Asymmetric tonsil size in children.

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.