Can Ultrasound Elastography Be Used as an Objective Measure in Tonsillectomy Indications?

Objectives: The objective of this study was to evaluate the diagnostic performance of the strain ratio (SR) and shear wave elastography (SWE) in distinguishing normal tonsils from those affected by adenotonsillar hypertrophy (ATH) and chronic tonsillitis (CT), and to assess their correlation and clinical applicability. Methods: This study consisted of 96 participants, which included 31 controls, 55 with ATH, and 10 with CT. The SR was measured, and SWE was performed bilaterally. After Shapiro-Wilk testing confirmed non-normality, groups were compared with the Kruskal-Wallis test and Dunn-Bonferroni post hoc analysis; differences in sex distribution were determined with the chi-square test; and the SR-SWE correlation was assessed with Spearman's coefficient. Diagnostic accuracy was assessed via ROC analysis (AUC, sensitivity, and specificity). Results: SWE and submandibular gland-based SR values were consistently higher in the ATH and CT groups than in controls, whereas the tongue-based SR showed less consistent differences. SWE achieved excellent diagnostic accuracy (AUC = 0.918 right, 0.892 left), outperforming the SR (highest AUC = 0.844). SWE achieved the highest sensitivity, and right-sided SWE achieved the highest specificity. SWE results correlated positively with the submandibular gland-based SR, whereas the tongue-based SR showed no consistent correlation. No sex-related differences were found (p = 0.587). Conclusions: Elastography effectively differentiates normal from pathological tonsillar tissue, with SWE providing superior diagnostic accuracy. As a non-invasive adjunct to conventional ultrasonography, SWE may help assess tonsillar disease severity, guide clinical management, and avoid unnecessary surgery.