Before antibiotics and the reduction in infectious childhood diseases over the past few generations, tonsils and adenoids caused greater health problems. Less often, the hypertrophy is due to repeated throat infections by cold viruses, strep throat , mononucleosis, and in times gone by, diphtheria . The acute infections are usually referred to as tonsillitis , the adenoids getting little recognition because they cannot be seen without special instruments. After the acute infection subsides, symptoms are generated simply by the size of the glands. Extremely large tonsils can impair breathing and swallowing, although that is quite rare.
Large adenoids can impair nose breathing and require a child to breathe through the mouth.
Because they encircle the only connection between the middle ear and the eustachian tube, hypertrophied adenoids can also obstruct it and cause middle ear infections. A simple tongue blade depressing the tongue allows an adequate view of the tonsils. Viewing adenoids requires a small mirror or fiberoptic scope. A child with recurring middle ear infections may well have large adenoids. A throat culture or mononucleosis test will usually reveal the identity of the germ.