Lingual tonsil hyperplasia is a rare condition that may cause obstructive sleep apnea (OSA). In the management of OSA, the lingual tonsils should be evaluated during the otorhinolaryngologic examination. We report the case of a 66-year-old man with findings of upper airway obstruction secondary to excessive lingual and palatine tonsil hyperplasia and with MRI findings of bilateral cervical lymphadenopathy. We review the clinical, radiologic, and histopathologic aspects of this case, and we discuss the surgical options for treating massive reactive lymphoid hyperplasia in conjunction with OSA. © 2011, Vendome Group, LLC.