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Can Large Tonsils Impact Speech in Children?

Many issues can cause speech impairments and speech disorders. But could speech impairment be caused by the tonsils? Can this often overlooked and forgotten part of the body be the problem itself?

It is quite common for large tonsils to go unnoticed and undiagnosed, and therefore leave parents confused as to what is causing the issue.

In this article, we will figure out the connection between large tonsils and speech. We will also explore what can be done about the issue and its effects.

What are Tonsils?

Tonsils are a pair of visible lymph nodes located in the back of the throat on both the left and right sides. One is positioned on each side of the uvula, which hangs down the middle of the back of your mouth. The tonsils are essentially masses of lymphatic tissue that are barely visible when the mouth is opened wide and the tongue is down saying “ahhh” during a throat exam.

The most important role of the tonsils is to filter out bacteria and other germs and help the body prevent infections. The tonsils will swell in response to an infection.

What are Adenoids?

Above the tonsils and behind the nasal cavity are the adenoids. Like the tonsils, adenoids are made up of the same masses of soft tissue. And along with tonsils, they can react to foreign infections by enlarging which is called adenoid hypertrophy. However, adenoids are not visible like tonsils are.

Everyone is born with adenoids. However, as we age throughout childhood and into adolescence, they will shrink. Typically they will disappear completely by adulthood.

Small children are highly susceptible to germs. It is believed that children tend to have bigger tonsils and adenoids because they are exposed to many new germs in their early years. In this period of a child’s life, the tonsils and adenoids are working overtime to protect the child from infection. But as we age, we’ve already encountered viruses and our body does not need to process them again. Therefore the tonsils and adenoids are activated much less often.

However, children will frequently experience large tonsils since their immune systems are still building. This can be even more difficult for a child to experience than an adult because they have less room in the oral cavity. This means they also have less room for breathing, speaking, and eating.

Enlarged Tonsils and Adenoids

Enlarged tonsils and adenoids (aka tonsillitis, tonsillitis, adenoiditis, or tonsil and adenoid hypertrophy) are common among children between the ages of three and five years old.

Typically these children will show some of the following symptoms:

  • Sore throat

  • Trouble swallowing

  • Unintelligible speech; can sound slurred and thick

  • Uncontrollable drooling

  • Excessive spittle and saliva

  • Have the mouth agape while at rest

  • Restless sleep

  • Fatigue

  • Untimely eating

  • Have difficulty eating and swallowing certain foods

  • Negative impact on consonant sounds made at the front of the mouth

  • Negative impact on the voice

  • Open mouth-breathing

  • Nasal-sounding speech or hypernasality

  • Hoarse voice

  • Slurring or jumbling words

Children experiencing issues with enlarged tonsils may also be experiencing:

  • Sleep apnea

  • Respiratory illness

  • Nasal infections

  • Chronic snoring

  • Inner ear infection

  • Bacterial or viral infection

  • Strep throat or other throat infections

Frequent misdiagnosis

As we’ve mentioned, the tonsils are often looked over when it comes to diagnoses. Additionally, the adenoids are a little more hidden, and cannot be seen without the use of medical imaging scopes or X-rays. Due to this difficulty, enlarged adenoids can be mistaken for allergy problems.

To prevent misdiagnosis, it can be helpful to differentiate between large tonsils and other conditions. These issues are commonly associated with and confused for large tonsils and adenoids:

  • Sinusitis: An infection of the sinuses can have similar characteristics to having enlarged adenoids. A pediatric doctor will need to do an exam to determine if the infection is caused by a virus or bacteria.

  • Tongue thrust: Tongue thrust occurs when a child gets in the habit of placing the tongue in the wrong place while swallowing. This could be either too far forward or too far on the sides. This causes an abnormal orthodontic condition called an open bite. Tongue thrust may also be caused by tongue tie, which is a restriction in the tongue’s range of motion.

Similar to enlarged tonsils and adenoids, the tongue thrust condition can also give the speech a nasal sound, or cause unintelligible speech. Either a doctor or a speech therapist can evaluate to determine if the child’s speech is affected by tongue thrust.

  • Snoring/sleep apnea: Sleeping can be greatly affected by enlarged tonsils and adenoids, causing snoring and sleep apnea. This will cause fatigue as well.

  • Frequent ear infections: This occurs when fluid is being prevented from draining in the middle ear. This can cause some speech delays.

  • Chronic nasal infections: These can affect speech quality through blockage of the nasal passages, increasing nasal resonance.

  • Adenoid hypertrophy: Recurring catarrhal otitis media can cause rhinogenic deafness in children. This is the stagnation of the secretion fluid in the middle ear cavity from the nose and throat, causing hearing loss. This is one of the most impactful and dangerous symptoms of adenoid enlargement. The child must see a doctor of otolaryngology who can diagnose the nasal obstruction.

Can Enlarged Tonsils Affect Children’s Speech?

As you can see, having large tonsils can not only cause a painful sore throat but can also cause unintelligible speech. So yes, large tonsils can impact speech in children. Large tonsils may even delay speech. This is because the tongue is being pushed forward by the growing tonsils, which can make it difficult to make speech sounds. However, this is not common.

For the child, the large tonsils will cause a change in vocal pitch, tone, and articulation. The quality of the child’s voice will change. Some children will sound hoarse, and muffled, with the resonance affected.

