Treatment for Unilateral Tonsillar Swelling with Recurrent Tonsil Stones
Tonsillectomy is NOT indicated for recurrent tonsilloliths (tonsil stones) alone, as this is not an established surgical indication according to current guidelines. 1
Initial Conservative Management
The appropriate approach for your two-week history of unilateral tonsillar swelling with tonsil stones is conservative management, as tonsilloliths are common clinical findings that rarely require surgical intervention. 2
- Small tonsilloliths should be managed expectantly with watchful waiting, as they typically pass on their own. 2
- Supportive care includes adequate hydration and analgesia for any associated discomfort. 3
- The evidence supporting tonsillectomy for tonsilloliths, halitosis, and chronic tonsillitis is limited and generally of lesser quality. 4
Critical Red Flags Requiring Immediate Evaluation
However, unilateral tonsillar swelling raises important concerns that must be addressed:
- Asymmetric tonsillar enlargement warrants evaluation for possible neoplasm, which IS an established indication for tonsillectomy. 1
- You should be examined by an otolaryngologist to rule out malignancy or other serious pathology, as unilateral presentation is atypical for simple tonsilloliths. 1
- If you develop fever >38.3°C, severe throat pain, difficulty swallowing, or signs of abscess formation, seek immediate medical attention. 4, 5
When Surgery Would Be Indicated
Tonsillectomy would only be appropriate in your case if:
- Biopsy or clinical evaluation reveals neoplasm or other serious pathology requiring surgical intervention. 1
- You develop a peritonsillar abscess (though tonsillectomy is only recommended after >1 abscess episode). 4, 6
- You meet Paradise criteria for recurrent tonsillitis: ≥7 documented episodes in the past year, ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years, with each episode including fever, adenopathy, exudate, or positive strep test. 1, 5
Practical Next Steps
- Schedule evaluation with an ENT specialist to assess the unilateral swelling and rule out concerning pathology. 1
- Document any throat infection episodes with specific clinical features (fever, adenopathy, exudate, positive strep test) for future decision-making. 5
- Continue conservative management with hydration and symptomatic relief while awaiting specialist evaluation. 2, 3
The key pitfall to avoid is assuming all unilateral tonsillar swelling is benign—asymmetric enlargement requires evaluation to exclude malignancy, even in the presence of tonsilloliths. 1