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Sep 14, 2007Article Details
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Main Article Content
Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsils?
Abstract
Objectives. The aims of the study were: (i) to determine
the necessity for diagnostic tonsillectomy in children with
asymmetrically enlarged tonsils; (ii) to determine the accuracy
of clinical assessment of tonsillar asymmetry; and (iii) to
determine how to manage children with clinical tonsillar
asymmetry in a developing-world practice.
Methods. A prospective study was carried out at Red Cross
War Memorial Children's Hospital in Cape Town, over an
8-month period. All children undergoing tonsillectomy
or adenotonsillectomy had a clinical assessment of tonsil
symmetry done, and all tonsil and adenoid specimens were
examined histologically. The maximum diameter and volume of
the resected tonsils were measured. A comparison was done of
true tonsil asymmetry in patients with asymmetrical tonsils and
a subgroup of matched controls with symmetrical tonsils.
Results. A total of 344 tonsils were analysed (172 patients).
The 13 patients (7.6%) diagnosed as having clinically
asymmetrically enlarged tonsils had no significant pathological
diagnosis. In the patients with symmetrical tonsils there were
2 abnormal pathological findings (tuberculosis of the adenoids
and T-cell lymphoma of the tonsils and adenoids).
In the clinically asymmetrical tonsil group, true tonsillar
asymmetry was 3 mm (maximum diameter), and 2.2 cm3
(volume), compared with 1.9 mm and 1.5 cm3 in the
symmetrical tonsil group. When patients with clinical tonsillar
asymmetry and symmetry were compared, the difference in
maximum diameter (p = 0.62) and volume (p = 0.73) was not
significantly different.
Conclusions. Clinical tonsillar asymmetry is usually apparent
rather than real. The incidence of significant pathology
in children with asymptomatic, asymmetrical tonsils is
low. Diagnostic tonsillectomy is indicated in children with
asymmetrically enlarged tonsils associated with constitutional
symptoms, cervical lymphadenopathy, rapid tonsil enlargement
or significant tonsillar asymmetry.
< South African Medical Journal Vol. 97 (5) 2007: pp. 367-370
