Can Tonsil or Adenoid Removal Help Adults with Obstructive Sleep Apnea (OSA)?

Quick Takeaways

• Enlarged tonsils or adenoids can narrow the airway, contributing
  to obstructive sleep apnea (OSA) symptoms in some
  adults.²
• In some cases, tonsil and adenoid removal (T&A) may help
  reduce OSA symptoms, especially in adults with large tonsils and mild to
  moderate OSA.¹⁹
• CPAP therapy remains the most effective treatment for
  OSA,²⁶ but surgery may help improve comfort or results when
  combined with CPAP.
• Surgery outcomes vary by body structure, age and overall health,
  so it’s important to discuss benefits, risks and recovery expectations
  with your doctor.^{38, 43, 44, 45}

Obstructive sleep apnea (OSA) is a condition where your upper airway
becomes blocked repeatedly during sleep, making it harder for air to
flow. These blockages can reduce or completely stop the flow of air,
causing your breathing to pause throughout the night.¹ In
some cases, these pauses can happen when large tonsils and adenoids
block the airway.²

If you’re looking for a way to manage your OSA symptoms, your doctor
may discuss treatment options such as a tonsillectomy/adenoidectomy
(T&A). For some adults, removing enlarged tonsils or adenoids may
make breathing easier during sleep.

Learn more about adenoid and tonsil removal for obstructive sleep
apnea before you schedule a surgical consultation.

Understanding the role of tonsils, adenoids and obstructive sleep apnea in adults

The structure and function of your airway may influence your risk for
obstructive sleep apnea (OSA). If you’re living with OSA, it can be
helpful to understand what tonsils and adenoids are and how they might
be contributing to your symptoms.

Body structure and airway function

Your tonsils and adenoids are part of your immune system. Tonsils,
which sit at the back of the throat, produce immune cells and help
filter bacteria and viruses.³ Adenoids are higher in your
throat, just behind your nose. They help filter out organisms that can
cause infections.⁴

Because of where they’re located, enlarged tonsils or adenoids may
narrow the airway, which can make it harder to breathe comfortably
during sleep and contribute to OSA symptoms in some
people.²

Airway structure can also affect the way tonsil or adenoid surgery
affects OSA. A tonsillectomy may be more appropriate for people who have
larger tonsils. When tonsils are noticeably enlarged, there’s more
tissue to remove. Removing additional tissue may help open the airway
and ease breathing during sleep in some people with obstructive sleep
apnea.

The same principle applies to the adenoids. Larger adenoids may be
linked to more noticeable OSA symptoms.⁷ Therefore, surgery
might work better in people who have higher tissue volumes.

Health care professionals use the Brodsky tonsillar hypertrophy scale
to assess tonsil size and understand how it might relate to obstructive
sleep apnea symptoms. The Brodsky scale ranges from 0 to 4. A grade of 4
indicates that the tonsils take up more than 75% of the middle part of
your throat.⁸

The term ‘apnea’ means that you stop breathing for at least 10
seconds. ‘Hypopnea’ is when you have a partial blockage of your airway,
so your breath is more shallow than normal.¹ An a t-home
sleep test or in-lab sleep study can provide your apnea-hypopnea index
(AHI), which tells you how many apneas and hypopneas you have per hour
while you sleep and gives you an average.

How common are enlarged tonsils/adenoids in adults with OSA?

Researchers haven’t determined exactly how many adults have both OSA
and enlarged tonsils. However, studies suggest that enlarged tonsils may
be linked to a higher likelihood of OSA. According to the American
Thoracic Society, enlarged tonsils are considered a risk factor for
OSA.¹¹ Adenoid enlargement is relatively uncommon in adults,
but when it occurs, it can partially block the airway during
sleep.¹² This may also contribute to OSA symptoms.

Obesity and tonsil/adenoid enlargement may both contribute to airway
narrowing. If you have large tonsils or adenoids, they can physically
block your airway. For people with excess weight or obesity, extra fat
around the neck, tongue and soft palate may further reduce space in the
airway.¹³ Together, these conditions may increase the
likelihood of airway narrowing during sleep, which can make breathing
more difficult.

Enlarged tonsils may have a greater impact if you have certain
features. For example, if you have a large tongue, it may press against
your tonsils. This makes the airway even narrower. Another example is
having a longer soft palate that may vibrate during sleep, increasing
the severity of snoring.¹⁴

The size of your tonsils might also be more significant if you have
obstructive sleep apnea with any of the following:⁴⁶

• Narrow lower jaw
• Narrow hard palate
• Nasal obstruction

How doctors evaluate if surgery might help

One of the first steps to finding the right treatment is to undergo a
sleep study. Home sleep tests (HSTs) are devices that you take home and
use while sleeping in the comfort of your own bed. They monitor your
body while you sleep and share valuable information back to your doctor
about your sleeping behavior.

