When first born all children have lymphoid tissue in the oral pharyngeal cavity that assists in providing immunity to the growing infant. At birth infants are dependent upon antibodies that were inherited from the mothers immune system. The tonsils and adenoid tissue are part of a ring of tissue known as Waldeyer's Ring. As we grow this tissue spontaneously resorbs and migrates to the tongue base (lingual tonsil), the lateral oral pharynx (palatine or faucial tonsils), and the nasopharynx (adenoids).

If the adenoids and tonsils do not absorb and become enlarged, they can cause obstruction of the posterior nasal chambers and lead to chronic ear infections (otitis media), chronic purulent nasal drainage (adenoiditis), and airway obstruction (obstructive tonsillitis and adenoiditis). If persistent or not responsive to medical therapy, surgical removal of the tonsils and adenoid tissue may be required. Chronic ear infections are often associated with enlarged or infected adenoid tissue; but there is no definite correlation between enlarged tonsils and chronic ear infection.

A more serious problem related to tonsil enlargement is obstructive upper airway syndrome.
There is some correlation thought to explain sudden infant death syndrome (SIDS) to markedly enlarged tonsils and adenoids that obstruct the young infant's airway when placed in certain positions in the crib. Diagrams and pictures are now available (Friedman Obstructive Apnea Staging Guide) that depicts 4 different appearances of the posterior oral cavity, tongue and tonsil size. This guide predicts the degree of risk for obstructive sleep apnea (episodes of cessation of breathing) and SIDS.

The American Academy of Otolaryngology Head and Neck Surgery has published indications and prerequisites for consideration of tonsillectomy and adenoidectomy. These published criteria relate to the number of infections, degree of sleep disturbance or apnea, missed days of school or work, unilateral tonsil enlargement or abscess, persistent or recurrent ear infections after the age of six, and abnormal appearance or hardness of the tonsil being primary reasons for referral to an ENT physician.

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