Ultrasonic Parameters of Palatine Tonsils in Healthy Children: Correlations with Individual Factors

Ultrasonic Parameters of Palatine Tonsils in Healthy Children: Correlations with Individual Factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Ultrasonic Parameters of Palatine Tonsils in Healthy Children: Correlations with Individual Factors Qi Zhang, Xiaopeng Li, Yue Gao, Xiangru Wang, Lei Sun, Hua Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8969268/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background High-frequency ultrasound is gradually being applied to the diagnosis of tonsil diseases. However,there remains a lack of relevant quantitative reference indicators and unified assessment standards. which limits the development and application of ultrasound examinations. Objective High-frequency ultrasound was applied to observe and measure the palatine tonsils of healthy children, and the reference value range of relevant parameters was initially established. Methods and methods A total of 375 healthy children aged 2-14 y were enrolled between June 2023 and September 2023.Basic data such as gender, age, height, weight, BMI, and BSA were recorded and the relevant parameters of bilateral palatine tonsils were measured by high-frequency ultrasound. The data were stratified by age group and gender. To explore the correlations between the relevant parameters of the palatine tonsils and individual factors. Results The normal reference value ranges for the superior-inferior diameters, anteroposterior diameters, left-right diameters, volumes and internal of bilateral palatine tonsils in 375 healthy children are as follows: (18.83-33.80)mm, (9.60-18.74)mm, (8.98-17.22)mm, (0.92-5.16)cm3, (9.32-25.50)mm. The parameters of bilateral palatine tonsils in healthy children were significantly positively correlated with height, weight, BSA and BMI. Conclusion This study initially established the reference values of quantitative parameters of the palatine tonsils in healthy children, which can provide reference value for clinical practice. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Palatine tonsil Health children High-frequency ultrasound Figures Figure 1 Figure 2 Figure 3 Introduction Tonsil diseases, particularly acute tonsillitis, are common and frequently occurring illnesses in children, significantly impacting their physical health.Currently, clinicians primarily rely on qualitative visual assessment through oral examination to judge the severity of tonsil lesions, lacking relevant quantitative reference indicators [ 1 ] .With the iterative advancement of ultrasound equipment, high-frequency ultrasound has significantly improved the resolution of soft tissue imaging. As a non-invasive, real-time, and repeatable examination method, it is gradually being applied in the diagnosis of tonsil diseases [ 2 ] .However, there is currently no unified standardized protocol for ultrasound examination, and quantitative reference data for healthy children are lacking, which restricts the development and application of this diagnostic method. This study aims to (1) apply high-frequency ultrasound to measure the dimensions and internal distance of bilateral palatine tonsils in healthy children aged 2 to 14 years, calculate their volume, and establish the normal reference ranges for each relevant parameter. (2) Investigate the correlations between palatine tonsil parameters and factors such as age, height, weight, BMI, and BSA. This aims to provide reference data from healthy children for the diagnosis of tonsil-related diseases. Materials and Methods Ethical approval The study complied with the Declaration of Helsinki,and the research protocol was approved by the Ethics committee of the Second Affiliated Hospital of Xi'an Jiaotong University(ethical approval number:2023503).A signed informed consent form was acquired from the parent or legal guardian of each child. Study Population This study was conducted at the Second Affiliated Hospital of Xi'an Jiaotong University from June 2023 to September 2023.A total of 375 children aged 2-14 years who underwent health examinations were enrolled as the study subjects,and their basic data such as gender, age, height, weight recorded,and calculated the Body Mass Index (BMI) (BMI (kg/m²)=weight (kg) / height (m)²) and Body Surface Area (BSA) (BSA (m²)=0.0061×height (cm) + 0.0128×weight (kg)-0.1529).Then, the children were divided into five age groups: 2-4y, 5-8y, 9-11y, 12-14y. The inclusion criteria were:children aged 2 to 14 years without any respiratory diseases or tonsil-related symptoms. The exclusion criteria were as follows:(i)children with acute upper respiratory tract infections; (ii) those presenting with tonsil-related symptoms such as snoring, nasal congestion, or breathing difficulties; (iii)individuals with a history of tonsil surgery; (iv)patients complicated with severe cardiac, cerebral, pulmonary, hepatic, renal, hematological, or endocrine system diseases; (v)those with psychiatric conditions unable to cooperate with the examination. Image acquisition A Mindray Resona R7 color Doppler ultrasound system was used, equipped with a C11-3U micro-convex array probe. The examined children were placed in a supine position with a small pillow under their shoulders and neck to achieve appropriate neck extension. The examination was conducted during quiet breathing. After applying an appropriate amount of coupling gel, the ultrasound probe was placed directly on the skin surface. Using the bilateral mandibular angles and the anterior midline of the neck as anatomical landmarks, real-time transverse and longitudinal scans were performed to visualize the palatine tonsils and their adjacent areas. During the scanning process, bilateral comparison was emphasized. Image assessment and measurement Using the bilateral mandibular angles as anatomical landmarks, transverse scanning was performed with the probe parallel to the mandibular angle and its orientation marker pointing toward the child's right side. After fully displaying the maximum cross-sectional view of the palatine tonsil, the image was frozen, and the widest left-right distance of the tonsil was measured as the left-right diameter. Longitudinal scanning was then conducted with the probe perpendicular to the mandibular angle and its orientation marker pointing toward the child's head. After fully displaying the maximum longitudinal view of the palatine tonsil, the image was frozen. The longest superior-inferior distance was measured as the superior-inferior diameter, and the widest anterior-posterior distance was measured as the anteroposterior diameter. During the longitudinal scans of the bilateral neck, the probe was positioned perpendicular to the mandible, with its indicator pointing toward the child's head. In this plane, the superior-inferior and anteroposterior diameters of the palatine tonsils were measured. For the transverse scans of the bilateral neck, the transducer was aligned parallel to the mandible, with its indicator directed toward the child's right side. The left-right diameter of the palatine tonsils was measured in this plane [3] .For the midline neck scan, the transducer was placed midline on the neck and oriented toward the skull base, with the indicator pointing to the child's right side. The probe was moved superiorly and inferiorly to clearly display the maximum dimensions of both palatine tonsils. The internal distance between the bilateral palatine tonsils was measured in this plane.