Tonsillitis (recurrent) or tonsillar enlargement Referral Access Criteria

Referrers should use this page when referring patients to public adult ENT outpatient services for recurrent tonsillitis or tonsillar enlargement.
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.
  • 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  
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):

  • Nil
To contact the relevant service, see Clinician Assist WA: Acute ENT assessment (external site)
Clinical indications for outpatient referral
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)
  • Suspicious unilateral tonsillar solid mass with or without ear pain       
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 in regional or remote areas or due to financial reason).

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, 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 three years or
    • extraordinary circumstances, for example excessive time off work (>three weeks per year) documented if frequency above not met
Examination
  • Nil
Investigations
  • Nil
Highly desirable
History
  • 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        
Examination
  • Nil
Investigations
  • Nil
Indicative clinical urgency 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
Exclusions
Useful information
  • Nil

Feedback

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Last reviewed: 02-10-2023