Background: Tonsillar hypertrophy, which is an indicator of tonsillectomy, is less accurate in making indications, so more specific indicators are needed. In chronic tonsillitis, biofilm bacteria are found which can cause antibiotic resistance. The presence of biofilm bacteria in chronic tonsillitis causes antibiotic drugs to not work properly, which is indicated to be the cause of delayed recovery in chronic tonsillitis. Purpose: Knowing the relationship between the gradation of biofilm bacterial density and tonsillar hypertrophy in patients with chronic tonsillitis. Method: This study was an observational analytic study with a cross-sectional study design. All patients with chronic tonsillitis who undergo tonsillectomy were selected by consecutive sampling. Gradations of tonsillar hypertrophy and bacterial biofilm were examined by scanning electron microscopy (SEM). Result: The results of biofilm density gradation from 26 samples obtained grade 0 results of 1 (3.85%) patient with T2 tonsils, class 1 as many as 1 (3.85%) patient with T2 tonsils. Class 2 were 2 (7.69%) patients with T2 tonsils and 3 (11.54%) patients with T3 tonsils. Class 3 were 1 (3.85%) patient with T2 tonsils, 7 (26.92%) patients with T3 tonsils and 1 (3.85%) patient with T4 tonsils. Class 4 (biofilms> 76%) as many as 2 (7.69%) patients with T3 tonsils and 8 (30.76%) patients with T4 tonsils. Conclusion: There is a relationship between the gradation of biofilm bacterial density and tonsillar hypertrophy in patients with chronic tonsillitis. The higher the gradation density of biofilm bacteria, the higher the gradation of tonsillar hypertrophy.

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