(Figure 1) Calculation of Palatine Tonsil Volume: The volume of the palatine tonsil was calculated in cubic centimeters (cm³) using the formula derived from the studies by Hosokawa T, et al. [4, 5] , defined as: (Superior-Inferior diameter×left-right diameter×Anteroposterior diameter)×0.52. Quality control All measurements were performed by two ultrasound physicians at or above the senior resident level and reviewed by one physician at or above the associate chief physician level.All data were jointly entered and cross-verified by two researchers to ensure accuracy. Statistical analysis All the statistical analysis was performed using SPSS software (version 25.0). Measurement data conforming to a normal distribution are presented as the mean±standard deviation(x̄±s), while data with a non-normal distribution are expressed as the median with the interquartile range (M (Q1, Q3)). Comparisons among multiple groups were conducted using the Kruskal-Wallis rank-sum test (H test). Spearman's correlation analysis was employed to assess the relationships between the various diameters, volume, and internal distance of the bilateral palatine tonsils and the individual factors. The Spearman correlation coefficient (|r|) 0.8 indicates a strong correlation.A two-tailed P-value of less than 0.05 was considered statistically significant. Results Participant characteristics This study enrolled a total of 375 healthy children aged 2 to 14 years, with a median age of 9 (7, 11) years. The cohort consisted of 171 boys (45.6%) and 204 girls (54.4%). The baseline characteristics, including height, weight,BMI, and BSA, are summarized in Table 1. Table 1 Summary of demographic information between males and females[IQR] Tatal(N=375) age 9(7,11)y Gender male 167(44.5%) female 208(55.5%) Height 135(120,146.6)cm Weight 29(21,38)kg BMI 16(14.4,18.1)kg/cm² BSA 1.08(0.88,1.29)m² N:number;BMI:body mass index;BSA:body surface area. Ultrasound imaging features of the palatine tonsils The palatine tonsils are located deep to the submandibular gland. On transverse scans, they appear roughly circular, while on longitudinal scans, they present as oval shape with a wider superiorly and narrower inferiorly. A complete capsular echo can be visualized. And the overall echogenicity of the tonsils is lower than that of the submandibular gland.The internal structure shows a striated pattern with alternating bands of medium and low echogenicity. In some children, hyperechoic gas may be observed within the palatine tonsil.(figure 2) Comparison of bilateral palatine tonsil volume and internal distance across age groups by sex The results showed that in the 9–11 age group, the internal distance between bilateral palatine tonsils was greater in boys than in girls, with a statistically significant difference(P0.05).(Table 2) Table 2 Comparison of bilateral palatine tonsil volume and internal distance across age groups by sex Age/y Gender Number right palatine tonsil left palatine tonsil internal distance between the bilateral tonsils volume/cm3 Z P volume/cm3 Z P distance/mm Z P 2-5 boy 27 1.79 (1.43,2.24) -1.077 0.281 1.66 (1.42,2.11) -1.805 0.071 13.50 (11.50,15.70) -0.706 0.48 girl 33 1.67 (1.25,2.04) 1.38 (1.26,1.82) 13.90 (11.00,15.50) 2-6 boy 52 2.32 (1.64,2.88) -1.383 0.167 2.20 (1.71,2.86) -0.739 0.46 17.10 (14.40,19.40) -0.73 0.465 girl 59 2.02 (1.47,2.90) 1.98 (1.73,2.84) 16.60 (13.70,18.30) 2-7 boy 52 2.43 (1.86,3.11) -1.106 0.269 2.48 (1.95,3.09) -0.735 0.462 19.35 (16.80,21.30) -2.15 0.032 girl 88 2.60 (2.04,3.35) 2.60 (2.05,3.17) 17.90 (15.15,20.05) 2-8 boy 36 3.12 (2.29,3.82) -1.191 0.234 2.93 (2.12,3.50) -1.123 0.261 20.30 (18.05,24.00) -1.76 0.078 girl 28 2.53 (1.90,3.45) 2.47 (2.00,3.47) 19.00 (16.40,21.20) Comparison of palatine tonsil volume by side across age groups The results showed no statistically significant differences in the volume between the left and right palatine tonsils across all age groups (all P > 0.05). Additionally, across different age groups, the volume of the palatine tonsils tended to increase with age.(Table 3) Table 3 Comparison of palatine tonsil volume by side across age groups Age/y Number side volume/cm 3 Z P 2-5 60 right 1.70 (1.27,2.09) -0.777 0.437 left 1.61 (1.31,2.00) 6-8 111 right 2.15 (1.54,2.90) -0.451 0.652 left 2.16 (1.73,2.85) 9-11 140 right 2.56 (2.01,3.18) -0.123 0.902 left 2.55 (2.03,3.14) 12-14 64 right 2.64 (2.20,3.74) -0.253 0.801 left 2.77 (2.08,3.50) Reference ranges for palatine tonsil ultrasound parameters in healthy children The normal reference ranges for the superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils in healthy children aged 2-14 years are as follows: (18.83-33.80)mm, (9.60-18.74)mm, (8.98-17.22)mm, (0.92-5.16)cm 3 , (9.32-25.50)mm. (Table 4 ) Table 4 95% Reference range for ultrasound measurement parameters of palatine tonsils in healthy children[P2.5-P97.5] Age/y superior-inferior diameter/mm anteroposterior diameter/mm left-right diameter/mm volume/cm3 internal distance/mm 2-5 16.30-28.39 9.40-17.29 8.61-16.19 0.69-4.11 6.43-20.48 6-8 18.90-32.74 9.67-18.53 8.60-17.28 0.91-5.06 7.88-16.14 9-11 20.10-33.70 10.10-18.39 9.10-17.20 1.06-4.89 8.55-27.15 12-14 20.62-36.71 9.89-20.76 9.30-17.81 1.07-6.17 11.98-26.80 Analysis of the correlations between ultrasonic parameters of the palatine tonsils and individual factors in healthy children The superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils all showed positive correlations with age, height, weight, body surface area (BSA), and body mass index (BMI) (all P 0.5).