Brodsky developed a grading system for describing tonsillar enlargement. This can be useful for communicating physical findings to other physicians. The author is from the State University of New York in Buffalo.


Method of examination: 2 tongue blades are gently pressed on the anterior two thirds of the tongue, anterior to the circumvallate papillae. Gagging will cause the tonsils to move medially which may make them appear larger than normal (false positive).


Parameters with the mouth wide open:

(1) distance between the anterior tonsillar pillars midway between the palate and the tongue

(2) minimum distance between the medial aspects of the 2 tonsils


occlusion of the oropharyngeal airway in percent =

= ((distance between the anterior pillars) - (distance between tonsils)) / (distance between the anterior pillars) * 100%

Percent Occlusion

Grade of Obstruction



1 - 24.9%


25 to 49.9%


50 to 75%


> 75%




• Grade 0 is when the tonsils are in the tonsillar fossa and do not extend medially to the anterior tonsillar fossa.


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