Hyperplastic tonsil

by Jason Wasserman MD PhD FRCPC
October 8, 2024


A hyperplastic tonsil is a benign (non-cancerous) condition that results from an increased number of cells normally found in the tonsil. The tonsils are small masses of lymphoid tissue located at the back of your throat and play a role in your immune system by helping to trap and fight off infections. When the number of these cells increases, the tonsil grows larger. This enlargement is known as hyperplasia, typically a response to repeated infections or inflammation. Hyperplastic tonsils are relatively common, particularly in children.

What are the symptoms of a hyperplastic tonsil?

The main symptom of a hyperplastic tonsil is an enlarged tonsil, which may be visible in the back of your throat. You may notice the following symptoms:

  • Difficulty swallowing.
  • A feeling of fullness in the throat.
  • Snoring or noisy breathing, especially during sleep.
  • A sore throat or frequent throat infections.

In some cases, hyperplastic tonsils do not cause noticeable symptoms, and the condition is only discovered during a routine examination.

What causes a hyperplastic tonsil?

Hyperplastic tonsils are often caused by repeated infections or inflammation. When your body fights an infection, your tonsils filter out harmful bacteria or viruses. This immune response can lead to an increase in the size of the tonsils.

Other causes include:

  • Chronic tonsillitis, where the tonsils are frequently infected.
  • Allergies, which can cause inflammation of the tonsils.
  • Irritants, such as smoke or pollution, can lead to tonsillar enlargement.

How is this diagnosis made?

The diagnosis of a hyperplastic tonsil is typically made by a doctor during a physical examination. If your tonsils appear larger than normal or you are experiencing symptoms such as difficulty swallowing, your doctor may recommend further evaluation. In some cases, a sample of the tonsil tissue may be removed during a procedure called a tonsillectomy. This tissue is then sent to a pathologist for examination under a microscope, where the diagnosis can be confirmed.

What are the microscopic features of a hyperplastic tonsil?

Under the microscope, a hyperplastic tonsil shows an increase in the number of lymphocytes, a type of white blood cell. These lymphocytes are organized into structures called follicles, which may appear larger and more numerous than normal. The increased lymphoid tissue is often described as reactive lymphoid hyperplasia, a benign (non-cancerous) condition where the immune system responds to repeated infections or inflammation. The squamous cells in the epithelium on the surface of the tonsil may also show signs of mild inflammation. Importantly, a hyperplastic tonsil does not show any signs of cancerous growth.

This image shows a hyperplastic tonsil examined at low power under the microscope.
This image shows a hyperplastic tonsil examined at low power under the microscope.
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