<P> Tonsils can become enlarged (adenotonsillar hyperplasia) or inflamed (tonsillitis) and may require surgical removal (tonsillectomy). This may be indicated if they obstruct the airway or interfere with swallowing, or in patients with frequent recurrent tonsillitis . However, different mechanisms of pathogenesis for these two subtypes of tonsillar hypertrophy have been described, and may have different responses to identical therapeutic efforts . In older patients, asymmetric tonsils (also known as asymmetric tonsil hypertrophy) may be an indicator of virally infected tonsils, or tumors such as lymphoma or squamous cell carcinoma . </P> <P> Tonsillitis is a disorder in which the tonsils are inflamed (sore and swollen). The most common way to treat it is with anti-inflammatory drugs such as ibuprofen, or if bacterial in origin, antibiotics, e.g. amoxicillin and azithromycin . Often severe and / or recurrent tonsillitis is treated by tonsillectomy . </P> <P> A tonsillolith is material that accumulates on the tonsil . They can range up to the size of a peppercorn and are white / cream in color . The main substance is mostly calcium, but they have a strong unpleasant odor because of hydrogen sulfide and methyl mercaptan and other chemicals . </P> <P> Tonsil enlargement can affect speech, making it hypernasal and giving it the sound of velopharyngeal incompetence (when space in the mouth is not fully separated from the nose's air space). Tonsil size may have a more significant impact on upper airway obstruction for obese children than for those of average weight . </P>

Are the largest tonsils and the type that get most often infected