The Relationship Between Tonsillar Size and Neutrophil-to-Lymphocyte Ratio in Children With Recurrent Tonsillitis

Abstract

 Objectives: To explore the relationships between tonsillar sizes and neutrophil-to-lymphocyte 
ratio (NLR) values in children with recurrent tonsillitis.
 Subjects and Methods: In total, 236 children (128 males, 108 females; average age 11.80±9.16 
years; range, 4-18 years) who underwent tonsillectomy with a diagnosis of recurrent tonsil
litis were included. The patients were divided into four groups according to the tonsillar sizes. 
Group A was consist of 56 children with grade 1 tonsil size, while group B, C and D was consist 
of 58, 70 and 52 children with grade 2, 3 and 4 tonsil size, respectively. Pre-operative NLR 
values of all groups were compared with measurements in the post-operative third month.
 Results: In group A, pre-operative NLR levels were 1.76±0.92, while post-operative NLR 
were 1.74±1.53. No statistically significant difference in NLR values was observed between 
pre- and post-operatively in group A (p=0.864). In group B, pre-operative NLR levels were 
1.56±1.14, while post-operative NLR were 1.29±0.65. In group C, pre-operative NLR levels 
were 1.48±1.47, while post-operative NLR were 1.22±0.79. In group D, pre-operative NLR 
levels were 1.44±1.52, while post-operative NLR were 1.19±0.96. Post-operative NLR values 
were significantly lower than pre-operative NLR values in both groups B, C, D (p=0.012, 
p=0.036, p=0.043, respectively).  
Conclusion: The larger tonsils affect the NLR levels and larger tonsils are strongly suspected 
to contribute to higher systemic inflammations. However, higher systemic inflammations can 
be prevented by tonsillectomy.