Tonsils and adenoids are lymphoid tissue that form part of the immune system in early childhood. The tonsils sit at the back of the throat on either side and are visible when you open the mouth. The adenoids sit higher up, behind the nose, and are not visible without a scope or imaging. Both tend to be largest between ages 2 and 7 and typically shrink as children grow older.

When tonsils and adenoids become enlarged — whether from recurrent infections or simply as a developmental variant — they can cause significant problems including obstructed breathing during sleep, difficulty swallowing, and recurrent bacterial throat infections. Tonsillectomy (removal of the tonsils) and adenoidectomy are among the most commonly performed pediatric surgeries, and for children who meet the right criteria, the results are transformative.

Not every child with large tonsils needs surgery. The decision is based on how much the tonsils are affecting the child’s quality of life — sleep, growth, behavior, and frequency of illness — not size alone. A pediatric ENT evaluation helps determine whether your child is a good surgical candidate.

The two main reasons children need tonsil surgery

Obstruction

Sleep-Disordered Breathing

Loud snoring most nights
Observed pauses in breathing during sleep
Restless sleep, unusual sleep positions
Mouth breathing during the day
Behavioral changes, hyperactivity, poor focus
Poor growth or daytime fatigue

Infections

Recurrent Tonsillitis

7 or more episodes of tonsillitis in one year
5 or more episodes per year for two years
3 or more episodes per year for three years
Multiple courses of antibiotics annually
Peritonsillar abscess
Persistent throat pain, difficulty swallowing

These two indications — obstruction and recurrent infection — are distinct and call for somewhat different conversations. Obstruction-related tonsillectomy in particular has compelling evidence supporting improvement not just in sleep but in behavioral outcomes, school performance, and growth in affected children.

What do enlarged adenoids cause?

Adenoid enlargement causes different problems than tonsillar hypertrophy, primarily because of their location behind the nose:

Chronic nasal obstruction and mouth breathing — the adenoids can block nasal airflow entirely in young children
Recurrent or chronic ear infections — enlarged adenoids obstruct the Eustachian tube opening and impair middle ear drainage
Persistent nasal congestion and runny nose — the adenoid tissue can harbor bacteria and perpetuate chronic infection
Snoring and sleep apnea — contributing to upper airway obstruction alongside enlarged tonsils
Speech changes — a hyponasal (blocked-sounding) quality to the voice

Important for parents Tonsillectomy and adenoidectomy are not the same procedure. Each gland has its own indications. Tonsillectomy is most often recommended for recurrent tonsillitis or airway obstruction from large tonsils. Adenoidectomy is most often recommended for recurrent ear infections, nasal obstruction, or adenoid-related sleep issues. In many children, both are performed together — but the decision for each is made independently based on your child’s specific presentation.

What to expect at the consultation

History of infections and sleep symptoms

Dr. Samarrai will review your child’s history of throat infections, antibiotic courses, sleep symptoms, breathing pattern, growth, and daytime behavior. Bring a list of infections with dates if you have it — it helps enormously.

Physical examination

Dr. Samarrai will examine the tonsils directly, assess their size and appearance, and examine the ears and nose. Nasal endoscopy may be used to assess adenoid size in cooperative children.

Shared decision-making

Dr. Samarrai will give you her recommendation based on the findings and discuss the expected benefits and risks of surgery versus continued observation. There is no pressure — the goal is to give you the information to make the right decision for your child.

Surgical planning if indicated

Tonsillectomy and adenoidectomy are performed under general anesthesia as outpatient procedures — children go home the same day. Recovery typically takes 10–14 days, during which soft foods and rest are important.

Frequently asked questions

My child snores loudly — does that mean they need surgery?

Not necessarily, but loud snoring warrants evaluation. The concern is whether the snoring reflects obstructive sleep apnea — repeated pauses in breathing that disrupt sleep architecture and have real consequences for behavior, learning, and growth. An ENT evaluation, and sometimes a sleep study, helps determine whether the snoring is benign or is affecting your child’s health enough to warrant tonsillectomy.

How many strep infections does my child need before considering tonsillectomy?

The clinical guidelines suggest tonsillectomy is reasonable when a child has 7 or more documented throat infections in one year, 5 or more per year for two years, or 3 or more per year for three years. Each episode should be documented with fever, positive strep test or culture, or antibiotic treatment. Keeping a record of your child’s infections is valuable when you come for evaluation.

Won’t removing the tonsils hurt my child’s immune system?

This is one of the most common concerns parents have, and the evidence is reassuring. While tonsils are lymphoid tissue, they are a very small part of the immune system and are not essential for immune function. Children who undergo tonsillectomy do not have higher rates of serious infection afterward. The immune system compensates fully.

What is recovery like after tonsillectomy?

Recovery takes approximately 10–14 days. The first week is typically the most uncomfortable — throat pain peaks around day 5–7 as the surgical scabs begin to separate. Pain management with scheduled acetaminophen and ibuprofen, soft cool foods, and good hydration are the cornerstones of recovery. Rarely, post-operative bleeding can occur and requires immediate medical attention.

At what age can a child have a tonsillectomy?

Tonsillectomy can be performed at any age, but it is most commonly done between ages 3 and 15. In very young children (under 3), there is more caution given the airway considerations and recovery challenges, but the procedure is performed in younger children when the indication is compelling — particularly severe obstructive sleep apnea with significant oxygen desaturation.

Serving Brooklyn & Staten Island

Seaside ENT sees patients at 6818 3rd Ave, Brooklyn, NY 11220 in Bay Ridge and 1191 Forest Ave, Staten Island, NY 10310. Dr. Samarrai is fellowship-trained in pediatric otolaryngology and speaks both Arabic and English. Most major insurance plans are accepted including Medicaid.

Pediatric ENT | Brooklyn & Staten Island

Concerned about your child’s tonsils or adenoids?

Call Seaside ENT to schedule a pediatric evaluation with Dr. Samarrai. Fellowship-trained in pediatric ENT.

Call (917) 992-3873

Brooklyn & Staten Island