Referral for tonsillectomy


SEE SIGN guideline 117 management of sore throat and indications for tonsillectomy

Referral criteria for tonsillectomy

Routine referral  for tonsillectomy

Urgent referral  for tonsillectomy

(Red Flag)


  1. 2 episodes of quinsy

  2. Quinsy with a previous or subsequent history of tonsillitis

Obstructive symptoms

  1. sleep apnoea

  2. Massive tonsils causing swallowing difficulties

Chronic tonsillitis

  1. Halitosis associated with white cheesy debris from tonsillar crypts

Recurrent tonsillitis


  1. x5/yr for 2 yrs or

  2. >x8 in 1 yr


  1. x3/yr for 2 yr or

  2. >6 in 1 yr

Requires biopsy

  1. Recent unilateral enlargement

  2. Ulceration

especially with associated cervical lymphadenoathy

Lesser criteria if episodes are

  1. very severe associated with hospital admissions

  2. associated with febrile convulsions, epilepsy, major asthma flare-ups or psoriasis