A polysomnography (PSG), or in-lab sleep study, is conducted overnight
in a lab, where a technician can monitor your sleep.¹ A PSG
records important information like brain waves, blood oxygen levels,
heart rate, breath rate and eye and leg movements to help diagnose sleep
disorders. Your doctor may recommend a PSG if you have a more complex
medical history and may benefit from comprehensive sleep monitoring. If
you were diagnosed with obstructive sleep apnea (OSA) years ago, your
doctor may recommend that you get a new sleep study. This can help your
doctor better understand your current needs and adjust your treatment
plan accordingly.

While a sleep study can help your doctor determine if you have OSA,
it is useful to have a physical exam to see if enlarged tonsils/adenoids
are contributing to your OSA.

Due to their location, adenoids aren’t as easy to see. To assess
them, your doctor may ask to insert a camera into your nose. The camera
is attached to a thin, flexible tube.¹⁶ You might feel some
mild discomfort, but most people don’t find it painful.

Your doctor may also recommend imaging tests or drug-induced sleep
endoscopy (DISE). Several types of imaging, including CT scans, X-rays
and MRIs, can help your doctor assess the airway and understand whether
enlarged tonsils or adenoids may be contributing to breathing
issues.¹⁷

DISE involves checking your upper airway under conditions that mimic
natural sleep.¹⁸ Before the procedure begins, you’ll receive
medicine to help you feel sleepy and relaxed. Then, a health care
provider will use a thin, flexible tube with a lighted camera to look
inside your airway. DISE can help a doctor observe how your airways
behave during sleep, which may reveal problems that aren’t apparent when
you’re fully awake.

Do tonsillectomy and adenoidectomy work for adults with obstructive sleep apnea?

Tonsillectomy and adenoidectomy may be considered potential treatment
options for some people with obstructive sleep apnea (OSA). In one
study, researchers found that participants who underwent tonsillectomy
experienced a reduction in their apnea-hypopnea index (AHI)
scores.¹⁹ On average, OSA severity decreased from moderate to
mild among the study participants.

Surgery results in adults

Research suggests the success rate for people who have
tonsillectomies to treat their OSA or snoring is 47.6%.²⁰

However, tonsillectomy and adenoidectomy might improve a person’s
quality of life. In one study, more than 90% of participants said
treatment improved energy levels, general health and
well-being.²³

Who benefits most from surgery?

People with larger tonsils may see more improvement from
tonsillectomy than people with smaller tonsils. ⁴⁷ This is
because larger tonsils may block the airway and make obstructive sleep
apnea (OSA) symptoms more noticeable. For people with obesity, removing
excess tissue from the airway may help improve airflow during sleep.

Tonsillectomy is generally considered safe for adults.²⁴
Older adults may experience a slower recovery due to other health
conditions. ²⁵ However, surgery for older adults should be
considered carefully by weighing the benefits and risks.

The severity of OSA may also play a role in determining if surgery is
the right approach. Some research suggests that tonsillectomy is most
effective among people with mild or moderate OSA.¹⁹ If you’ve
been diagnosed with severe obstructive sleep apnea, your doctor can help
determine whether surgery is appropriate as part of your overall
treatment plan.

Comparing surgery to other treatments

Continuous positive airway pressure (CPAP) is highly effective and
the most used and understood method for treating OSA.²⁶ It’s
also a drug-free obstructive sleep apnea treatment with no
medication-related side effects. When used as directed, it can help
alleviate some of your OSA symptoms.^27,28

If you have enlarged tonsils or adenoids, your doctor may suggest
combining surgery with CPAP therapy. In some cases, other procedures
other than tonsillectomy and/or adenoidectomy may be considered. For
example, uvulopalatopharyngoplasty (UPPP) may be an option if your soft
palate is contributing to your obstructive sleep apnea.²⁹
Your doctor can help determine which approach may be most appropriate
based on your airway structure and overall health.

Tongue-based procedures may be considered if your tongue blocks your
airway during sleep. Examples of tongue-based procedures include
radiofrequency ablation, genioglossus advancement and hypoglossal nerve
stimulation.^30,31,32 These procedures target different
aspects of the airway, so it’s important to talk with your doctor about
whether any of these options might be right for you.

