Tonsils are an often overlooked, undiagnosed, and troublesome part of the human body. What makes them even more of a nuisance is that children have an incredibly small oral cavity--and while a child’s mouth grows with age--while they are little, there is very little “extra room” for any abnormalities, such as enlarged tonsils. The tonsils serve as a defense mechanism for the throat against airborne, breathed, bacteria; however, much like the appendix--the tonsils are an organ that the human body can live without.

The tonsils are located in the back of the mouth, one positioned on each side of the uvula which hangs at the back of the mouth. Tonsils are above the “throat” where the trachea leads to your lungs, and your esophagus to your stomach. Tonsils are supposed to be minimally visible when a mouth is opened widely and the tongue is down (think--say “ahhhh”), but they do swell with infection and contact to germs because it’s their job to stop the germs from getting further into the body. Small children are highly susceptible to daily contact with germs, and their immune systems are still building, which leads to frequently enlarged tonsils. In addition, enlarged adenoids (which are located behind your nasal cavity, also help prevent infection, and are not visible to the naked eye) occur frequently with enlarged tonsils due to smaller nasal passage and heightened exposure to germs.

The size of the tonsils are given a rating scale from 1-5 with 1 being normal, minimally visible, and 5 being that the tonsils are “kissing” or touching each other in the middle of the back of throat. A speech pathologist or pediatric ENT will be able to provide an approximate “rating scale” from 1-5 after they see a visual of the tonsils. For children old enough to follow directions, “open and say aaahhh” may be enough. For children who are too young and distractible, or find it difficult to sit still, allow others near their mouths, or follow directions, it may take a few “tricks” to obtain a visual. One trick speech therapists use to visualize a patient’s tonsils is to have them lie on their back with the therapist positioned over them and facing them while they attempt to have a child imitate silly faces, lick a lollipop, or make funny noises. Often times, when children are crying or protesting loudly, their mouths are often widely open as well and the tonsils can be seen. In regards to enlarged adenoids, speech therapists can use their skills to assess and assume, but because adenoids are not visible to the naked eye, there is not a way to officially confirm adenoid enlargement until an ENT is involved.

While a speech therapist can approximate tonsil size, assess a child’s speech and sound productions, and can provide counsel and education regarding tonsils and adenoids and negative impacts there is not as much that can be done to help reduce speech/language, feeding, or breathing impairments, while the tonsils/adenoids are still in. It would be similar to using a broken umbrella in the rain. While the umbrella is supposed to be keeping you dry, it’s not living up to its potential or doing its job well enough because of its current status. Tonsils and adenoids are not supposed to be enlarged, and the difficulties that they cause when they are can be very troublesome to children and parents.

Combine the small airway, the large amount of germ contact with enlarged/swollen tonsils and/or adenoids and the results are frequently speech therapy related issues. Such issues include; nasally sounding speech (like you’re talking with a plugged nose), hoarse

sounding voice, excessive spittle/saliva, drooling, slurring or jumbling words, snoring, restless sleeping, fatigue, open mouth breathing, extended time eating, and more. If you’ve ever noticed your child exhibiting these symptoms, it may be a good idea to have a trained professional check their tonsils. If your child has frequent bouts of strep, sore throat, respiratory illness, or nasal infections it might also be beneficial to see an ENT or a speech therapist for further evaluation.

Tonsils and adenoids are supposed to protect from icky germs and resulting illness and infection. Tonsils and adenoids are not supposed to cause unintelligible speech, uncontrollable drool, uncomfortable sleep, or untimely eating. When children’s tonsils and adenoids are not doing their job, it often becomes the parent and speech therapist’s job to advocate for their child’s body and well being. Although no surgery requiring general anesthesia is “simple”, a tonsillectomy and/or adenoidectomy is a very common surgery. The procedures occur under the close watch of an anesthesiologist, usually takes less than half an hour, can be recovered from in as little as 1 week, and is often an outpatient procedure. Often times with a special kind of removal process, the recovery has become quicker, the pain and discomfort afterwards is less, and the follow up care is now easier.

General pediatricians/physicians or ENT’s may encourage parents to wait for several rounds of strep prior to supporting removing your child's tonsils. They may be more likely to comply if a patient needs general anesthesia for another reason such as PE tubes for

frequent ear infections. Speech language pathologists are specially trained to notice, observe, and evaluate the negative effects of enlarged tonsils/adenoids. They can provide parents and caregivers with tricks, tips, and things to try if their child suffers recurring nasal/throat illness, drooling, slurred speech, long eating times, or any of the other symptoms listed above, or if they want to seek a tonsillectomy or adenoidectomy. If you believe your child is suffering from any of these issues or may have enlarged tonsils or adenoids, seek help from your ENT and a speech language pathologist. Small mouths, throats, and sinuses paired with frequent exposure to germs make children the perfect targets for swollen tonsils or adenoids. Don’t let tonsil or adenoids become an overlooked, undiagnosed, or troublesome part of your family.

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