Please click here to view the full Tonsillectomy Commissioning Statement.
Please click here to access the referral form.
Red Flags - urgent referral or admission is required for1, 2
- Peritonsillar abscess (quinsy)
- Adult obstructive sleep apnoea with tonsillar enlargement (if trials of continuous positive airway pressure (CPAP) and the use of mandibular advancement devices are unavailable or unsuccessful).
- Severe neck infection
- Excluding possible malignancy eg lymphoma
- Sleep disordered breathing (apnoea) in children
- Patients with sore throat who have stridor, progressive dysphagia, bleeding, increasing pain or severe systemic symptoms (may require hospital admission)
- Tonsil bleeding
In all other cases, a six month period of watchful waiting is recommended prior to referral for tonsillectomy to establish the pattern of symptoms and to allow the patient time to fully consider the implications of the operation.
Before referral to secondary care, discuss with patient/parents or carers the benefits and risks of tonsillectomy vs watchful waiting, as emphasised by the Royal College of Surgeons guidance3. Information should be provided and reassurance given if no further treatment or referral for tonsillectomy is deemed necessary at this stage. This discussion should be documented.
Patient information about tonsillitis and tonsillectomy available at tonsillitis
Referral criteria for possible tonsillectomy
Tonsillectomy will only be commissioned in accordance with the criteria specified below for recurrent acute sore throat in adults and children in the following circumstances:
Consider referral, using the referral form, if SIGN criteria are met4
- 7 or more clinically significant, adequately treated sore throats in the preceding 12 months confirmed by a GP
- 5 or more episodes in each of the preceding two years, treated with antibiotics confirmed by a GP
- 3 or more episodes in each of the preceding three years confirmed by a GP
- There has been significant severe impact on quality of life and normal functioning, as indicated by documented objective evidence (eg absence from school, failure to thrive)
The impact of recurrent tonsillitis on a patient’s quality of life must be taken into consideration. A fixed number of episodes, as described above, may not be appropriate for adults with severe symptoms.
Other indications for tonsillectomy may include:
- Marked tonsillar asymmetry, which there is clinical suspicion of sinister pathology
- Adult obstructive sleep apnoea with tonsillar enlargement (if trials of CPAP or mandible advancement devices are unsuccessful)
The CCG will also consider funding in children (<16) with sleep disordered breathing if ANY ONE of the following applies:
- Witnessed episodes of apnoea exceeding 10 seconds OR choking episodes during sleep
- A positive sleep study
- Significant impact on quality of life (daytime behaviour/sleepiness)
Tonsillectomy for the treatment of halitosis associated with tonsillar debris is NOT routinely commissioned.
Within secondary care, there should be3
- Confirmation of primary care assessment, fulfilment of SIGN criteria for tonsillectomy and impact on quality of life and ability to work/attend school.
- Consultation with patient about management options using shared decision making strategies and tools where appropriate
- Management options: tonsillectomy, or referral back to primary care for on-going monitoring.
Treatment in all other circumstances is not normally funded and should not be referred unless there is prior approval by the Individual Funding Request Panel.
Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that justifies deviation from the rule of this policy. Individual cases will be considered by the individual funding request panel. To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.