Clinical grading of tonsils: does it truly represent total tonsil volume in patients with recurrent tonsillitis

Venkatesha B. K., Yogeesha B. S., Asha M.


Background: Tonsils undergo hypertrophy due to recurrent infection or as a part of generalized lymphoid hypertrophy. There is a good correlation between clinical tonsil grade and objective tonsil volume in adult snorers and obstructive sleep apnea (OSA) patients.Relationship between clinical grading, oropharyngeal tonsil volume and total tonsil volume has been investigated in OSA patients but a very few in recurrent tonsillitis patients.

Methods: A total of 50 tonsillectomy specimens from 25 patients who underwent tonsillectomy for recurrent tonsillitis were evaluated for tonsil volume oropharyngeal volume. These volumes were evaluated by a mathematical formula. Total volume, oropharyngeal and tonsillar volume were correlated with clinical grading of the tonsil. Also neck circumference, body mass index was assessed and correlation with clinical grading was found out with spearman correlation coefficient.  

Results: A spearman’s correlation was used to determine the relationship between 50 tonsillectomy specimens for total volume and clinical grading. There was a moderate positive monotonic correlation between total tonsil volume and clinical grading (rs =0.407, n =50, p <0.01, Correlation is significant at the 0.01 level 2-tailed) and there was a mild positive monotonic correlation between intraoral tonsil volume and clinical grading (rs =0.351, n =50, p <0.05 Correlation was significant at the 0.05 level 2-tailed).

Conclusions: Total tonsil volume and oropharyngeal volume correlates well with clinical grading of the tonsil. BMI and neck circumference does not correlate with the clinical grading of the tonsil.


Tonsil volume, Chronic tonsillitis, Tonsillar hypertrophy

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