Variation in tonsil size in 4- to 17-year-old schoolchildren

J Otolaryngol. 2006 Aug;35(4):270-4. doi: 10.2310/7070.2005.0118.


Objective: The purpose of this study was to evaluate the variation in tonsil size and prevalence of asymmetric tonsils in 4- to 17-year-old schoolchildren and the relationships between tonsillar hypertrophy and frequent tonsillitis, frequent fever, and sleep-related symptoms observed by parents.

Design: Cross-sectional study.

Setting: Six daycare centres, four primary schools, and four high schools.

Methods: Questionnaire and physical examination.

Main outcome measures: The size of the tonsils was evaluated and scored on a 4-point scale. The interrelationships between tonsillar hypertrophy and other studied symptoms were examined.

Results: In the study, the parents of 1784 children, consisting of 803 (45%) boys and 981 (55%) girls, completed the questionnaires. The prevalence rates of snoring, habitual snoring, observed apnea, and habitual observed apnea were 24.6%, 4.1%, 3.8%, and 0.9%, respectively. The results of tonsil scoring were grade 1, 62.7%; grade 2, 28.4%; grade 3, 3.3%; and grade 4, 0.1%. The prevalence rate of grade 1 tonsils was increasing, whereas the prevalence rates of grade 2 and 3 tonsils were decreasing with increasing age. Tonsil size peaked in 4- to 8-year-old children. The prevalence rates of tonsillar hypertrophy and asymmetric tonsils were 3.4% and 1.7%, respectively. Tonsillar hypertrophy was found to be significantly associated with male gender, a history of frequent tonsillitis, a history of frequent fever, often or always snoring, and often or always observed apnea.

Conclusions: A tonsil size curve was developed in 4- to 17-year-old schoolchildren. Children aged 4- to 8 years with oropharyngeal symptoms and particularly male gender should undergo consultation with otorhinolaryngology and pediatric pulmonology physicians for the evalution of adenotonsillar tissue.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypertrophy / epidemiology
  • Hypertrophy / pathology
  • Male
  • Palatine Tonsil / pathology*
  • Prevalence
  • Sleep Apnea Syndromes / epidemiology
  • Sleep Apnea Syndromes / pathology
  • Snoring / epidemiology
  • Snoring / pathology
  • Surveys and Questionnaires
  • Tonsillitis / epidemiology
  • Tonsillitis / pathology
  • Turkey / epidemiology