Enlargement/inflammation of nasopharyngeal tonsil. Common in small children.

Clinical features

May be due to enlargement, inflammation, or both

  • Obstruction of the nose leading to mouth breathing, difficulty eating, snoring, jaw deformities
  • Obstruction of Eustachian tube leading to hearing loss, which fluctuates due to fluid in middle ear (”Glue ear”)
  • Recurrent otitis
  • Discharge from the nose
  • Recurrent cough
  • Physical and other developmental retardation, e.g. small size for age


  • Diagnosis is usually based on history
  • X-ray for neck soft tissue: lateral view shows narrowing of the post-nasal space

Differential diagnosis

  • Other causes of nasal obstruction and discharge, e.g, rhinitis, FB, deviated septum, sinusitis
  • Dental and jaw diseases or abnormalities


Mild (If symptoms are not marked)

  • Give conservative treatment with chlorpheniramine 1-2 mg daily (depending on
    age) for 7 days
  • Topical nasal steroids if available

Moderate and Severe (If symptoms are marked or do not improve on treatment)

  • Refer to ENT surgeon for surgery