(Figure 3) Discussion In this single-center study, the superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils were measured and calculated in 375 healthy children aged 2–14 years. Based on these measurements, preliminary reference ranges for palatine tonsil-related parameters in healthy children of this age group were established. Additionally, the correlations between these parameters and age, height, weight, BMI, and BSA were analyzed. The findings provide objective and reliable quantitative data to support the diagnosis of palatine tonsil-related diseases. The main findings are as follows: (1)High-frequency ultrasound can clearly and completely visualize the bilateral palatine tonsils in children. High-frequency ultrasound can objectively measure the size of the palatine tonsils and clearly display the internal structure, blood flow distribution, and surrounding tissues of the tonsils in most children [6] .It provides an objective reference basis for clinical research and disease diagnosis.Previous studies have shown a strong agreement between the tonsillar volume measured by high-frequency ultrasound and the actual volume [7] . Compared to other imaging modalities such as X-ray, CT, and MRI, high-frequency ultrasound offers advantages including safety, non-invasiveness, and the ability to perform repeat examinations within a short period [8] . The palatine tonsils are located deep to the submandibular gland. On transverse scans, they appear roughly circular, while on longitudinal scans, they present as oval shape with a wider superiorly and narrower inferiorly. A complete capsular echo can be visualized. And the overall echogenicity of the tonsils is lower than that of the submandibular gland.The internal structure shows a striated pattern with alternating bands of medium and low echogenicity. In some children, hyperechoic gas may be observed within the palatine tonsil. (2)Reference ranges for palatine tonsil ultrasound parameters in healthy children aged 2 – 14 years have been established, providing a data reference for clinical research. The palatine tonsils are prone to recurrent infections during childhood [9-11] . The accumulation of numerous inflammatory factors and lymphocytes in this area leads to tonsillar hyperplasia and hypertrophy [12] .Enlarged tonsils may obstruct the airway, leading to serious consequences and significantly impacting children's health. Currently, clinical diagnosis relies primarily on subjective qualitative indicators to assess the severity of tonsil-related diseases, which is not conducive to early diagnosis and prognosis improvement. This study has preliminarily established reference ranges for palatine tonsil-related parameters in healthy children aged 2–14 years, providing objective quantitative reference indicators for early disease diagnosis and clinical research. Jiang et al. [3] performed ultrasonic measurements of bilateral palatine tonsils in 224 healthy children aged 1-16 years, reporting volumes of 1.58 (1.23, 1.88) cm³ for boys and 1.46 (1.20, 1.69) cm³ for girls. The study did not further stratify the data by gender and age, limiting its clinical reference value. In contrast, the data stratification conducted in this research better aligns with the growth and development characteristics of children. Furthermore, palatine tonsillar hypertrophy is a significant contributing factor to pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) [13] . This study introduced the measurement of the internal distance between bilateral palatine tonsils, aiming to provide a simple and efficient method for reflecting the impact of tonsillar enlargement on the airway. The feasibility of this indicator for assessing the risk of pediatric OSAHS requires further confirmation through clinical research. Similarly, comparison of left and right palatine tonsil volumes within the same age groups showed no significant lateral differences. This suggests that significant asymmetry is not a typical feature of normal tonsillar development in individuals. Therefore, the identification of substantial size disparity between bilateral tonsils during clinical evaluation may serve as an indicator of potential pathology [14, 15] . (3)Correlation between ultrasonic parameters of the palatine tonsils and individual factors in healthy children The superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils all showed positive correlations with age, height, weight, BSA, and BMI (all P < 0.01). Additionally, the volume of bilateral palatine tonsils and the internal distance between them exhibited an increasing trend with age.which is generally consistent with previous studies [4, 16-20] . Hosokawa et al. [4] ,Muleta et al. [21] and Jiang et al. [3] suggested a strong correlation between palatine tonsil size and height, a finding that aligns with our results. Furthermore, our study also identified a high correlation between tonsil size and body surface area, in addition to height. This finding suggests that height and body surface area could serve as standards for establishing reference ranges for normal palatine tonsil size in children. Given that body surface area is closely associated with growth changes in children, using body surface area-standardized palatine tonsil volume may be a more reasonable approach [22] . Limitations of the Study This research is a single-center study that only included Chinese children aged 2–14 years, and therefore may not reflect the actual conditions in regions such as Europe, the United States, or Indonesia. Future studies should involve multiple centers, broader geographical representation, and more researchers to further validate and expand upon these findings. Conclusion In summary, based on high-frequency ultrasound examinations of 375 healthy children aged 2–14 years, this study preliminarily established reference ranges for ultrasonic measurement parameters of pediatric palatine tonsils. This work highlights the role and value of high-frequency ultrasound scanning technology in disease screening and diagnosis. Declarations Author's Contribution Statement Qi Zhang: Literature retrieval, data collection and analysis, thesis conception and writing. Xiao-peng Li: Research guidance, Experimental Design. Yue Gao: Data Collection and Analysis, Xiang-ru Wang: Image data and data organization. Lei Sun: Research guidance, proofreading and quality control, paper review Hua Wang: Research guidance, financial support, proofreading and quality control. Data availability statement The research data are confidential due to ethical restrictions. Conflict of interest The authors declare no conflicts of interest to declare. 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Sonographic Estimation of Normal Palatine Tonsil Size in Under 18 Year Olds Who Visited a Tertiary Teaching Hospital in Addis Ababa, Ethiopia[J]. Radiology Research and Practice, 2025,2025(1): 9996789. Chen Lei, Zhang Xinxian, Xia Dandan, et al. Magnetic resonance imaging study of olfactory bulb volume in normal children [J]. Chinese Journal of Magnetic Resonance Imaging, 2022, 13(1): 110-113. