Standardized grading of tonsil size

Tonsil size is most often described on a scale from 0 to 4+:

0 – Tonsils are entirely within the tonsillar pillar or previously removed by surgery.
1+ – Tonsils occupy less than 25% of the lateral dimension of the oropharynx, as measured between the anterior tonsillar pillars (solid yellow arrow).
2+ – Tonsils occupy 26 to 50% of the lateral dimension of the oropharynx.
3+ – Tonsils occupy 51 to 75% of the lateral dimension of the oropharynx.
4+ – Tonsils occupy more than 75% of the lateral dimension of the oropharynx.

Drawing based on text description in: Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989; 36:1551.

Graphic 103834 Version 4.0

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