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

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
Immediately 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

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

Highly desirable

History

Examination

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

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
See HealthPathways: Tonsillitis and Sore Throat (external site)

Last reviewed: 27-05-2024

Tonsillitis (recurrent) Referral Access Criteria

Related links