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8969268","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":611242547,"identity":"ac55644e-380e-4f33-ad70-655d30c58b9f","order_by":0,"name":"Qi Zhang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Zhang","suffix":""},{"id":611242548,"identity":"0fd6480f-cb9e-4f8c-b6d4-4d9addf2021c","order_by":1,"name":"Xiaopeng Li","email":"","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Xiaopeng","middleName":"","lastName":"Li","suffix":""},{"id":611242549,"identity":"3acbefb0-fea9-4aa8-8da2-ea55ba29adf5","order_by":2,"name":"Yue Gao","email":"","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Gao","suffix":""},{"id":611242550,"identity":"a1e4fb5e-4211-42e9-9e0d-a14c1af0855b","order_by":3,"name":"Xiangru Wang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Xiangru","middleName":"","lastName":"Wang","suffix":""},{"id":611242551,"identity":"bfb5b546-fcb7-4dd2-b7f5-dc0f048baf5f","order_by":4,"name":"Lei Sun","email":"","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Sun","suffix":""},{"id":611242552,"identity":"82c285b2-c49e-47be-9317-17ce78396508","order_by":5,"name":"Hua Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJACZiC2sz/ewGAA5h4gUksyw5kDDAYHSNHC2HAjAaqakBaD42cPvy5ss2NmnPnGoPhjG4Mc340Exs8F+LScyUuzntmWzMcsnZZgcLCNwVjyRgKz9Aw8WswO5JgZ87YxM7NJJx8AaUnccCOBjZkHn5bzb0Ba6hl7JA82gLTUE9ZyI8f4MW/bYcYZEsxgWxIMCGmxv/HGjJnn3PFkAx6gX86ckzCceeZhszQ+LZL9Ocafecqq7QzYz5gZVJTZyPMdTz74GZ8WIGCTgDGAsQ9iMzbg1wCMyQ8wxgNCSkfBKBgFo2BkAgA2g0xwosE8SgAAAABJRU5ErkJggg==","orcid":"","institution":"the Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Hua","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-02-25 15:23:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8969268/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8969268/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105476761,"identity":"6cb9a729-e5b8-402c-937a-a1c750a65cf1","added_by":"auto","created_at":"2026-03-26 12:59:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":455422,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasonic examination method for palatine tonsil and corresponding image measurement methods. (A):Schematic diagram of the scanning method of median neck transverse of plane;(a):Ultrasonic measurement of the interal distance of the bilateral palatine tonsils;(B)Schematic diagram of the scanning method of longitudinal section of the left palatine tonsil;(b)Ultrasonic measurement of the longitudinal Section of the left palatine tonsil;(C)Schematic diagram of the scanning method of transverse section of the left palatine tonsil;(c)Ultrasonic measurement of the transverse section of the left palatine tonsil.the right side scan method and ultrasonic measurement are the same as the left.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8969268/v1/8acb70f6b5ae96c4c288c082.png"},{"id":105476762,"identity":"35b5069a-420a-4788-92ce-9b4aac12954f","added_by":"auto","created_at":"2026-03-26 12:59:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":158246,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound imaging of the palatine tonsil.＊:palatine tonsil; #:submandibular gland; \u0026amp;:lingual Muscles.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8969268/v1/23086a9800fe4ce5e3dc9da3.png"},{"id":105476764,"identity":"1ef3f9ca-7e93-4809-8dc1-eda90cfb03b7","added_by":"auto","created_at":"2026-03-26 12:59:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":196777,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between ultrasonic parameters of the palatine tonsils and individual factors in healthy children.R-SD:superior-inferior diameter of the right palatine tonsil,R-AD:anteroposterior diameter of the right palatine tonsil,R-LD:left-right diameter of the right palatine tonsil,R-V:volume of the right palatine tonsil,L-SD:superior-inferior diameter of the left palatine tonsil,L-AD:anteroposterior diameter of the left palatine tonsil,L-LD:left-right diameter of the left palatine tonsil,L-V:volume of the left palatine tonsil,ID:internal distance of bilateral palatine tonsils.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8969268/v1/b2e23dfb62013863f693f345.png"},{"id":105901520,"identity":"911f8391-71a2-42e8-a939-c771ae6ee753","added_by":"auto","created_at":"2026-04-01 09:29:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1401428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8969268/v1/0c5e99b3-5a7d-46ac-b50c-0e79eb31e52a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ultrasonic Parameters of Palatine Tonsils in Healthy Children: Correlations with Individual Factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTonsil diseases, particularly acute tonsillitis, are common and frequently occurring illnesses in children, significantly impacting their physical health.Currently, clinicians primarily rely on qualitative visual assessment through oral examination to judge the severity of tonsil lesions, lacking relevant quantitative reference indicators\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.With the iterative advancement of ultrasound equipment, high-frequency ultrasound has significantly improved the resolution of soft tissue imaging. As a non-invasive, real-time, and repeatable examination method, it is gradually being applied in the diagnosis of tonsil diseases\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.However, there is currently no unified standardized protocol for ultrasound examination, and quantitative reference data for healthy children are lacking, which restricts the development and application of this diagnostic method.\u003c/p\u003e \u003cp\u003eThis study aims to (1) apply high-frequency ultrasound to measure the dimensions and internal distance of bilateral palatine tonsils in healthy children aged 2 to 14 years, calculate their volume, and establish the normal reference ranges for each relevant parameter. (2) Investigate the correlations between palatine tonsil parameters and factors such as age, height, weight, BMI, and BSA. This aims to provide reference data from healthy children for the diagnosis of tonsil-related diseases.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study complied with the Declaration of Helsinki,and the research protocol was approved by the Ethics committee of the Second Affiliated Hospital of Xi'an Jiaotong University(ethical approval number:2023503).A signed informed consent form was acquired from the parent or legal guardian of each child.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy Population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted at the Second Affiliated Hospital of Xi'an Jiaotong University from June 2023 to September 2023.A total of 375 children aged 2-14 years who underwent health examinations were enrolled as the study subjects,and their basic data such as gender, age, height, weight recorded,and calculated the Body Mass Index (BMI) (BMI (kg/m²)=weight (kg) / height (m)²) and Body Surface Area (BSA) (BSA (m²)=0.0061×height (cm) + 0.0128×weight (kg)-0.1529).Then, the children were divided into five age groups: 2-4y, 5-8y, 9-11y, 12-14y.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were:children aged 2 to 14 years without any respiratory diseases or tonsil-related symptoms. The exclusion criteria were as follows:(i)children with acute upper respiratory tract infections; (ii) those presenting with tonsil-related symptoms such as snoring, nasal congestion, or breathing difficulties; (iii)individuals with a history of tonsil surgery; (iv)patients complicated with severe cardiac, cerebral, pulmonary, hepatic, renal, hematological, or endocrine system diseases; (v)those with psychiatric conditions unable to cooperate with the examination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImage acquisition\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA Mindray Resona R7 color Doppler ultrasound system was used, equipped with a C11-3U micro-convex array probe.