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What Is Tonsil Grading?

Tonsil grading is a special technique that determines how inflated your tonsils are just by looking at their size. This is usually done by a medic but you can also do it yourself, at home, in front of a mirror with good lighting. All you have to do is to know how many stages of inflated tonsils are there. Doctors use tonsil grading in order to determine the severity of your sickness. The technique is extremely easy and you can even do it yourself or ask a friend to take a look.

Adenotonsillar enlargement is the major etiologic factor of obstructive sleep apnea. The American Academy of Pediatrics recommends adenotonsillectomy as the first-line treatment for most pediatric obstructive sleep apnea. Although this is well accepted, there is no specific definition of what constitutes larger-than-normal tonsils. Part of the difficulty is that there is a complex and dynamic interaction among other airway variables, and there is no absolute cutoff for larger than normal size. Another problem is the lack of a reliable, and valid grading system. This is particularly relevant for purposes of research that necessitates reproducible assessment of the size of the tonsils.

For tonsillar size, several grading systems have been adopted in previous studies. Among them, the most well-known grading scale was proposed by Brodsky. On the Brodsky grading scale, the size of the tonsils is categorized as 1 of 5 grades based on the percentage of oropharyngeal airway occupied by the 2 tonsils. The oropharyngeal airway is denoted by the linear distance between the 2 anterior tonsillar pillars. Despite its popularity, the reproducibility of such a grading scale has not been assessed yet.

The stages of tonsil grading

Tonsil grading has four categories. The first one is the normal one, which shows no sign of inflammation. This means that you do not see tonsils because they are hidden within the pillars. In the second category, you can see a bit of tonsils because they extend to the pillars. In the third stage, they are swollen and you can easily see them because they have passed the pillars. The fourth stage is the worst because you can’t see anything else besides tonsils, since they extend to midline. This stage usually shows danger because they can leave to room for air and the patient can die from asphyxiation. Some doctors consider that there is a stage zero, in the cases of surgically removed tonsils. In this case, you have nothing to worry about.

Enlarged tonsils can be a problem or a temporary result of an infection. Your tonsils are part of your immune system, so they get bigger as your body fights the illnesses. Healthcare professionals aren't exactly sure what causes chronically enlarged tonsils, but secondhand smoke and air pollution can make them larger. If your child's tonsils are very large, they may snore really loud, called "heroic snoring," or have trouble swallowing certain foods.

Some kids with enlarged tonsils have obstructive sleep apnea, where they stop breathing for a few seconds and then snort loudly to start breathing again. This is because the tonsils partially block the airway. A test done overnight in the hospital called a sleep study can help determine if someone has sleep apnea. Sometimes, a child with sleep apnea may need to wear a special mask at night that helps with breathing.

Remember, enlarged tonsils are very common. Treatment depends on the size of the tonsils and whether or not they interfere with eating, sleeping, or breathing. This is why it is much better to consult a doctor, although you can look for yourself and have an idea about the severity of the sickness.