Related Experiment Video
Updated: Jul 6, 2026

CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
The frequency of lingual tonsil enlargement in obese children
Carolina V A Guimaraes1, Maninder Kalra, Lane F Donnelly
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039, USA.
Insights
Obese children frequently have enlarged lingual tonsils, especially after tonsillectomy. This finding suggests enlarged lingual tonsils may contribute to obstructive sleep apnea in this population.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Radiology
Background:
- Enlargement of lingual tonsils is an emerging cause of obstructive sleep apnea (OSA).
- Obesity is a known risk factor for OSA.
- The prevalence of enlarged lingual tonsils in obese children is not well-established.
Purpose of the Study:
- To evaluate the frequency of enlarged lingual tonsils in obese children.
- To compare lingual tonsil size in obese children with and without a history of tonsillectomy.
Main Methods:
- Seventy-one obese children underwent MRI to measure lingual tonsil size.
- Lingual tonsils > 10 mm were considered markedly enlarged.
- Comparison between children with and without prior palatine tonsillectomy.
Main Results:
- 62% of obese children had measurable lingual tonsils, a higher rate than previously reported.
- 14% had markedly enlarged lingual tonsils (> 10 mm).
- Children with prior tonsillectomy showed a significantly higher prevalence of enlarged lingual tonsils (78% vs. 22%) and markedly enlarged tonsils (90% vs. 10%).
Conclusions:
- Obese children exhibit a high frequency of lingual tonsil enlargement.
- Previous tonsillectomy is associated with a significantly higher prevalence of enlarged lingual tonsils in obese children.
- Enlarged lingual tonsils may contribute to the development of obstructive sleep apnea in obese children.
Objective:
Enlargement of the lingual tonsils is being increasingly recognized as a not uncommon and treatable cause of obstructive sleep apnea, particularly in patients with Down syndrome who have undergone palatine tonsillectomy and adenoidectomy. We have recognized an increasing number of patients who are obese and have obstructive sleep apnea with enlarged lingual tonsils. The purpose of this study was to evaluate the frequency of enlarged lingual tonsils in obese children.
Subjects And Methods:
Seventy-one obese children (mean body mass index = 41.6 kg/m(2)) underwent sagittal fast spin-echo inversion recovery imaging. Lingual tonsils were identified and measured in the greatest anteroposterior diameter. Lingual tonsils > 10 mm were considered markedly enlarged. The subgroup with absent palatine tonsils (previous tonsillectomy) (n = 41) were compared with those with palatine tonsils present (n = 30).
Results:
Forty-four (62%) of the obese children had measurable lingual tonsils, which is greater than the frequency previously reported in normal subjects (0%), subjects with obstructive sleep apnea (33%), or subjects with Down syndrome and obstructive sleep apnea (50%). Ten (14%) had lingual tonsils > 10 mm. Obese subjects with absent palatine tonsils (previous tonsillectomy) had a higher prevalence of measurable lingual tonsils than those with palatine tonsils (78% vs 22%, respectively; p < 0.001) and a higher prevalence of lingual tonsils > 10 mm (90% vs 10%, p < 0.001).
Conclusion:
Obese children have a high frequency of enlargement of the lingual tonsils with a significantly higher prevalence in those with previous tonsillectomy. Enlarged lingual tonsils may play a role in the pathogenesis of obstructive sleep apnea in obese children.
Related Concept Videos
Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
Obesity
Tonsillitis II: Management
Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
Drug Dosing: Obese Patients

