Tonsillitis (recurrent) or tonsillar enlargement

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Acute tonsillitis with airway obstruction and/or unable to tolerate oral intake and/or uncontrolled fever
  • Tonsillar haemorrhage of any amount
  • Airway compromise - Stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia, severe obstructive sleep apnoea with desaturations

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute ENT Assessment

Presenting issues
  • Recurrent sore throat due to acute tonsillitis where the episodes of sore throat are disabling and prevent normal functioning (i.e. tonsillitis indicated for tonsillectomy)
  • Suspicious unilateral tonsillar solid mass with or without ear pain
Mandatory referral information (referral will be returned if this information is not included)


  • Relevant history, onset, duration, frequency and severity of symptoms

*Episodes must be well documented, clinically significant and adequately treated as per best practice guidelines for primary care:

  • 7 or more episodes in the last 12 months or
  • 5 or more episodes in each of the last 24 months or
  • 3 or more episodes in each of the preceding 3 years or
  • extraordinary circumstances, for example excessive time off work (>3 weeks per year) documented if frequency above not met

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
  • Number of hospital admissions for tonsillitis in the previous 12 months
  • Degree of systemic upset
  • Details of previous treatment (including systemic and topical medications and antibiotics prescribed) including the course and outcome of the treatment 
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Suspected neoplasm – ulceration, or recurrent unilateral enlargement, particularly with associated cervical lymphadenopathy
  • Acute episode unable to tolerate fluids/non-resolution despite optimal medical management
  • Noisy breathing, breathing difficulty, voice change or severe odynophagia 
Category 2
Appointment within 90 days
  • No defined category 2 criteria
Category 3
Appointment within 365 days
  • Chronic or recurrent infection with fever/malaise and decreased PO intake and any of the following:
    • 7 or more episodes in the last 12 months
    • 5 or more episodes in the last 24 months
    • sleep apnoea due to tonsillar hypertrophy
    • tonsillar concretions with halitosis
    • absent from work/university/college for 4 weeks in a year 
Last reviewed: 02-10-2023