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Tonsils–what every SLP should know

Tonsils are often overlooked, often undiagnosed, often troublesome part of the human body.  A visual look at a patient’s tonsils should be included in all oral mechanism evaluations done by speech therapists because enlarged tonsils can cause a variety of speech-related issues such as unintelligible speech, uncontrollable drooling, restless sleeping, or untimely eating. Tonsils are located above the “throat” where the trachea leads to your lungs and your esophagus to your stomach.  The tonsils hang out way in the back of the mouth, one positioned on each side of the uvula, which hangs in the “middle” and back part of your mouth. Tonsils are supposed to be minimally visible when a mouth is opened widely and the tongue is down (think–say “ahhhh”), but they do swell with infection and contact to germs because it’s their job to stop the germs from getting further into the body.  

Small children are highly susceptible to daily contact with germs and their immune systems are still building –leading to frequently enlarged tonsils. What makes them even more of a nuisance for children is that there is very little “extra room” in their smaller oral cavity, so when tonsils become enlarged they take up room needed for breathing, speaking, and eating. The size of the tonsils is given a rating scale from 1-5 with 1 being normal and minimally visible and 5 being that the tonsils are “kissing” or touching each other in the middle of the back of the throat.  A speech pathologist or pediatric ENT will be able to provide an approximate “rating scale” from 1-5 after they see a visual of the tonsils. For children old enough to follow directions, “open and say aaahhh” may be enough to get a peek.

For children who are too young, too distractible, or find it difficult to sit still, allow others near their mouths, or follow directions, it may take a few “tricks” to obtain a visual. One trick speech therapists can use to visualize a patient’s tonsils is to use a supine view. Have the patient lie on their back with the therapist positioned over them, face-to-face, while they attempt to have a child imitate silly faces, lick a lollipop, or make funny noises. Also, sometimes when children are crying or protesting loudly, their mouths are often wide enough to visualize the tonsils.  The use of a mirror can also be beneficial in obtaining client interest and proper visualization.

If a child has enlarged/swollen tonsils, there can be speech therapy-related complications such as nasal sounding speech (like you’re talking with a plugged nose), hoarse sounding voice, excessive spittle/saliva, drooling, slurring or jumbling words, snoring, restless sleeping, fatigue, open mouth breathing, extended time eating, and more. If a child has frequent bouts of strep, sore throat, respiratory illness, or nasal infections and/or they are chronic snorers, droolers, take a long time to eat, have nasalized speech, or their articulation is “garbled”, the tonsils might be to blame! Make sure your next oral mechanism evaluation includes a glimpse at the precocious tonsils!

Author: Sarah Cicconetti