Long-term results

According to researchers, in adults with OSA, tonsillectomy has been
shown to lead to long-term improvement in about 38.5% of
cases.³³ However, OSA symptoms can return over time.

For example, if your body mass index increases, OSA symptoms may
reappear — even without extra tonsil or adenoid tissue to block your
airway.⁴⁹ If you have any of the airway differences mentioned
above, you may require other treatments to keep obstructive sleep apnea
symptoms at bay.

Practical considerations for adults thinking about surgery

If surgery is an option, it’s helpful to understand what happens
during the procedure and what you can expect during recovery. Like all
surgeries, tonsillectomy and adenoidectomy have some risks.

What happens during surgery

What happens during your procedure depends on which method the
surgeon uses. Some surgeons use traditional techniques, while others use
an intracapsular approach.³⁴ The traditional method involves
removing the entire tonsil, including the thin covering (capsule) that
separates it from the muscles in your throat. With the intracapsular
method, the surgeon removes the tonsil while leaving the capsule in
place.

In some cases, it’s possible to combine tonsillectomy/adenoidectomy
with other procedures. For example, you might undergo a tonsillectomy
and a tongue reduction at the same time.³⁷ Combining
procedures has some risks, so it’s a good idea to discuss safety
considerations with your doctor.

Recovery and possible risks

Your surgeon may recommend resting for 1 to 2 weeks after a
tonsillectomy.³⁸ However, the recovery process is personal
and can vary from person to person. You might need a little extra time
to return to your normal activities.

It’s common to experience some pain after the procedure. Your surgeon
may prescribe pain relievers or direct you to take over-the-counter
medications.³⁹ For example, some doctors recommend
alternating ibuprofen with acetaminophen.

Although tonsillectomy is a common procedure, there are some
potential risks:⁴¹

• Bleeding

• Voice changes⁴²

• Temporary swallowing difficulties⁴²

Some people also have throat pain and problems with the jaw, mouth,
or teeth. In some cases, these problems may persist for more than six
months after surgery.⁴² If you have long-term complications,
contact your surgeon.

Making the decision

If surgery is being considered, here are some questions to ask your
doctor:

• What type of procedure do you recommend? Why?
• What will happen if I don’t have surgery?
• What are the risks?
• What is the recovery process like?

It’s also helpful to set realistic expectations for improvement.
There may be some swelling and bleeding after your surgery. This can
disrupt your sleep and make it difficult to determine if the surgery is
helping you manage your OSA symptoms.

Surgery has risks and can be considered an expensive option for some
people. Therefore, it might be a good idea to consider other,
non-surgical treatments first. CPAP therapy continues to be the standard
treatment for OSA. Losing weight, changing your sleep position and
making other lifestyle changes may also help you manage obstructive
sleep apnea symptoms.⁴³

Special considerations for higher-risk adults

For people living with severe obesity, you may have a higher risk of
complications during surgery.⁴⁴ Your doctor might recommend a
pre-surgery checkup to determine whether surgery is a safe option. This
evaluation can help your surgical team take extra measures to protect
you.⁴⁵

You may need additional care if you’re an older adult, have unique
facial or airway structures, or experience airway obstruction in more
than one area. In some cases, your surgeon may recommend combining
procedures to address blockages in different parts of the throat.

Although continuous positive airway pressure (CPAP) therapy remains
the standard treatment for OSA, your doctor may recommend surgery if
CPAP treatment alone isn’t achieving the desired results. Surgery may
also be an option for people who have blockages caused by differences in
airway structure. Removing these blockages may help reduce obstructive
sleep apnea symptoms.

Looking to dive deeper into your health and learn more about your
sleep? Take a quick sleep assessment today.

References:

