Objectives: This study was undertaken to investigate the presence and nature of granulomatous changes in the adenotonsillar tissues and their relation to systemic disorders. Materials and Methods: The study was a retrospective clinicopathological review; 21,410 specimens of tonsil and adenoid tissue were subjected to histological examination during the period from 1995 to 2003. Twenty-three cases of tonsillar and adenoid granuloma (12 males and 11 females) were identified. Haemotoxylin and eosin stains were reviewed and clinical features noted. Results: Of 23 cases, 11 were adenotonsillectomies, 10 tonsillectomies, 1 adenoidectomy and 1 excision biopsy of the right tonsil. Histologically, the slides reviewed showed 4 types of granulomatous inflammation that can affect the adenotonsillar tissues. The most common type was non-caseating epithelioid granulomas. Clinically, 22 cases presented with symptoms of chronic tonsillitis, nasal obstruction and obstructive sleep apnoea. None had any systemic granulomatous disorders. Only 1 case had tuberculosis. Conclusion: In all the cases but one there was no obvious systemic aetiology for the granulomatous changes in the adenotonsillar tissues. Hence, the cost effectiveness of clinicopathological examination of the resected adenoid and tonsil is still questionable.