Reviewed on : 16 May 2019

Reviewed by : Rob Fontaine and Gateway Editor

Expires : 16 May 2021

Surgical Management of Recurrent Tonsillitis

Prior approval from the CCG is be required before any treatment proceeds in secondary care.

Refer to Secondary Care provider via RSS using the appropriate Prior Approval Referral Form.

The following criteria¹are indications for consideration and funding of tonsillectomy/ adenontonsillectomy for both children and adults:

Sore throats due to acute tonsillitis AND the following documented evidence applies:

• 7 or more clinically significant, adequately treated sore throats in the preceding year;

OR

• 5 or more episodes in each of the preceding two years;

OR

3 or more episodes in each the preceding three years

The CCG will also fund patients after specialist assessment for:

• Acute and chronic renal disease resulting from acute bacterial tonsillitis
• As part of the treatment of severe guttate psoriasis
• Metalbolic disorders where periods of reduced oral intake could be dangerous to health
• Periodic fever, Apthous stomatitis, Pharyngitis, Cervical adenitis (PFAPA)
• Severe immune deficiency that would make episodes of recurrent tonsillitis dangerous

Note that this guidance only relates to patients with recurrent tonsillitis.

This policy should not apply to other conditions where tonsillectomy should continue to be funded and they include:

• A convincing history of obstructive sleep apnoea associated with tonsillar enlargement (which will be supported by a sleep study or other accepted method of diagnosis)
• One episode of peri-tonsillar abscess (recurrent quinsy)
• Patients with tonsillar enlargement causing acute upper airway obstruction requiring emergency surgery
• Suspected cancer

 ¹ SIGN 117 (Scottish Intercollegiate Guidelines Network, April 2010) ‘Management of Sore Throat and Indications of Tonsillectomy’.