Obstructive Hyperplasia of the Tonsils and Adenoids

Adenotonsillar hypertrophy is the most common cause of obstructive sleep apnoea in children

Aetiology

  • Tonsils and adenoids continue to grow from birth to 12 years of age, with the greatest increase in size during the ages of 2 and 8
  • During this period of time, the disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a relatively narrower upper airway

Clinical presentation

Adenoid

  • Obligate mouth breathing
  • Hyponasal voice
  • Snoring and other signs of sleep disturbance
  • AOM/OME

Tonsils

  • Snoring and other signs of sleep disturbance
  • Muffled voice
  • Visibly enlarged tonsils without symptoms means nothing

Management

  • Removal of the tonsils and adenoids is indicated if there is recurrent or persistent obstructive or infectious symptoms related to adenoid hypertrophy