Tonsillectomy and biopsy for asymptomatic asymmetric tonsillar enlargement: are we right?

Objective: The aim of this study was to evaluate the incidence of malignancy in patients with clinically asymmetrical tonsils and who are otherwise asymptomatic.

Design: Retrospective review of our experience based on case note review, carried out in a district general hospital setting during a period of two years.

Material and methods: 142 patients who had undergone tonsillectomy and biosy were included in the study. Histological studies of all these patients obtained and correlated with the clinical findings.

Results: None of the patients with asymmetric enlargement of tonsils but are otherwise asymptomatic had shown histological evidence of malignancy. However all the 3 patients with associated suspicious symptoms in the presence of asymmetric tonsils were diagnosed as having tonsillar malignancy.

Conclusion: Tonsillar asymmetry in the absence of other associated risk factors may not indicate malignancy and a period of watchful waiting is considered appropriate prior to any surgical intervention.