Tonsillitis (recurrent) Referral Access Criteria

• 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             

• 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

• 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             

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.

• 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)

• Size of tonsils
• Height and weight

• Nil

• Nil

• Nil            

• EBV serology/monospot results
• FBC

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             

• 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             

• See Clinician Assist WA: Tonsillitis and Sore Throat (external site)