Tonsillar Size in 2-to 14-Year-Old Children With and Without Snoring

Background: Few investigations have assessed tonsillar size in children of variable age, sleep-disordered breathing (SDB) status and degree of adiposity. This study evaluated the size of tonsils in young and older, lean and obese children, without or with snoring. Methods: Children attending the Emergency Department or Pulmonology Clinic were recruited and tonsillar size was scored 1-4. Snoring >= 1 night/week was considered diagnostic of SDB and body mass index z-score >= 1.645 was defined as obesity. Age was analyzed as dichotomous variable (7 years old). Results: 362 children (2-14 years old) were recruited; 78 (21.5 %) were obese and 108 (29.8 %) had SDB. SDB-but not age or obesity-was significantly related to tonsillar size (P = 0.001). There was not enough evidence to support the presence of interactions between SDB and age or obesity regarding the size of tonsils (P = 0.157 and P = 0.978, respectively). Young subjects without SDB had larger tonsils than older subjects without SDB (1.9 +/- 0.7 vs. 1.7 +/- 0.8; P = 0.017), whereas age did not affect tonsillar size in children with SDB (P = 0.78). Conclusions: Young and older children with SDB have similar tonsillar size. In contrast, older subjects without snoring have smaller tonsils than young subjects without snoring. Tonsillar enlargement in children with SDB probably occurs in early childhood without change in older age. Pediatr Pulmonol. 2009; 44:1216-1222. (C) 2009 Wiley-Liss, Inc