\u003c/p\u003e\n\u003cp\u003eThe examined children were placed in a supine position with a small pillow under their shoulders and neck to achieve appropriate neck extension. The examination was conducted during quiet breathing. After applying an appropriate amount of coupling gel, the ultrasound probe was placed directly on the skin surface. Using the bilateral mandibular angles and the anterior midline of the neck as anatomical landmarks, real-time transverse and longitudinal scans were performed to visualize the palatine tonsils and their adjacent areas. During the scanning process, bilateral comparison was emphasized.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImage assessment and measurement\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUsing the bilateral mandibular angles as anatomical landmarks, transverse scanning was performed with the probe parallel to the mandibular angle and its orientation marker pointing toward the child's right side. After fully displaying the maximum cross-sectional view of the palatine tonsil, the image was frozen, and the widest left-right distance of the tonsil was measured as the left-right diameter.\u003c/p\u003e\n\u003cp\u003eLongitudinal scanning was then conducted with the probe perpendicular to the mandibular angle and its orientation marker pointing toward the child's head. After fully displaying the maximum longitudinal view of the palatine tonsil, the image was frozen. The longest superior-inferior distance was measured as the superior-inferior diameter, and the widest anterior-posterior distance was measured as the anteroposterior diameter.\u003c/p\u003e\n\u003cp\u003eDuring the longitudinal scans of the bilateral neck, the probe was positioned perpendicular to the mandible, with its indicator pointing toward the child's head. In this plane, the superior-inferior and anteroposterior diameters of the palatine tonsils were measured. For the transverse scans of the bilateral neck, the transducer was aligned parallel to the mandible, with its indicator directed toward the child's right side. The left-right diameter of the palatine tonsils was measured in this plane\u003csup\u003e[3]\u003c/sup\u003e.For the midline neck scan, the transducer was placed midline on the neck and oriented toward the skull base, with the indicator pointing to the child's right side. The probe was moved superiorly and inferiorly to clearly display the maximum dimensions of both palatine tonsils. The internal distance between the bilateral palatine tonsils was measured in this plane.(Figure 1)\u003c/p\u003e\n\u003cp\u003eCalculation of Palatine Tonsil Volume: The volume of the palatine tonsil was calculated in cubic centimeters (cm³) using the formula derived from the studies by Hosokawa T, et al.\u003csup\u003e[4, 5]\u003c/sup\u003e, defined as: (Superior-Inferior diameter×left-right diameter×Anteroposterior diameter)×0.52.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuality control\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll measurements were performed by two ultrasound physicians at or above the senior resident level and reviewed by one physician at or above the associate chief physician level.All data were jointly entered and cross-verified by two researchers to ensure accuracy.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll the statistical analysis was performed using SPSS software (version 25.0). Measurement data conforming to a normal distribution are presented as the mean±standard deviation(x̄±s), while data with a non-normal distribution are expressed as the median with the interquartile range (M (Q1, Q3)). Comparisons among multiple groups were conducted using the Kruskal-Wallis rank-sum test (H test). Spearman's correlation analysis was employed to assess the relationships between the various diameters, volume, and internal distance of the bilateral palatine tonsils and the individual factors. The Spearman correlation coefficient (|r|) \u0026lt; 0.3 indicates a very weak or negligible correlation, 0.3–0.5 indicates a low correlation, 0.5–0.8 indicates a moderate correlation, and \u0026gt; 0.8 indicates a strong correlation.A two-tailed P-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eParticipant characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study enrolled a total of 375 healthy children aged 2 to 14 years, with a median age of 9 (7, 11) years. The cohort consisted of 171 boys (45.6%) and 204 girls (54.4%). The baseline characteristics, including height, weight,BMI, and BSA, are summarized in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1\u0026nbsp;Summary of demographic information between males and females[IQR]\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTatal(N=375)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9(7,11)y\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e167(44.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e208(55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135(120,146.6)cm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29(21,38)kg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16(14.4,18.1)kg/cm\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.08(0.88,1.29)m\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eN:number;BMI:body mass index;BSA:body surface area.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUltrasound imaging features of the palatine tonsils\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe palatine tonsils are located deep to the submandibular gland. On transverse scans, they appear roughly circular, while on longitudinal scans, they present as oval shape with a wider superiorly and narrower inferiorly. A complete capsular echo can be visualized. And the overall echogenicity of the tonsils is lower than that of the submandibular gland.The internal structure shows a striated pattern with alternating bands of medium and low echogenicity. In some children, hyperechoic gas may be observed within the palatine tonsil.(figure 2)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eComparison of bilateral palatine tonsil volume and internal distance across age groups by sex\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed that in the 9\u0026ndash;11 age group, the internal distance between bilateral palatine tonsils was greater in boys than in girls, with a statistically significant difference(P\u0026lt;0.05). In the remaining age groups, there were no statistically significant differences in the volume of bilateral palatine tonsils or the internal distance between them between boys and girls(all P\u0026gt;0.05).