Tonsillitis (recurrent) or tonsillar enlargement Referral Access Criteria

• 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  

• Nil

• 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       

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.

• 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

• Nil

• Nil

• 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        

• Nil

• Nil

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

• Excluded condition for the following:
  • If the patient is not willing to have surgical treatment
  • Halitosis without other symptoms
    • See Clinician Assist WA: Tonsillitis and Sore Throat (external site)

• Nil