Background: Unilateral tonsil enlargement frequently poses a clinical dilemma regarding tonsillectomy to rule out malignancy. There is clear morbidity associated with tonsillectomy including bleeding, the risk of anaesthesia and post operative pain. Therefore a decision has to be made considering the risks of tonsillectomy versus the risk of missing malignancy if the tonsil is not removed.

Method: A pubmed search was performed using the terms unilateral tonsil enlargement and unilateral tonsil hypertrophy.

Results: The likelihood of finding a malignancy in unilateral tonsil enlargement, with no other clinical features, is low and does not warrant a tonsillectomy in all cases. In this situation we would suggest a “watchful waiting” policy of three months. However, age, systemic and specific symptoms, and how quickly the swelling developed are important factors to take into account when assessing the patient.

Conclusions: We suggest a period of “watch and wait” in patients who present with asymmetric tonsil enlargement, with no other clinical symptoms or signs on examination.


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