Your tonsils and adenoids are parts of your immune system. Normally, they help protect your body from disease. If you get an infection, your tonsils and adenoids step up and help fight infections.  However, they can sometimes become the problem themselves, by becoming chronically or repeatedly infected, or by becoming so large they block breathing, sinus drainage, and ear drainage.

Your tonsils include the following parts: 

• Two palatine tonsils 
• The adenoids 
• One lingual tonsil 

The two palatine tonsils are the two round lumps in the back of your throat (pharynx).

The adenoids are located high in the throat behind the nose and the roof of the mouth (referred to as your soft palate). You can’t see the adenoids without using special instruments like a scope or with an x-ray.

The lingual tonsil is far back at the base of the tongue, on its rear surface. 

All of your tonsils create a ring around where your nasal cavity and mouth meet the throat. They are called the tonsillar ring due to this positioning. This ring allows your tonsils to effectively trap bacteria and viruses that enter the body through your nose or mouth.

The most common cause of problems with tonsils and adenoids is infections. Infections can cause your tonsils to swell. Tonsil and adenoid infections and enlargement can contribute to other health issues, such as: 

• Issues with breathing
• Nasal obstruction
• Swallowing difficulties
• Sleeping problems

Several conditions can impact your tonsils. Here are the six most common tonsil conditions:

5. Enlarged (hypertrophic) tonsils. When your tonsils become enlarged, this can lead to infection and inflammation in your body. Enlarged tonsils can lead to other health issues if left untreated, such as recurring ear infections, chronic sinus infections, and obstructive sleep apnea.

Tonsillitis is an infection of the tonsils. Most common tonsil conditions, as listed above, cause similar symptoms. Symptoms of tonsil and adenoid problems may include:

• Bad breath
• Swelling of the tonsils
• Difficulty or painful feeling when swallowing
• A slight change in the voice due to the swelling
• Tonsils that are darker and redder than normal
• White or yellow coating on the tonsils
• Sore throat along with ear pain
• Swollen lymph nodes in the back of your neck
• Fever
• Stomachache
• Stiff neck
• A scratchy or muffled voice 

Enlarged tonsils or adenoids can make it difficult for you or your child to breathe through the nose, which can also cause difficulty sleeping. Additional signs of adenoid and/or tonsil enlargement include:

• Breathing through the mouth instead of the nose most of the time
• The nose sounds “blocked” when the person speaks, making their voice sound funny
• A chronic runny nose
• Noisy breathing during the day, when engaging in non-physical activities
• Recurrent ear infections
• Snoring at night
• Restlessness during sleep or pauses in breathing for a few seconds at night (this may indicate sleep apnea or other sleeping disorder)

To diagnose problems of the ear, nose, and throat, your physician will start by examining your head and neck. In addition to looking at and touching your nose, ear, and throat, your physician will use a small flexible mirror and a lighted instrument to examine your ear, nose, and throat. 

In addition to a physical examination with basic instruments, there are other tests and techniques your physician may use to check your tonsils and adenoids, including: 

• Throat culture - to identify what type of infection you have in your throat
• Strep test - if your physician suspects you have strep throat
• Blood test - to diagnose infections such as mononucleosis
• Sleep study or polysomnogram - to diagnose sleep apnea caused by enlarged tonsils and adenoids
• Small flexible scope - to visually see the size of the adenoids

How your tonsil and adenoid problem is treated depends upon its cause. 

Antibiotics are commonly used when you have a bacterial infection of the tonsils. Antibiotics are the first line of defense, especially with Streptococcus. 

Tonsillectomy or adenoidectomy is when your tonsils or adenoids are removed. This procedure is performed when infections keep returning even after using antibiotics. It is also an option if enlarged tonsils or adenoids are causing difficulty breathing. 

Frequently infected adenoids can lead to fluid collection in the middle ear, causing temporary hearing loss. It can also lead to frequent ear infections. Removing the adenoids (adenoidectomy) is used to help children with chronic earaches accompanied by fluid in the middle ear, referred to as otitis media with effusion. 

Another reason to remove the tonsils and adenoids is a tumor or cancer in adults.

Steroids can be useful for patients with infectious mononucleosis, where severe enlargement may obstruct the airways. In such cases, treatment with steroids (e.g., prednisone) can be helpful.

• Difficulty swallowing