Clinical-Endoscopic Discrepancy in Severe Tonsillar Hypertrophy: When Oropharyngeal Examination Underestimates Airway Obstruction

Palatine tonsillar hypertrophy is a common cause of upper airway obstruction and is often assessed through oropharyngeal examination using the Brodsky classification. However, this bidimensional method may underestimate the actual tonsillar volume, particularly in cases of atypical anatomy. We report the case of a patient with long-standing rhinophonia associated with dysphonia and vocal fatigue. Oroscopic examination suggested tonsillar hypertrophy. Due to the discrepancy between symptoms and physical examination findings, videolaryngoscopy was performed, revealing more significant airway compromise than initially appreciated. This case highlights the importance of clinical-endoscopic correlation and suggests that discordance between symptoms and oroscopic findings should prompt endoscopic evaluation to avoid the underdiagnosis of clinically relevant airway obstruction.