Evaluation of the management of asymptomatic unilateral tonsillar enlargement -- can we avoid diagnostic surgery?

Evaluation of the management of asymptomatic unilateral tonsillar enlargement -can we avoid diagnostic surgery?Key points:1. Malignancy is very rare in asymptomatic unilateral tonsillar enlargement.2. We found no malignancies in our cohort of 78 patients with asymptomatic UTE who underwent tonsillectomy over a 5-year period.3.In a comprehensive literature review, only 2 out of 1152 patients (0.17%) were found to have lymphoma with unilateral tonsillar enlargement as the only presenting symptom and no other suspicious features.4.There is huge variability between the size of normal tonsils and 3 out of 10 patients in our study had a volume difference of 50% or more between their tonsils.A quarter of patients also had inaccurate clinical diagnosis of asymmetrical tonsils. 5.In patients with asymptomatic unilateral tonsillar enlargement, clinicians should consider a period of watchful observation, rather than performing diagnostic tonsillectomy in the first instance.