Objective To assess the clinical implications of asymmetrically enlarged tonsils
in children.
Design A prospective controlled study of asymmetric tonsil size in children
scheduled for tonsillectomy with or without adenoidectomy. Data were recorded
on tonsil size and position, tonsillar fossa depth, degree of asymmetry, and
pathological findings. Control patients were matched for age, sex, race, diagnosis,
and surgical procedure.
Patients A total of 258 children, aged 2 to 18 years, scheduled for tonsillectomy
with or without adenoidectomy during a 27-month period.
Setting A tertiary care academic medical center.
Results Forty-seven children (18.2%) were determined to have asymmetric tonsils.
There were 43 matched controls with symmetric tonsils. Three-dimensional quantitative
measurements of the resected tonsils revealed little or no actual asymmetry
in tonsil size even though preoperative intraoral observations gave the impression
that one tonsil was larger than the other. Statistically, tonsillar asymmetry
was more apparent than real. When measured by volume, there was asymmetry
in both groups. However, there was no statistical difference in the degree
of asymmetry between the groups (P = .50). A difference
in the depth of the tonsil fossa contributed to the putative asymmetry (P<.001). No malignant neoplasms were identified on microscopic
examination in either group.
Conclusions Tonsillar asymmetry in children may often be an illusion secondary to
a difference in the depth of the tonsillar fossa. Tonsillar asymmetry in children
in the absence of other findings such as ipsilateral cervical adenopathy or
other constitutional symptoms may not indicate a malignancy.
