Brodsky Grading of Tonsillar Enlargement

Brodsky Grading of Tonsillar Enlargement

Brodsky grading helps assess the degree of oropharyngeal airway obstruction and is particularly useful in pediatric obstructive sleep apnea (OSA) and surgical decision-making.

🔍 What is Brodsky's Grading?

Note: While students sometimes refer to this as the Brodsky scale, the correct clinical terminology is the Brodsky grading system.

Brodsky grading system classifies the size of the tonsils based on the percentage of the oropharyngeal airway they occupy.

Here is the step-by-step breakdown for the clinical grading of tonsils:

✅ Grade 0

• Tonsils lie completely within the tonsillar fossa
• Not visible or barely protruding
• Seen typically in patients post-tonsillectomy or with atrophic tonsils

✅ Grade 1

• Tonsils occupy < 25% of the oropharyngeal width
• Minimal airway obstruction
• Mildly enlarged

✅ Grade 2

• Tonsils occupy 25–50% of the oropharyngeal width
• May cause mild airway obstruction

✅ Grade 3

• Tonsils occupy 50–75% of the oropharyngeal width
• Associated with moderate airway obstruction

✅ Grade 4

• Tonsils occupy > 75% of the oropharyngeal width
• Tonsils touch or nearly touch in the midline
• Often referred to as “kissing tonsils”
• Associated with severe airway obstruction

🩺 Clinical Significance of Brodsky Grading

• Assigning a Brodsky tonsil grade helps evaluate the severity of airway compromise, especially in:

  • Pediatric Obstructive Sleep Apnea (OSA)
  • Chronic or recurrent tonsillitis

• Aids decision making for tonsillectomy

Note: This topic is a common viva question in ENT practical examinations, where examiners ask you to outline the Brodsky tonsil grading scale.