1. Source: Slowik, J.M., Sankari, A., & Collen, J.F. 2025, March 4. Obstructive sleep apnea. StatPearls Internet. https://www.ncbi.nlm.nih.gov/books/NBK459252/
2. Source: https://onlinelibrary.wiley.com/doi/epdf/10.1002/lary.25931
3. Source: National Library of Medicine. 2022, November 30. In brief: How do the tonsils work? InformedHealth.org Internet. https://www.ncbi.nlm.nih.gov/books/NBK279406/
4. Source: Agency for Healthcare Research and Quality. n.d.. Adenoids. https://effectivehealthcare.ahrq.gov/health-topics/adenoids
5. Source: Segal, Y., Malhotra, A., & Pillar, G. 2008. Upper airway length may be associated with the severity of obstructive sleep apnea syndrome. Sleep Breath., 124: 311-316. https://pubmed.ncbi.nlm.nih.gov/18516636/
6. Source: Matarredona-Quiles, S., Carrasco-Llatas, M., et al. 2022, November-December. Is there a relationship between tonsil volume and the success of pharyngeal surgery among adults with obstructive sleep apnea? Brazilian Journal of Otorhinolaryngology, 885: S156-S161.
7. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC12597206/
8. Source: Lv, C., Yang, L., et al. 2023. Role of the tonsil-oropharynx on lateral cephalograms in assessing tonsillar hypertrophy in children seeking orthodontic treatment. BMC Oral Health, 231. https://www.researchgate.net/publication/375454935_Role_of_the_tonsil-oropharynx_ratio_on_lateral_cephalograms_in_assessing_tonsillar_hypertrophy_in_children_seeking_orthodontic_treatment
9. Source: Jara, SM., & Weaver, E.M. 2018, April. Association of palatine tonsil size and obstructive sleep apnea in adults. Laryngoscope, 1284: 1002-1006.
10. Source: Johns Hopkins Medicine. n.d.. What is obstructive sleep apnea? https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea
11. Source: American Thoracic Society. 2024, February. What is obstructive sleep apnea in adults? https://site.thoracic.org/advocacy-patients/patient-resources/what-is-obstructive-sleep-apnea-in-adults
12. Source: Rout, M.R., Mohanty, D., et al. 2013.Adenoid hypertrophy in adults: A case Series. Indian J Otolaryngol Head Neck Surg., 653: 269-74.
13. Source: Godoy, I.R., Martinez-Salazar, E.L., et al. 2016. Fat accumulation in the tongue is associated with male gender, abnormal upper airway patency and whole-body adiposity. Metabolism, 6511: 1657-1663. https://pmc.ncbi.nlm.nih.gov/articles/PMC5367267/
14. Source: Beigh, Z., Khursheed, R.S., et al. 2014. Management of palatal snoring, Z palatoplasty and uvulopalatopharyngoplasty. Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 153: 211-214.
15. Source: Rundo, J.V., &, Downey R. III. 2019. Polysomnography. Handb Clin Neurol.. 160: 381-392. https://pubmed.ncbi.nlm.nih.gov/31277862/
16. Source: Johns Hopkins University. n.d.. Nasal endoscopy. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nasal-endoscopy
17. Source: Lavalle, S., Caranti, A., et al. 2025. The impact of diagnostic imaging on obstructive sleep apnea: feedback from a narrative review. Diagnostics Basel, 153: 238.
18. Source: Carrasco-Llatas, M., Matarredona-Quiles S., et al. Drug-induced sleep endoscopy: technique, indications, tips and pitfalls. Healthcare Basel. 73: 93.
19. Source: Makkonen, J., Blomster, H., et al. 2025. Adult obstructive sleep apnea treated with tonsillectomy: A randomized controlled clinical trial. Acta Otolaryngol., 14510: 989-996.
20. Source: Sjöblom, H.M., Nahkuri, M., et al. 2022. Treatment of sleep apnoea with tonsillectomy: A retrospective analysis using long-term follow-up data. Eur Arch Otorhinolaryngol., 2797: 3727-3732.
21. Source: Camacho, M., Li, D., et al. 2016. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope, 1269: 2176-86.
22. Source: American Thoracic Society. 2022, November. Epworth sleepiness scale ESS. https://site.thoracic.org/assemblies/srn/sleep-related-questionnaires/ess
23. Source: Nikakhlagh, S., Rahim F., et al. 2012. The effect of adenotonsillectomy on quality of life in adults and pediatric patients. Indian J Otolaryngol Head Neck Surg., 642: 181-3.
24. Source: Chen, M.M., Roman, S.A., et al. 2014. Safety of adult tonsillectomy: A population-level analysis of 5968 patients. JAMA Otolaryngol Head Neck Surg., 1403: 197-202.
