One or both tonsils may be absent. It is important to find the cause since this may have implications for the patient.
Congenital with bilateral absence:
(1) agammaglobulinemia (either X-linked to autosomal recessive)
(2) ectopia
Congenital and unilateral absence:
(1) associated with regional defects of external ear and other structures (probably associated with a defect in the first and second branchial structures)
Acquired (may affect one or both tonsils):
(1) surgery
(2) trauma
(3) radiation
(4) chemotherapy
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