediatric and adult patients at:

  • Randall Children’s Hospital and Legacy Emanuel Hospital
  • Adventist Medical Center
  • Providence Milwaukie Hospital

If you have Tonsil & Adenoid problems, please call (503) 257-3204 or request a visit online with us.


American Academy of Otolaryngology−Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357, 1-703-836-4444. 2011 AAO-HNS/AAO-HNSF
Baugh, R. F., S. M. Archer, et al. (2011). “Clinical practice guideline: tonsillectomy in children.” Otolaryngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 144(1 Suppl): S1-30.
Mitchell, R.B. and J. Kelly, Behavioral Changes in Children with Mild Sleep-Disordered Breathing or Obstructive Sleep Apnea after Adenotonsillectomy. Laryngoscope, 2007.
Garetz, S. L. (2008). “Behavior, cognition, and quality of life after adenotonsillectomy for pediatric sleep-disordered breathing: summary of the literature.” Otolaryngol Head Neck Surg 138(1 Suppl): S19-26.
Witsell, D. L., L. J. Orvidas, et al. (2008). “Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis.” Otolaryngol Head Neck Surg 138(1 Suppl): S1-8.
Goldstein, N. A., M. G. Stewart, et al. (2008). “Quality of life after tonsillectomy in children with recurrent tonsillitis.” Otolaryngol Head Neck Surg 138(1 Suppl): S9-S16.