Occasionally people present with tonsils that are different in size to me. This is an important scenario. Assymetric tonsils may be associated with a number of conditions but most patients, unless significantly unwell will come to a surgical removal.
The reason for this is because there is a risk of one of the tonsils being associated with a malignant pathology. However, some people end up with assymetric tonsils after recurrent infections (tonsillitis). Occasionally tumours from outside the tonsil push the tonsil into the oropharynx making it look assymetrical.
One of the indications for a tonsillectomy is clearly an assymetric tonsil for a histological diagnosis and this should be carried out fairly quickly to get the diagnosis.