Unilateral tonsillar swelling: role and urgency of tonsillectomy

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Unilateral tonsillar swelling is a fairly common presenting complaint in an Ear, Nose and Throat (ENT) department. It may or may not be associated with any other symptoms. Most of the time, the tonsil asymmetry is secondary to previous history of tonsillitis, quinsy, and tonsil stones. Other benign lesions to cause tonsil swelling may include a mucus retention cyst, lipoma, polyp or papilloma. Sometimes, it is the site of primary malignancy but in these situations, it is often associated with red flag symptoms like pain in the mouth, dysphagia, odynophagia, referred otalgia, weight loss, night sweating, haemoptysis, haematemesis, hoarseness or neck nodes. Most of the patients with suspected tonsillar malignancy have underlying risk factors like smoking and excessive alcohol intake. However, lately, the tonsil squamous cell carcinoma can be found in younger patients with no history of smoking or drinking as there is rising incidence of human papilloma virus related oropharyngeal malignancy. Sometimes, lymphoma may manifest as a tonsil enlargement. If, after detailed history and examination, there remains any doubt about the underlying cause of unilateral tonsil swelling then tonsillectomy should be considered for histological analysis. it is our practice to perform bilateral tonsillectomy in such cases. We present a case of unilateral tonsillar swelling and discuss its management.