Musharaf Baig, Faheem Pervaiz Akhtar.
Asymmetrical tonsils: Clinical, microbiological and histopathological evaluation.
J Rawal Med Coll Jan ;8(2):90-2.

Background: To ascertain the different causes of asymmetrical tonsils with histopathological examination. Methods: This study was performed on 50 patients in the Department of ENT, Holy Family Hospital, Rawalpindi. All had to undergo tonsillectomy for asymmetrical tonsils which were causing some problem to the patients. These 50 cases were out of a total of 372 cases, selected for tonsillectomy over a one year period. A surface tonsillar swab for microscopy and culture (including acid fast staining) was obtained pre-operatively with a sterile swab. The tonsils of all 50 patients were examined histopathologically. Tonsils were fixed in 4% formalin solution, dehydrated, embedded and cut at 6 micron thickness. The sections were stained with hematoxylin-eosin for histopathological examination. Tonsillar surface bacteriological examination and histopathological picture were also compared. Results: In our study, 31 (62%) patients were male and 19 (38)%) were females. The age of most patients ranged between 3 and 25 years, with maximum number of patients between 13 to 18 years of age and only 5 above 25 years. Swab from tonsillar surface for culture showed predominantly beta-hemolytic streptococcus in 38% cases while 10% had H. influenzae. 6% patients had Staph. aureus and 4% had Esch. coli. Rest of the patients showed no growth on culture. Results of histopathological examination were different; 70% tonsils showed chronic non-specific inflammation, 18% tonsils were tuberculous while 4% had lymphoma. The remaining 8% were normal hypertrophied asymmetrical tonsils. Conclusions: In asymmetrical tonsils, there is no correlation between tonsillar surface culture and histopathological examination after tonsillectomy, especially in specific tonsillitis. Chronic tonsillitis is the commonest cause. Tuberculosis of the tonsils is not uncommon and should always be considered, confirmed and treated appropriately.

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