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This guidance covers recurrent acute tonsillitis and referral for tonsillectomy.
Typical features of tonsillitis include:
Caution with examination of the throat of anyone with suspected epiglottitis (dysphonia, drooling, sepsis or stridor)
Consider differential diagnoses:
Consider immediate admission to hospital if patient presents with:
Throat swabs should not be carried out routinely in primary care management of sore throat unless scarlet fever is suspected.
Consider serology for infectious mononucleosis.
Formulary Chapter 5: Infections - Upper respiratory tract infections - Acute sore throat
Tonsillectomy will only be routinely commissioned in adults and children in Devon in the following circumstances:
Documented evidence of:
AND
In line with NHS England guidance (2018), after appropriate specialist assessment tonsillectomy may be considered at a lower threshold than the above for the following indications:
Tonsillectomy/adenotonsillectomy will be funded in children under 16 where obstruction of the airway results in obstructive sleep apnoea syndrome, and the following apply:
Tonsillectomy is not routinely commissioned solely for the management of snoring.
Tonsillectomy is not routinely commissioned for the treatment of tonsilloliths (tonsil stones).
Head and Neck cancer services are commissioned by NHS England as part of specialist cancer services; treatment of malignancy is therefore out of scope of this guideline and the policy below.
Click on the link for the complete Tonsillectomy Commissioning Policy
e-Referral selection:
e-Referral selection:
Clinical Knowledge Summary: Sore throat - acute
SIGN guidance on tonsillectomy
This guideline has been signed off on behalf NHS Devon.
Publication date: March 2020
Updated in accordance with the Devon Tonsillectomy Commissioning Policy July 2024