This speech change will likely affect the child’s schooling. In particular, it can have a big effect when the child is learning to read. An enlarged adenoid will likely cause the child’s voice to be nasally (much like the way it sounds when plugging your nose).

Treatment Options for Large Tonsils

Young children experiencing enlarged tonsils will need to seek a pediatric doctor or speech therapist for their speech problems.

To restore the child’s breathing and speaking capabilities, there are a few treatment options. Let’s take a close look at how to treat large tonsils.

Tonsillectomy and/or adenoidectomy

These surgeries remove the tonsils and/or adenoids. Removing the tonsils will allow the resonance issues to be resolved. But you may be wondering how the child will fight infection without the use of these lymph nodes. Fortunately, there does not appear to be a reduction in the strength of the immune system.

Sometimes doctors think these surgeries are the only choice to get the child back to breathing and speaking normally. However, it is possible surgery may not be needed since most children will outgrow the issue before they hit puberty. Here are a few cases in which a tonsillectomy and/or adenoidectomy might be considered:

  • Acute tonsillitis: This occurs when bacteria or the swelling of the tonsils has caused a sore throat, which is common in school-age children. Typically symptoms will go away within 3 to 4 days. For this reason, surgery will likely not be needed. While acute tonsillitis is not contagious, the cold or flu that caused it will be.

  • Chronic tonsillitis: This is a long-term tonsil infection. In this case, it is often ideal to get the surgery.

  • Recurrent tonsillitis: When the child gets tonsillitis a few times a year. If it is a problem, it may be a good idea to get surgery.

  • Acute mononucleosis “mono”: Also known as the “kissing disease, mono is highly contagious and is transferred through saliva. It will often occur with fever, and acute tonsillitis and affect the lymph nodes, liver, and spleen. Corticosteroids can be given to reduce the swelling, or a tonsillectomy can be performed in severe cases.

  • Recurring strep throat: If the child has strep throat seven or more times in one year, a tonsillectomy may be recommended by a doctor. However, it is still possible for the child to get strep throat after the tonsils have been removed. Luckily, they will likely experience strep throat less often and less severely.

  • Tonsil stones or tonsilloliths: These are hard bits of bacteria and debris that have gotten stuck within the crevices of the tonsils. They can be painful and cause bad breath and sore throats. Tonsil stones tend to form when the stuck debris has hardened or calcified. Often this will happen to those with long-term swelling and inflammation of the tonsils, causing recurrent or chronic tonsillitis. If tonsil stones turn into a long-term problem, it would be helpful to get surgery.

  • Enlarged (hypertrophic) tonsils: This condition has been known to most frequently affect speech patterns in children. It will also reduce the size of the airway, which can cause snoring or sleep apnea.

The number of children undergoing tonsillectomies has gone down dramatically since 1965. These days, we see about 250,000 kids under the age of 15 getting a tonsillectomy, much less than the 1965 average of 1 million kids yearly getting the surgery. This is due to more commonly recurrent infections back in the day, while today the surgery is mostly used for obstructive sleep problems.

Speech pathology

Open-mouth breathing caused by large tonsils can have an impact on the development of children’s jaw and face structure. This can hinder speech. Fortunately, this issue can be worked on in speech pathology sessions.

While speech pathology may not resolve the problem of large tonsils directly, it can still benefit children with this impairment. The child can get used to the swollen throat and nasal passage and will adapt their speech style around it during crucial stages of language development. This causes dysfunction within the speech mechanisms.

Working on exercises with a speech-language pathologist (SLP), can help a child exercise and strengthen the vocals that are not being used optimally.

If the tonsils remain swollen, speech pathology will not provide much auditory improvement. It would be more beneficial to either wait till after surgery or till the swelling has subsided to start speech therapy.

Speech therapy can be helpful for those children who have endured enlarged tonsils and adenoids for a lengthy period during speech development. These children probably have some issues with intelligibility.

The first examination can be done by a speech therapist’s oral mechanism evaluation to check the tonsils. It can be helpful for both the child’s pediatrician, otolaryngologist (ENT or ear, nose, and throat doctor), and speech therapist to accurately diagnose the child’s issue. SLPs are trained specially to notice, observe, and evaluate the tonsils and adenoids and come up with an accurate diagnosis and treatment plan. They can help the caregiver make the best decision for the child’s situation, helping to mitigate any speech delays that might occur as a result.

To find an experienced and licensed SLP, parents should look no further than our Rite-Care Centers which provide beneficial individualized care for children affected by speech issues. CARSF provides direct funding to these wonderful care centers located throughout the state of California.

Mitigating the Effects Large Tonsils Have on Children’s Speech

If the cause of a child's speech impairment is unknown, it can be wise to have a licensed SLP look to see if he or she has large tonsils. Large tonsils and speech unintelligibility are correlated because the tonsils give the mouth less room for articulation.

Luckily, there are solutions. The child can undergo a tonsillectomy and/or adenoidectomy, as well as gain some speech therapy. While speech therapy will not eliminate the original problem, it can help the child undo some of the speech patterns that were learned when the tonsils were enlarged.

If you’d like to support these children in their need for ongoing speech therapy, donate to the CASRF today!


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