Tonsillitis

Indications for urgent referral

Table 1: Indications for urgent referral
Urgent adult referral Urgent paediatric referral Emergency paediatric referral
  • 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.
  • Acute episode 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.
  • Acute episode unable to tolerate fluids.
  • Stridor.
  • Acute respiratory distress.
  • Peritonsillar cellulitis or abscess (quinsy).

For urgent referrals, contact the ENT Register at the relevant hospital.

Criteria for routine specialist referral via 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).
  • Episodes must be well documented, clinically significant and adequately treated as per best practice guidelines for primary care:
    • seven or more episodes in the preceding year or
    • five or more episodes in each of the preceding two years or
    • three or more episodes in each of the preceding three years or
    • extraordinary circumstances, for example excessive time off work (>three weeks per year) or school (>four weeks per year), documented if frequency above not met.

Routine referral information required

Documented frequency of episodes of tonsillitis, the severity of the episodes, and a summary of the treatment given and response to date.

Information about community management

Further information regarding primary care management of ENT conditions is available on HealthPathways WA (external site). Please email the HealthPathways team to obtain the login details: healthpathways@wapha.org.au. HealthPathways are currently working on responding to the new criteria and will have all the ENT pathways adapted to WA as soon as possible.