(Table 2)\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;Comparison of bilateral palatine tonsil volume and internal distance across age groups by sex\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eAge/y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003eright palatine tonsil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003eleft palatine tonsil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003einternal distance between the bilateral tonsils\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003evolume/cm3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003evolume/cm3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003edistance/mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eboy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.79 (1.43,2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.66 (1.42,2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.50 (11.50,15.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egirl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.67 (1.25,2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.38 (1.26,1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.90 (11.00,15.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eboy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.32 (1.64,2.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.20 (1.71,2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.10 (14.40,19.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egirl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.02 (1.47,2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98 (1.73,2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.60 (13.70,18.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eboy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.43 (1.86,3.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.48 (1.95,3.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.35 (16.80,21.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egirl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.60 (2.04,3.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.60 (2.05,3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.90 (15.15,20.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eboy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.12 (2.29,3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.93 (2.12,3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.30 (18.05,24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egirl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.53 (1.90,3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.47 (2.00,3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.00 (16.40,21.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eComparison of palatine tonsil volume by side across age groups\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed no statistically significant differences in the volume between the left and right palatine tonsils across all age groups (all P \u0026gt; 0.05). Additionally, across different age groups, the volume of the palatine tonsils tended to increase with age.(Table 3)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3 Comparison of palatine tonsil volume by side across age groups\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge/y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003evolume/cm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.70 (1.27,2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.61 (1.31,2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e6-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.15 (1.54,2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.16 (1.73,2.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e9-11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.56 (2.01,3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.55 (2.03,3.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e12-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.64 (2.20,3.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.77 (2.08,3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eReference ranges for palatine tonsil ultrasound parameters in healthy children\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe normal reference ranges for the superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils in healthy children aged 2-14 years are as follows: (18.83-33.80)mm, (9.60-18.74)mm, (8.98-17.22)mm, (0.92-5.16)cm\u003csup\u003e3\u003c/sup\u003e, (9.32-25.50)mm. (Table 4 )\u003c/p\u003e\n\u003cp\u003eTable 4\u0026nbsp;95% Reference range for ultrasound measurement parameters of palatine tonsils in healthy children[P2.5-P97.5]\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge/y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003esuperior-inferior diameter/mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eanteroposterior diameter/mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eleft-right diameter/mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003evolume/cm3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003einternal distance/mm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.30-28.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.40-17.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.61-16.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.69-4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.43-20.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.90-32.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.67-18.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.60-17.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.91-5.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.88-16.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9-11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.10-33.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.10-18.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.10-17.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.06-4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.55-27.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e12-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.62-36.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.89-20.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.30-17.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.07-6.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.98-26.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eAnalysis of the correlations between ultrasonic parameters of the palatine tonsils and individual factors in healthy children\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils all showed positive correlations with age, height, weight, body surface area (BSA), and body mass index (BMI) (all P\u0026lt;0.01). Specifically, the superior-inferior diameter demonstrated a strong positive correlation with height, weight, and BSA (r \u0026gt; 0.5).(Figure 3)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this single-center study, the superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils were measured and calculated in 375 healthy children aged 2–14 years. Based on these measurements, preliminary reference ranges for palatine tonsil-related parameters in healthy children of this age group were established. Additionally, the correlations between these parameters and age, height, weight, BMI, and BSA were analyzed. The findings provide objective and reliable quantitative data to support the diagnosis of palatine tonsil-related diseases.