Is unilateral tonsillar enlargement alone an indication for tonsillectomy?

Area of Science:

• Otolaryngology
• Surgical Pathology
• Oncology

Background:

• Unilateral tonsillar enlargement (UTE) is a common clinical finding.
• Tonsillectomy is often performed to rule out malignancy in patients with UTE.
• The necessity of tonsillectomy for UTE requires further investigation.

Purpose of the Study:

• To determine the necessity of tonsillectomy for unilateral tonsillar enlargement.
• To analyze the rate of malignancy in patients with UTE alone versus UTE with associated clinical features.

Main Methods:

• Retrospective case-note review of tonsillectomies performed for histological examination over a five-year period.
• Analysis of histological findings in 53 patients with UTE, categorized into UTE alone and UTE with other clinical features.
• Fisher's exact test used to compare malignancy rates between groups.

Main Results:

• Of 53 patients with UTE, 33 had UTE alone and 20 had associated clinical features.
• No malignancy was found in the UTE alone group (0%).
• Malignancy was detected in 9 out of 20 patients (45%) with UTE and associated clinical features (p<0.001).

Conclusions:

• The prevalence of malignancy in tonsils with UTE and no other clinical features is very low.
• A 'watch and wait' policy is recommended initially for UTE without other symptoms.
• Tonsillectomy should be considered if symptoms or signs progress.