Friedman et al graded the size of the tonsils based on their appearance in situ. The authors are from Rush-Presbyterian-Saint Luke's Medical Center in Chicago.
Gross Appearance of the Tonsils in Situ
tonsils absent (status post tonsillectomy)
tonsils are in the tonsillar fossa, barely visible behind the anterior tonsillar pillar; posterior pillar visible
tonsils are visible behind the anterior tonsillar pillar, projecting into the airway; posterior tonsils not visible
tonsils extend across the midline, up to three quarters of the way to the midline
tonsils completely obstruct the airway, meeting in the midline ("kissing tonsils")
From an operational viewpoint, it would be nice to make the description more objective. One approach would be a ratio between the distance between the tonsils to the distance between the anterior pillars.
= (distance between the tonsils) / (distance between the anterior pillars)
0.76 - 0.99
0.25 - 0.75
It is tempting to make a fractional grade between Grades III and IV, with Grade IV implying direct contact between the tonsils.
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Specialty: Otolaryngology, Infectious Diseases, Surgery, general, Pedatrics