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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7 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!

  4. My son, now 15, has had a long history of ear infections and some breathing difficulty through sport/exercise. For years the doctors diagnosed the ear infections for poor hearing. its wasnt until last year someone looked at his adenoids and noticed they where enlarged. He also has poor bite and crowded teeth, which he is almost finished with his brace treatment. The doctors straight away mentioned removing the adenoids. I didnt want to do this just based on 1 first look, without comparing them somewhat later to see if they would get better with age. I would like to know if it is still possible for him to grow out of them before making a decision.

  5. Dear Doctor Park, I have enjoyed reading your page and have your books to read I have read the free one. I am in Melbourne Australia.
    I had tonsils out at age 5, and am 61yo. have suffered sore throats for 6 weeks, now up to 8 then 12 weeks. which means most of the year I am unwell. It is not just a sore throat. it is really painful. Eventually GP sent me to ENT . She diagnosed GERD, I took the medication but it did not help. I do know what reflux feels like I had it when I was pregnant. it was not that.
    I went back to ENT Victoria and saw a different ENT. a more experienced one. He diagnosed
    Chronic lingual tonsillitis. but he referred to my use of antibiotics for skin condition. I have auto immune disease and immune dysfunction markers in bloods. I have ME/.CFS . Hashemotos. and had rare cancer, and sciatica. in both legs. pancreatitis which is from gall stones. so not healthy but I am happy person.
    I snore really badly at night, I have had surgery for deviated septum. as all my family have had.( my mother and kids ). it was not successful, according to ENT. they cannot get the endoscope down that nostril. but ok down the other one. There is scarring in the nostril also. as the ENT took the stitches out too early. ( he read notes wrong ) I can feel scar tissue. but its no problem.
    the problem is these sore throats that go on for so long. he said it was viral and ( surgeon Dr Benjamin Cooke at ENT Vic. ). the only other person he knows with CLT is two women. not related they both have rosacea and use low does antibiotics. Have you found this ?
    So I have tried strong antibiotics as per Australian government medical ruling. first time it worked but it could be that I was just going to get over it. This day so far has not worked.
    I am on Tramadol SR 200 mgs twice a day for nerve pain. failed back surgery syndrome.
    it works on that most of the time. unless I have a flare of pain in my spine which is facet joint OA problem at L5 S1 .. same place as sciatica .but this is now pain in lower lumbar and both legs now. I have physio. and extra rest. and going to pain clinic at the moment. just started.
    My GP mentioned surgery for Chronic Lingual Tonsilitis. I want to know if you think this is a safe and successful surgery to have. ? I am totally fed up with the sore throats. that go on and on. It gets me down more than anything else I have. I have awful post nasal drip.
    I will get on with reading your books. Thanks for your web page. All the best to you.
    I enjoy the pod casts also. you may contact Dr Benjamin Cook as I will see him sometime soon. after my other medical appointments. I am 12 days post initial cold. the cold is mild compared to the throat. I was got one sided CLT post dental work. I never blow my nose. it always drips down. regards, Rhonda B – Australia

  6. Lorraine,

    I can’t make any recommendations without examining your son, but in general, I recommend doing whatever it takes to makes sure you have optimal nasal breathing. Nasal congestion is a major source for malocclusion and dental crowding. Good luck.

  7. Ms. Rhonda,

    Sorry to hear about your health condition. I can’t make any recommendations or talk with your doctors since I’m not your treating physician. I do see a lot of patients with similar problems, and will be writing more articles in the future on CFS/Fibro and other chronic pain disorders. Obstructed breathing leads to reflux which can cause persistently inflamed tonsils and adenoids.