Tonsillectomy for biopsy in children with unilateral tonsillar enlargement

Abstract

Objective: Unilateral tonsillar enlargement (UTE) may be a sign of underlying malignancy and tonsillectomy is often recommended for histology. The limited evidence available suggests that the incidence of malignancy in children with UTE is very low, and that in many cases, the apparent enlargement is due to asymmetry of the mucosa of the tonsillar pillars. The purpose of this study was to evaluate the necessity of tonsillectomy as a routine practice for every case of UTE. Methods: We attempted to identify every child (age<16 years) undergoing tonsillectomy in our unit from January 1991 to January 2000 where the indication for surgery was UTE. Patients were excluded if the primary indication for surgery was anything other than UTE. The case notes and pathology records were reviewed. Results: Exactly 47 children were identified, aged between 4 and 15 years of age (mean 9.5 years), of whom 29 (62%) were girls. In all cases, the tonsillar asymmetry was noted by the otolaryngologist, but had not been noted by the patient or parents, or commented on by the referring General Practitioner. Eighteen of the children (38%) had no history of sore throats. No malignancies were encountered. When the tonsils were measured by the pathologist after excision, the actual degree of asymmetry in size ranged from 0 to 25 mm. In seven cases (15%), the clinically larger tonsil was actually the smaller of the two when examined by the pathologist. In 17 cases (36%) there was no difference in size at all. Conclusions: We conclude that apparent UTE is often spurious, and that many unnecessary tonsillectomies are performed when UTE is taken as an indication for surgery in the absence of any other suspicious features. Tonsillectomy carries risks and clinical observation may be prudent where clinical suspicion is low.