Tonsillary Hypertrophy in Children

The palatine tonsils and adenoids are tissues of the Waldeyer ring, a group of lymphoepithelial tissues that includes tubal tonsils in the nasopharynx and the lingual tonsil. Collectively, these tissues participate in the mucosal immune system of the pharynx. The size of the tonsils appears to correlate with their level of immunologic activity, peaking between the ages of 3 and 10 years and demonstrating age-dependent involution. There is also some evidence that their size increases with bacterial load. The tonsils and the adenoid are sites of continuous stimulation of the lymphoid cells. The most excellent immunological activity of the tonsils is found between the ages of 3 and 10 years; the tonsils are most prominent during this childhood period and subsequently demonstrate age-dependent involution. There is some evidence that their size increases with the bacterial load and the population of B and T cells. At birth, the palatine tonsils are approximately 5 mm in anteroposterior diameter and 3.5 mm in vertical diameter, weighing about 0.75 g. During childhood, the palatine tonsils descend within their fossae as their vertical diameter grows faster than their anteroposterior diameter. When lymphoid tissue occupies disproportionate space in the pharynx, the upper airway becomes compromised.