Tonsils tend to reach their largest size near puberty, and they gradually undergo atrophy thereafter. However, they are largest relative to the diameter of the throat in young children.
Tonsils can become enlarged or inflamed (tonsillitis) and may be surgically removed in tonsillectomy. This may be indicated if they obstruct the airway or interfere with swallowing. In older patients, asymmetric tonsils (also known as asymmetric tonsil hypertrophy) may be an indicator of virally infected tonsils, or tumors such as lymphoma or squamous cell carcinoma.
Some doctors who are not ear, nose and throat (ENT) specialists are conservative on recommending the removal of tonsils[citation needed], because the tissue cannot be put back, and some claim that removal decreases the power of the immune system[citation needed]. ENT specialists generally recommend removal if there are frequent recurrent tonsillitis, adenotonsillar hyperplasia causing symptomatic partial upper airway obstruction or asymmetry.[citation needed]
Tonsil enlargement can affect speech making it hypernasal and giving it the sound of velopharyngeal incompetence.[1]
