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What are potential impacts of enlarged tonsils and adenoids?

Tonsils and adenoids are the body’s first line of defense as part of the immune system. Your tonsils are easy to see, located at the back of your throat on either side, and they are responsible for producing antibodies to help fight nose and throat infections. Adenoids are high in the throat, behind the nose and the roof of the mouth (soft palate), and are not visible through the mouth or nose without special instruments. Like tonsils, your adenoids help your immune system recognize and fight off germs.


Children tend to have larger tonsils and adenoids than adults, likely because children are exposed to so many new germs which the tonsils and adenoids are helping fight off. By the time we reach adulthood, our bodies have encountered many viruses and the tonsils and adenoids no longer playing such a large role.


The Impact of Enlarged Tonsils and Adenoids


Although tonsils and adenoids can become enlarged due to infection, chronically enlarged tonsils and adenoids can have a negative impact on breathing, sleeping, swallowing, and speech. Let’s take a closer look at how.


Talk Time Speech and Language Therapy | Color picture of boy at the end of a yellow slide | The impact of enlarged tonsils and adenoids

Breathing


If your child’s tonsils or adenoids are enlarged, it may be hard to breathe through the nose resulting in open mouth breathing. Open mouth breathing can often lead to dry mouth, cracked lips, bad breath, and runny nose. Enlarged tonsils and adenoids can also contribute to noisy, heavier breathing.


Sleeping


Enlarged tonsils can cause the airway to become narrow and can affect the child's ability to intake optimal oxygen when sleeping. Narrowing of the airway can cause:

  • Snoring,

  • Sleep apnea (a pause in breathing while asleep, and doctors often recommend tonsillectomies for children with sleep apnea),

  • Open mouth breathing when sleeping, and

  • Restlessness

A change in optimized oxygen intake when sleeping can impact a child’s executive functioning when they are awake and lead to anxiety, impulsivity, changes in behavior, and more.


*It should be noted that while snoring can be associated with sleep apnea, not all children who snore have sleep apnea. Snoring occurs due to vibration of the soft tissues in the upper airway and enlarged tonsils and adenoids can contribute to these noises.


Swallowing


A tongue thrust swallow may be present as a compensatory strategy due enlarged tonsils. A tongue thrust is when the tongue is placed forward from the position where it should be resting before attempting to swallow. Enlarged tonsils push the tongue forward in the mouth because the space that is usually occupied by the back of the tongue is taken up by the enlarged tonsils. The thrust is exhibited when the tongue moves forward through the teeth while swallowing foods and liquids. Swallow patterns can be assessed and treated by a speech pathologist.


Talk Time Speech and Language Therapy | Color picture of girl eating a tomato on her fork with plate of salad and cup of water | The impact of enlarged tonsils and adenoids

Speech


The adenoids play an important role in the speech development of children. When a young child produces a speech sound, the soft palate rises and touches the adenoids, creating a seal. This prevents air from escaping through the nose when speaking and is necessary for clear speech. Enlarged adenoids can result in hyponasality and difficulty producing nasal sounds like /m,n/ and “ng”. Adenoids become less important to speech with age and begin to shrink around age 15 (the wall at the back of your throat touches the soft palate to create a seal instead).


While healthy tonsils do not play much of a role in speech development, enlarged tonsils can have a major impact on speech and resonance. Enlarged tonsils can cause the tongue to touch more forward in the mouth; it can cause fronting of backed sounds (e.g., /k,g/ produced as /t,d/).


It is important to point out that speech therapy cannot effectively resolve challenges with breathing, sleeping, swallowing, and/or speech if the root cause of the issue is structural. An ear, nose, and throat doctor can evaluate and determine an appropriate plan of treatment. Removal of the tonsils and/or adenoids can help resolve challenges with breathing, sleeping, swallowing, and/or speech, however speech therapy services may be necessary to support learning correct patterns for any of these skills.


If your child presents with any of these characteristics, we would love to help! Contact us with any questions or concerns, or to schedule an evaluation.

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