Can Your Child Outgrow Tonsils or Adenoids?

Coincidentally, I saw three patients a few days ago that were told by another physician that they will outgrow their large tonsils or adenoids. One was a 9 year old girl with golf-ball sized kissing tonsils who kept getting recurrent throat infections. Since none of her throat cultures came back positive, surgery wasn’t recommended. The second patient was a 29 year old man with life-long history heavy snoring. When he was 6 years old, his ENT surgeon told his parents that he would eventually outgrow his large tonsils. The last patient was a 17 year old girl with repeated ear infections as a young child and chronic nasal congestion. Similarly, she was told that she would grow out of her large adenoids.

By the time I saw all three of these patients, their doctors were all correct: They  all grew out of their large tonsils and adenoids. In fact, all of their tonsils were markedly smaller than what was described many years prior.

However, all three patients had one thing in common: severe dental crowding, a high arched hard palate, and chronic nasal congestion due to a deviated nasal septum, bilateral turbinate hypertrophy, and nasal valve (nostril) collapse. All three were found not to have any significant apneas on a sleep study.  

Over the years, a number of studies revealed that for some conditions related to obstructive sleep apnea, a watchful waiting method may be an option. One such finding was reported in the recent Childhood Adenotonsillectomy (CHAT) Study, a multi-institutional, prospective, randomized study of 464 children undergoing surgery vs. watchful waiting. They looked at various outcomes after seven months, including sleep study and neurocognitive information. Not surprisingly, children with more severe cases of obstructive sleep apnea had more improved outcomes. However, about 30 to 50% of children who underwent observation only had normal sleep studies after 7 months. There were also no significant differences in cognition between the two groups. Adenotonsillectomy, however, was found to have more significant improvements in sleep duration and quality.

The CHAT study didn’t look at nasal breathing measures or any changes to craniofacial or dental measurements. Additionally, 7 months is is very short period of time to follow-up children after a surgical procedure. It would be interesting if they measured all these variables 5 or even 10 years later.

Despite the results of the CHAT study, I don’t hesitate to offer adenotonsillectomy in a child with obviously large tonsils, who snore and choke at night.

Have you or your child ever been told by a physician that you can outgrow your large tonsils or adenoids? If so please tell us your story below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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3 thoughts on “Can Your Child Outgrow Tonsils or Adenoids?

  1. I had my daughter’s tonsils removed. I’ve heard that kids can outgrow them and I don’t deny that’s true. Frankly, it doesn’t matter as the developmental problems will remain. And as an adult, having no tonsils improves the odds of avoiding sleep apnea, when it’s much more painful to do. This coming from an anti-surgery person.

    You didn’t note it but there’s a lot of controversy here too about the efficacy of tonsil removal. My brother had large tonsils so they removed his when he was 5. They decided it probably ran in the family so removed mine when I was 2! A decade later I developed severe OSA nonetheless (or maybe I had it all along still!).

    The point is, debate continues over whether tonsil removal alone is sufficient to prevent OSA. Dr Guillemenaulot published a paper two years ago basically saying no. Allergies also need to be addressed as well as palatal expansion. Trouble is, there’s so little data here and these treatments are by no means minor. Expanding a palate and praying that the mandible will catch up? Drug side effects? Turbinate reduction in a child? Whether forward growth is possible remains debatable. My impression so far has been that Stanford has their opinions and everyone else has different ones, even Pediatric sleep doctors.

    After removing tonsils, my plan is to treat my daughter’s allergies. We’ll run through medications up to the topical steroids and if that fails we’ll do allergy shots. We’ll see an orthodontist at 7 for early treatment to fix her bite (though at this point she made eventually need surgery anyway to close the open bite). If this all fails, then we can consider surgery to open up her nasal passage around 9-10 so that there’s hope that any facial deformities can still self correct in this last few years of development.

    This is all speculation of course but I think it’s a decent middle of the line approach.

  2. Thanks for commenting, Uri. You’re right in that there are a number of different reasons for OSA that are combined. Taking out the tonsils helps significantly, but almost never completely. My feeling is that large tonsils are a sign of predisposition to OSA due to jaw underdevelopment. Reflux from obstructions can cause lymphoid tissues to swell, causing more obstructed breathing, leading to more reflux. In many children, treating OSA is a multi-step process. What you’re describing are reasonable options. Unfortunately, many pediatricians and even some ENT surgeons would rather take the “watch and wait” attitude.

  3. It’s good to know that adenoids can be eventually outgrown over time. I remember having very large tonsils when I was ten years old. That’s something that I’ve been worried about until I noticed that my large tonsils look smaller now. It’s good to read how the three patients you mentioned who experienced the same thing also eventually outgrew their adenoids. Thanks for posting this!