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Unilateral tonsil enlargement in children and adults: is routine histology tonsillectomy warranted? A multi-centre series of 323 patients

Published online by Cambridge University Press:  28 September 2022

D Edwards Open the ORCID record for D Edwards [Opens in a new window] ,
S Sheehan Open the ORCID record for S Sheehan [Opens in a new window]  and
D Ingrams
D Edwards*
Affiliation:
Department of ENT Surgery, University Hospital of Wales, Cardiff, UK
S Sheehan
Affiliation:
Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
D Ingrams
Affiliation:
Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
*
Corresponding author: Mr Daniel Edwards; E-mail: [email protected]
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Abstract

Background

This study aimed to establish whether histology tonsillectomy is justified for unilateral tonsil enlargement.

Methods

A retrospective review was conducted of histology tonsillectomies in three health organisations over five years, with strict exclusion criteria, focusing on benign-appearing unilateral tonsil enlargement.

Results

Ninety paediatric and 233 adult cases were included. No paediatric cases and five adult cases of malignancy were detected. All malignant cases presented with other symptoms. Using binary logistic regression, a history of rapid unilateral tonsil enlargement was the only factor found to be significantly associated with malignant outcome. Thirty-three per cent of subjectively larger tonsils were smaller on post-operative histological measurement. Of the cases, 12.1 per cent re-presented with post-tonsillectomy bleeding.

Conclusion

The authors recommend avoiding histology tonsillectomy for unilateral tonsil enlargement unless ‘red flag’ signs of malignancy are present, with particular attention to rapid unilateral tonsil enlargement. This study demonstrated discrepancy between clinical examination findings and true tonsil asymmetry; there may be a role for cross-sectional imaging prior to histology tonsillectomy in high-risk patients.

Keywords

TonsilTonsillectomy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 1022 - 1026
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr D Edwards takes responsibility for the integrity of the content of the paper

Preliminary data from this paper were presented at the ENT Wales Annual Meeting, 15 October 2021, Cardiff, Wales, UK.

References

Akcay, A, Kara, CO, Dagdeviren, E, Zencir, M. Variation in tonsil size in 4- to 17-year-old schoolchildren. J Otolaryngol 2006;35:270–4CrossRefGoogle ScholarPubMed
Guimaraes, AC, de Carvalho, GM, Correa, CRS, Gusmao, RJ. Association between unilateral tonsillar enlargement and lymphoma in children: a systematic review and meta-analysis. Crit Rev Oncol Haematol 2015;93:304–11CrossRefGoogle ScholarPubMed
Jones, GH, Burnside, G, McPartland, J, Markey, A, Fallon, M, De, S. Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature. Int J Pediatr Otorhinolaryngol 2018;110:57–60CrossRefGoogle ScholarPubMed
Royal College of Surgeons. National Prospective Tonsillectomy Audit Final Report. London: Royal College of Surgeons, 2005Google Scholar
Amin, N, Bhargava, E, Prentice, JG, Shamil, E, Walsh, M, Tweedie, DJ. Coblation intracapsular tonsillectomy in children: a prospective study of 1257 consecutive cases with long term follow up. Clin Otolaryngol 2021;46:1184–92CrossRefGoogle ScholarPubMed
Addison, AB, Whittaker, M, Maddox, T, Pelser, A, Watts, S. Tonsillectomy for asymmetrical tonsils, are we over-diagnosing and managing: a review of 157 cases: our experience. Clin Otolaryngol 2015;40:278–80CrossRefGoogle ScholarPubMed
Oluwasanmi, AF, Wood, SJ, Baldwin, DL, Sipaul, F. Malignancy in asymmetrical but otherwise normal palatine tonsils. Ear Nose Throat J 2006;85:661–3CrossRefGoogle ScholarPubMed
Hwang, MS, Kaye, KE, Waxman, JA, Friedman, M. What is the best management of asymptomatic unilateral tonsillar enlargement? Laryngoscope 2015;125:2438–40CrossRefGoogle ScholarPubMed
Brodsky, L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551–69CrossRefGoogle ScholarPubMed
Friedman, M, Tanyeri, H, La Rosa, M, Landsberg, R, Vaidyanathan, K, Pieri, S et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 2009;109:1901–7CrossRefGoogle Scholar
Kumar, DS, Valenzuela, D, Kozak, FK, Ludemann, JP, Moxham, P, Lea, J et al. The reliability of clinical tonsil size grading in children. JAMA Otolaryngol Head Neck Surg 2014;140:1034–7CrossRefGoogle ScholarPubMed
Van Lierop, AC, Prescott, CAJ, Fagan, JJ, Sinclair-Smith, CC. Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsils? S Afr Med J 2007;97:367–70Google ScholarPubMed
NHS England. Consultant-led Referral to Treatment Waiting Times Data 2021-22. In: https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2021-22/ [15 April 2022]Google Scholar
Adil, EA, Medina, G, Cunningham, MJ. Pediatric tonsil cancer: a national and institutional perspective. J Pediatr 2018;197:255–61CrossRefGoogle ScholarPubMed
Berkowitz, RG, Mahadevan, M. Unilateral tonsillar enlargement and tonsillar lymphoma in children. Ann Otol Rhinol Laryngol 1999;108:876–9CrossRefGoogle ScholarPubMed
Laskar, S, Bahl, G, Muchaden, MA, Nair, R, Gupta, DM, Bakshi, A et al. Primary diffuse large B-cell lymphoma of the tonsil. Is a higher radiotherapy dose required? Cancer 2007;110:816–23Google ScholarPubMed
Mehanna, H, Evans, M, Beasley, M, Chatterjee, S, Dilkes, M, Homer, J et al. Oropharyngeal cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 2016;130(suppl S2):S90–6CrossRefGoogle ScholarPubMed
Duggal, R, Rana, A, Vaid, A, Sood, N, Kumar Handa, K. Bilateral tonsillar enlargement as a first manifestation of chronic lymphocytic leukemia/small lymphocytic lymphoma with an unusual interfollicular pattern of infiltration. Indian J Hematol Blood Transfus 2016;32(suppl 1):152–5CrossRefGoogle ScholarPubMed
Bersabe, AR, Romain, JT, Ezzell, EE, Renshaw, JS. Chronic lymphocytic leukemia as an unusual cause of rapid airway compromise. Case Rep Oncol Med 2017;2017:8247353Google ScholarPubMed
Spinou, E, Kubba, H, Konstantinidis, I, Johnston, A. Tonsillectomy for biopsy in children with unilateral tonsil enlargement. Int J Ped Otolaryngol 2002;63:15–17CrossRefGoogle Scholar
Harley, EH. Asymmetric tonsil size in children. Arch Otolaryngol Head Neck Surg 2022;128:767–9CrossRefGoogle Scholar
Lundstrom, F, Stalfors, J, Ostvoll, E, Sunnergren, O. Practice, complications and outcome in Swedish tonsil surgery 2009-2018. An observational longitudinal national cohort study. Acta Otolaryngol 2020;140:589–96Google ScholarPubMed
Thompson, N, Street, I. 709: A prospective analysis of post-tonsillectomy haemorrhage and hospital readmission rates in a tertiary pediatric centre. Br J Surg 2021;108(suppl 6)CrossRefGoogle Scholar
Bhatia, KSS, King, AD, Yeung, DKW, Mo, F, Vlantis, AC, Yu, K-H et al. Can diffusion-weighted imaging distinguish between normal and squamous cell carcinoma of the palatine tonsil? Br J Radiol 2010;83:753–8CrossRefGoogle ScholarPubMed