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Unilateral tonsil enlargement in children and adults: is routine histology tonsillectomy warranted? A multi-centre series of 323 patients

Published online by Cambridge University Press:  28 September 2022

D Edwards Open the ORCID record for D Edwards [Opens in a new window] ,
S Sheehan Open the ORCID record for S Sheehan [Opens in a new window]  and
D Ingrams
D Edwards*
Affiliation:
Department of ENT Surgery, University Hospital of Wales, Cardiff, UK
S Sheehan
Affiliation:
Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
D Ingrams
Affiliation:
Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
*
Corresponding author: Mr Daniel Edwards; E-mail: Daniel.edwards@wales.nhs.uk
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Abstract

Background

This study aimed to establish whether histology tonsillectomy is justified for unilateral tonsil enlargement.

Methods

A retrospective review was conducted of histology tonsillectomies in three health organisations over five years, with strict exclusion criteria, focusing on benign-appearing unilateral tonsil enlargement.

Results

Ninety paediatric and 233 adult cases were included. No paediatric cases and five adult cases of malignancy were detected. All malignant cases presented with other symptoms. Using binary logistic regression, a history of rapid unilateral tonsil enlargement was the only factor found to be significantly associated with malignant outcome. Thirty-three per cent of subjectively larger tonsils were smaller on post-operative histological measurement. Of the cases, 12.1 per cent re-presented with post-tonsillectomy bleeding.

Conclusion

The authors recommend avoiding histology tonsillectomy for unilateral tonsil enlargement unless ‘red flag’ signs of malignancy are present, with particular attention to rapid unilateral tonsil enlargement. This study demonstrated discrepancy between clinical examination findings and true tonsil asymmetry; there may be a role for cross-sectional imaging prior to histology tonsillectomy in high-risk patients.

Keywords

TonsilTonsillectomy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 1022 - 1026
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr D Edwards takes responsibility for the integrity of the content of the paper

Preliminary data from this paper were presented at the ENT Wales Annual Meeting, 15 October 2021, Cardiff, Wales, UK.

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