Tonsil asymmetry in an adult is usually benign, but it is also how tonsil carcinoma and lymphoma present. The features that change the odds are progression, ulceration, firmness, a neck node, otalgia and systemic symptoms.
Examine the neck, ask about weight loss, night sweats and referred ear pain, and look at the tongue base. When red flags are present, arrange tissue diagnosis rather than reassurance.
- Ask about otalgia, dysphagia, weight loss and night sweats.
- Palpate both sides of the neck for nodes.
- Look for ulceration, firmness or extension to the tongue base.
- Arrange biopsy or excision when red flags are present or the asymmetry is progressing.
Why it matters
Most asymmetric tonsils are benign, so the red flags are what keep the cancers from being reassured away.
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