What is the best management of asymptomatic unilateral tonsillar enlargement?

BACKGROUND Lymphoma is the most common pediatric cancer of the head and neck, typically involving the cervical lymph nodes. However, primary tonsillar lymphoma accounts for <1% of head and neck cancer. It is generally believed that tonsillectomy is indicated to treat unilateral tonsillar enlargement (UTE), due to concern for lymphoma in the enlarged tonsil. This is particularly true in the setting of suspicious symptoms such as constitutional symptoms or cervical lymphadenopathy. Yet many patients with isolated UTE, with no associated symptoms, are still treated surgically. However, recent research suggests that treating asymptomatic UTE with tonsillectomy may be unnecessarily invasive, because clinical assessment of asymmetric tonsils may be inaccurate and because very few enlarged tonsils actually contain malignancies.