Tonsillitis & Enlarged Adenoids in Children: When Is Surgery Needed?

By Dashvanth Healthcare Medical Team · Reviewed by our specialists · East Delhi

What Are Tonsils and Adenoids?

Tonsils are two oval tissue pads at the back of the throat (visible when you open your mouth wide). Adenoids are similar tissue at the back of the nose. Both are part of the immune system — largest and most active in early childhood, naturally shrinking by adolescence.

Tonsillitis

Inflammation of tonsils — most commonly from viral infections (adenovirus, EBV) or bacterial infection (Group A Streptococcus — "strep throat").

• Symptoms: Sore throat, fever, difficulty swallowing, swollen neck glands, white/yellow patches on tonsils (bacterial)
• Treatment: Viral — supportive (fluids, paracetamol). Bacterial strep — antibiotics (amoxicillin 10 days). Full course essential to prevent rheumatic fever

Enlarged Adenoids

• Mouth breathing, snoring, nasal voice
• Recurrent ear infections (otitis media) — adenoids obstruct Eustachian tube
• Sleep-disordered breathing or sleep apnoea
• Chronic runny nose, poor sleep, daytime tiredness

When Is Surgery Needed?

Tonsillectomy indications:

• ≥7 episodes of tonsillitis in 1 year, or ≥5/year for 2 years, or ≥3/year for 3 years (Paradise criteria)
• Peritonsillar abscess
• Obstructive sleep apnoea confirmed on sleep study