\u003c/p\u003e\n\u003cp\u003eThe main findings are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(1)High-frequency ultrasound can clearly and completely visualize the bilateral palatine tonsils in children.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHigh-frequency ultrasound can objectively measure the size of the palatine tonsils and clearly display the internal structure, blood flow distribution, and surrounding tissues of the tonsils in most children\u003csup\u003e[6]\u003c/sup\u003e.It provides an objective reference basis for clinical research and disease diagnosis.Previous studies have shown a strong agreement between the tonsillar volume measured by high-frequency ultrasound and the actual volume\u003csup\u003e[7]\u003c/sup\u003e. Compared to other imaging modalities such as X-ray, CT, and MRI, high-frequency ultrasound offers advantages including safety, non-invasiveness, and the ability to perform repeat examinations within a short period\u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe palatine tonsils are located deep to the submandibular gland. On transverse scans, they appear roughly circular, while on longitudinal scans, they present as oval shape with a wider superiorly and narrower inferiorly. A complete capsular echo can be visualized. And the overall echogenicity of the tonsils is lower than that of the submandibular gland.The internal structure shows a striated pattern with alternating bands of medium and low echogenicity. In some children, hyperechoic gas may be observed within the palatine tonsil.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(2)Reference ranges for palatine tonsil ultrasound parameters in healthy children aged 2\u003c/em\u003e\u003cem\u003e–\u003c/em\u003e\u003cem\u003e14 years have been established, providing a data reference for clinical research.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe palatine tonsils are prone to recurrent infections during childhood\u003csup\u003e[9-11]\u003c/sup\u003e. The accumulation of numerous inflammatory factors and lymphocytes in this area leads to tonsillar hyperplasia and hypertrophy\u003csup\u003e[12]\u003c/sup\u003e.Enlarged tonsils may obstruct the airway, leading to serious consequences and significantly impacting children's health. Currently, clinical diagnosis relies primarily on subjective qualitative indicators to assess the severity of tonsil-related diseases, which is not conducive to early diagnosis and prognosis improvement. This study has preliminarily established reference ranges for palatine tonsil-related parameters in healthy children aged 2–14 years, providing objective quantitative reference indicators for early disease diagnosis and clinical research.\u003c/p\u003e\n\u003cp\u003eJiang et al.\u003csup\u003e[3]\u003c/sup\u003eperformed ultrasonic measurements of bilateral palatine tonsils in 224 healthy children aged 1-16 years, reporting volumes of 1.58 (1.23, 1.88) cm³ for boys and 1.46 (1.20, 1.69) cm³ for girls. The study did not further stratify the data by gender and age, limiting its clinical reference value. In contrast, the data stratification conducted in this research better aligns with the growth and development characteristics of children.\u003c/p\u003e\n\u003cp\u003eFurthermore, palatine tonsillar hypertrophy is a significant contributing factor to pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS)\u003csup\u003e[13]\u003c/sup\u003e. This study introduced the measurement of the internal distance between bilateral palatine tonsils, aiming to provide a simple and efficient method for reflecting the impact of tonsillar enlargement on the airway. The feasibility of this indicator for assessing the risk of pediatric OSAHS requires further confirmation through clinical research.\u003c/p\u003e\n\u003cp\u003eSimilarly, comparison of left and right palatine tonsil volumes within the same age groups showed no significant lateral differences. This suggests that significant asymmetry is not a typical feature of normal tonsillar development in individuals. Therefore, the identification of substantial size disparity between bilateral tonsils during clinical evaluation may serve as an indicator of potential pathology\u003csup\u003e[14, 15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3)Correlation between ultrasonic parameters of the palatine tonsils and individual factors in healthy children\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe superior-inferior diameter, anteroposterior diameter, left-right diameter, volume, and internal distance of bilateral palatine tonsils all showed positive correlations with age, height, weight, BSA, and BMI (all P \u0026lt; 0.01). Additionally, the volume of bilateral palatine tonsils and the internal distance between them exhibited an increasing trend with age.which is generally consistent with previous studies\u003csup\u003e[4, 16-20]\u003c/sup\u003e. Hosokawa et al.\u003csup\u003e[4]\u003c/sup\u003e,Muleta et al.\u003csup\u003e[21]\u003c/sup\u003e and Jiang et al.\u003csup\u003e[3]\u003c/sup\u003esuggested a strong correlation between palatine tonsil size and height, a finding that aligns with our results. Furthermore, our study also identified a high correlation between tonsil size and body surface area, in addition to height. This finding suggests that height and body surface area could serve as standards for establishing reference ranges for normal palatine tonsil size in children. Given that body surface area is closely associated with growth changes in children, using body surface area-standardized palatine tonsil volume may be a more reasonable approach\u003csup\u003e[22]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is a single-center study that only included Chinese children aged 2–14 years, and therefore may not reflect the actual conditions in regions such as Europe, the United States, or Indonesia. Future studies should involve multiple centers, broader geographical representation, and more researchers to further validate and expand upon these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, based on high-frequency ultrasound examinations of 375 healthy children aged 2–14 years, this study preliminarily established reference ranges for ultrasonic measurement parameters of pediatric palatine tonsils. This work highlights the role and value of high-frequency ultrasound scanning technology in disease screening and diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor's Contribution Statement \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQi Zhang: Literature retrieval, data collection and analysis, thesis conception and writing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiao-peng Li: Research guidance, Experimental Design.\u003c/p\u003e\n\u003cp\u003eYue Gao: Data Collection and Analysis,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiang-ru Wang: Image data and data organization.