25. Source: Dualeh, S.H.A., & Suwanabol, P.A. 2024, February 28. Anticipating needs among older adults after major surgery: A focus on 30- and 180-day hospital readmissions. JAMA Netw Open, 72. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815565
26. Source: Division of Sleep Medicine at Harvard Medical School. 2021, April 16. Understanding PAP. https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-37
27. Source: Djonlagic, I., Guo, M., et al. 2015. First night of CPAP: Impact on memory consolidation attention and subjective experience. Sleep Med., 166: 697-702.
28. Source: Summer, J.V. 2024. Before and after CPAP machine effects: How your body changes. Sleep Foundation. https://www.sleepfoundation.org/cpap/before-and-after-cpap-machine-body-changes
29. Source: Surgical Algorithm for Obstructive Sleep Apnea: An Update, 2020. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7435437/
30. Source: American Academy of Otolaryngology-Head and Neck Surgery. 2014, July 31. Position statement: Submucosal ablation of the tongue base for OSAS. https://www.entnet.org/resource/position-statement-submucosal-ablation-of-the-tongue-base-for-osas/
31. Source: Emanuelli, E., O’Connor, M.K., & Garg, R.K. 2023. Genioglossus advancement: Technique modification for improved chin contour. Plast Reconstr Surg Glob Open, 113: e4846.
32. Source: Olson, M.D., & Junna, MR. 2021. Hypoglossal nerve stimulation therapy for the treatment of obstructive sleep apnea. Neurotherapeutics, 181: 91-99.
33. Source: Knubb, J., Sjöblom, H.M., et al. 2024. Long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults. Acta Otolaryngol., 14411-12: 646-651.
34. Source: Mesolella, M., Allosso, S., et al. 2023. Extracapsular tonsillectomy versus intracapsular tonsillotomy in paediatric patients with OSAS. J Pers Med., 135: 806.
35. Source: Harrison, N. 2025, March 27. Coblation adenoidectomy and intracapsular tonsillectomy. NHS Hull University Teaching Hospitals. https://www.hey.nhs.uk/patient-leaflet/coblation-adenoidectomy-and-intracapsular-tonsillectomy/
36. Source: Carvalho, B., Hsia, J., et al. 2012. Surgical therapy of obstructive sleep apnea: a review. Neurotherapeutics., 94: 710-716.
37. Source: Ulualp, S. 2019. Outcomes of tongue base reduction and lingual tonsillectomy for residual pediatric obstructive sleep apnea after adenotonsillectomy. Int Arch Otorhinolaryngol., 234: e415-e421.
38. Source: Otolaryngology Associates of Tennessee. 2024, November 11. Tonsillectomy recovery: What to expect and how to prepare. https://www.oatenn.com/blog-posts/2024/11/11/tonsillectomy-recovery-what-to-expect-and-how-to-prepare
39. Source: Jensen, D.R. 2021. Pharmacologic management of post-tonsillectomy pain in children. World J Otorhinolaryngol Head Neck Surg., 29;73: 186-193.
40. Source: UMMC Health Care. n.d.. Home care for tonsillectomy and adenoidectomy-adult. https://umc.edu/Healthcare/ENT/Patient-Handouts/Adult/Adenoids_tonsils/Tonsil_Adenoidectomy_Adult.html
41. Source: Urík, M., Bartoš, M., et al. 2021. Risk factors for postoperative bleeding after adenoidectomy. Children Basel, 83: 242.
42. Source: Odhagen, E., Alm, F., et al. 2023. Long-term complications after tonsil surgery: An analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery. Front Surg., 1210: 1304471.
43. Source: National Heart, Lung, and Blood Institute. 2025, January 9. Sleep apnea – treatment. https://www.nhlbi.nih.gov/health/sleep-apnea/treatment
44. Source: Ri, M., Aikou, S., & Seto, Y. 2017. Obesity as a surgical risk factor. Ann Gastroenterol Surg., 28;21: 13-21.
45. Source: King, M.S. 2000. Preoperative evaluation. Am Fam Physician, 622: 387-396.
46. Source: Iber, C., et al. & Collaborators. 2019. Surgical therapy of obstructive sleep apnea: tonsil grading and outcomes. Sleep Medicine, 64, 1-8. https://www.sciencedirect.com/science/article/abs/pii/S107387461930057X
47. Source: Arabi Mianroodi, A., Barzegar, S., Dehghani, A., Amini, H., Rahmani, M., & Samadi, R. 2016. Effects of tonsil size on pulmonary function test results after tonsillectomy in children. Iran Journal of Otorhinolaryngology, 2884, 61–66. https://pmc.ncbi.nlm.nih.gov/articles/PMC4735618/
48. Source: https://publications.ersnet.org/content/errev/16/106/132
49. Source: Wei, X., et al. 2025. Recurrence of Obstructive Sleep Apnea in Post-adenotonsillectomy Obese Pediatric Patients: A Systematic Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC12184734/