Tonsillitis (recurrent) Referral Access Criteria

Referrers should use this page when referring patients to public paediatric ENT outpatient services for tonsillitis (recurrent). This RAC is applicable to referrals for patients aged <16 years only. Please refer to the ENT (Adult) RAC for referrals for patients aged 16 years or more.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Foreign body (button batteries – inhaled or ingested). if suspicion of button battery immediate emergency review
  • Acutely enlarging neck mass with any associated airway symptoms e.g., stridor, drooling, dysphagia etc
  • Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/ severe odynophagia
  • Trauma
  • Abscess or haematoma (e.g., peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
  • Post-tonsillectomy haemorrhage
  • Hoarseness associated with neck trauma or surgery
  • If new onset hoarse voice and any airway obstructive symptoms             
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric ENT assessment (seen within 7 days):
  • Acute episode tonsillitis with non-resolution despite optimal medical management
  • Noisy breathing, voice change or severe odynophagia/obstructive sleep apnoea.
  • Suspected neoplasm – ulceration, or recurrent unilateral enlargement, particularly with associated cervical lymphadenopathy
To contact the relevant service, see HealthPathways: Acute Paediatric ENT assessment (external site)
Presenting issues
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • 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), and:
  • Episodes must be well documented, clinically significant and adequately treated:
    • ≥7 episodes in the last 12 months, or
    • ≥5 episodes per year for 2 consecutive years, or
    • ≥3 episodes per year for 3 consecutive years, or
    • >4 weeks missed for school or parents’ attendance at work             
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

History
  • Relevant history, frequency, and severity of episodes, including details of:
  • Sleep apnoea symptoms or sleep disordered breathing symptoms
  • Details of previous treatment and outcome
  • Relevant past medical history (including any syndromes, cardiac conditions, haematological conditions, and metabolic conditions)
Examination
  • Size of tonsils
  • Height and weight
Investigations
  • Nil
Highly desirable
History
  • Nil
Examination
  • Nil            
Investigations
  • EBV serology/monospot results
  • FBC

Indicative triage category

Category 1

Appointment within 30 days           

  • No defined category 1 criteria 

Category 2

Appointment within 90 days

 

  • Ulceration and/or recurrent unilateral enlargement, with/without lymphadenopathy 

 

Category 3

Appointment within 365 days

  • Recurrent sore throat due to acute tonsillitis and any of the following:
    • 7 or more episodes in the last 12 months
    • 5 episodes per year for 2 consecutive years
    • 3 episodes per year for 3 consecutive years
    • more than 4 weeks missed for school or parents’ attendance at work
    • history of quinsy             
Exclusions
  • Recurrent tonsillitis is an excluded condition when the following features apply:
    • If the patient is/parents are not willing to have surgical treatment.
    • Halitosis without other symptoms             
Useful information

Feedback

If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.

Last reviewed: 27-05-2024