\u003c/p\u003e\n\u003cp\u003eLei Sun: Research guidance, proofreading and quality control, paper review\u003c/p\u003e\n\u003cp\u003eHua Wang: Research guidance, financial support, proofreading and quality control.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research data are confidential due to ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The authors declare no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNair L S R, George S, Anandaraj S, et al. Interexaminer agreement among pediatric dental specialists in assessment of tonsil size, Friedman tongue position, and Friedman staging of obstructive sleep apnea in children: An observational study[J]. Journal of the Indian Society of Pedodontics and Preventive Dentistry, 2024,42(2): 91-97.\u003c/li\u003e\n\u003cli\u003eRosto M, Del Signore F, et al. Evaluation of Presumptive Normal Feline Tonsils with Low-Field Magnetic Resonance Imaging: A Preliminary Retrospective Study[J]. Veterinary Sciences, 2023,10(10): 619.\u003c/li\u003e\n\u003cli\u003eJiang Ru, Pian Linping, Wang Quanjiang, et al. Ultrasonic measurement of palatine tonsil size and elasticity in healthy children and their correlation with individual factors [J]. Chinese Journal of Medical Imaging, 2022, 30(11): 1119-1122.\u003c/li\u003e\n\u003cli\u003eHosokawa T, Yamada Y, Takahashi H, et al. Size of the Tonsil on Ultrasound in Children Without Tonsil-Associated Symptoms[J]. Ultrasound quarterly, 2020,36(1): 24-31.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;ZT\u0026Uuml;RK M. Transcervical ultrasonographic examination of palatine tonsil size and its correlation with age, gender and body-mass index in healthy children[J]. International Journal of Pediatric Otorhinolaryngology, 2017,95: 24-28.\u003c/li\u003e\n\u003cli\u003eCao Y, Sun L, Li X, et al. Ultrasonic Image Characteristics of Palatine Tonsils in Healthy Children and Analysis of Factors Influencing Image Quality[J]. Journal of Clinical Ultrasound, 2025,53(3): 436-444.\u003c/li\u003e\n\u003cli\u003eAsimakopoulos P, Pennell D J L, Mamais C, et al. Ultrasonographic assessment of tonsillar volume in children[J]. International Journal of Pediatric Otorhinolaryngology, 2017,95: 1-4.\u003c/li\u003e\n\u003cli\u003eCoquia S F, Hamper U M, Holman M E, et al. Visualization of the Oropharynx With Transcervical Ultrasound[J]. AJR Am J Roentgenol, 2015,205(6): 1288-1294.\u003c/li\u003e\n\u003cli\u003eAbulikemu N, Liu Z, Liu Y. Novel Findings on the Development and Immunological Functions of Palatine Tonsils[J]. Clin Rev Allergy Immunol, 2025,68(1): 58.\u003c/li\u003e\n\u003cli\u003eHarabuchi Y, Takahara M. Pathogenic role of palatine tonsils in palmoplantar pustulosis: A review[J]. J Dermatol, 2019,46(11): 931-939.\u003c/li\u003e\n\u003cli\u003eHarabuchi Y. Tonsil-induced autoimmune/inflammatory syndrome: Current insights into the pathogenic role of tonsils in immunoglobulin A nephropathy, palmoplantar pustulosis and psoriasis[J]. Auris Nasus Larynx, 2025,52(4): 463-470.\u003c/li\u003e\n\u003cli\u003eMasters K G, Lasrado S. Anatomy, Head and Neck: Tonsils[J]. 2025.\u003c/li\u003e\n\u003cli\u003eOttinger A M, Singh R, Chen D, et al. Unilateral Tonsillar Enlargement as Initial Presentation of Bilateral Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma[J]. 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Shear-wave elastography of palatine tonsils: A normative study in children[J]. Journal of Medical Ultrasound, 2023,31(3): 223.\u003c/li\u003e\n\u003cli\u003eAn Zhongbin, Li Huiwen, Wang Shumin. Ultrasonic Assessment of Tonsillar Volume in Children [J]. Journal of Imaging Research and Medical Applications, 2020, 4(5): 152-153.\u003c/li\u003e\n\u003cli\u003eHong H S, Lee J Y, Jeong S H. Normative Values for Tonsils in Pediatric Populations Based on Ultrasonography[J]. J Ultrasound Med, 2018,37(7): 1657-1663. \u003c/li\u003e\n\u003cli\u003eMuleta R T, Bezabih N A, Abera M T, et al. Sonographic Estimation of Normal Palatine Tonsil Size in Under 18 Year Olds Who Visited a Tertiary Teaching Hospital in Addis Ababa, Ethiopia[J]. Radiology Research and Practice, 2025,2025(1): 9996789.\u003c/li\u003e\n\u003cli\u003eChen Lei, Zhang Xinxian, Xia Dandan, et al. Magnetic resonance imaging study of olfactory bulb volume in normal children [J]. Chinese Journal of Magnetic Resonance Imaging, 2022, 13(1): 110-113.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Palatine tonsil, Health children, High-frequency ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-8969268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8969268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e High-frequency ultrasound is gradually being applied to the diagnosis of tonsil diseases. However,there remains a lack of relevant quantitative reference indicators and unified assessment standards. which limits the development and application of ultrasound examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e High-frequency ultrasound was applied to observe and measure the palatine tonsils of healthy children, and the reference value range of relevant parameters was initially established.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and methods \u003c/strong\u003eA total of 375 healthy children aged 2-14 y were enrolled between June 2023 and September 2023.Basic data such as gender, age, height, weight, BMI, and BSA were recorded and the relevant parameters of bilateral palatine tonsils were measured by high-frequency ultrasound. The data were stratified by age group and gender. To explore the correlations between the relevant parameters of the palatine tonsils and individual factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe normal reference value ranges for the superior-inferior diameters, anteroposterior diameters, left-right diameters, volumes and internal of bilateral palatine tonsils in 375 healthy children are as follows: (18.83-33.80)mm, (9.60-18.74)mm, (8.98-17.22)mm, (0.92-5.16)cm3, (9.32-25.50)mm. The parameters of bilateral palatine tonsils in healthy children were significantly positively correlated with height, weight, BSA and BMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e This study initially established the reference values of quantitative parameters of the palatine tonsils in healthy children, which can provide reference value for clinical practice.\u003c/p\u003e","manuscriptTitle":"Ultrasonic Parameters of Palatine Tonsils in Healthy Children: Correlations with Individual Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 12:59:50","doi":"10.21203/rs.3.rs-8969268/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6804860-b62f-472f-9752-efd1290fadc3","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65032865,"name":"Health sciences/Diseases"},{"id":65032866,"name":"Health sciences/Health care"},{"id":65032867,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-01T09:25:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 12:59:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8969268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8969268","identity":"rs-8969268","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}