Tonsillectomy for Recurrent Tonsillitis or its Complications (e.g. Quinsy) in Children <16 and in adults

Threshold

Unequivocal Indications for Tonsillectomy

Patients with the following are exempt from this policy and immediate referral for treatment is recommended:

• Peri-tonsillar abscess (Quinsy) – one episode of quinsy with history of recurrent tonsillitis OR 2^nd episode of quinsy
• Acute upper airways obstruction
• Suspected tonsillar malignancy

Tonsillectomy for Recurrent Tonsillitis

This procedure will be funded for the treatment of sore throats in adults and children if the following criteria can be met:

• Sore throats are due to acute tonsillitis

AND

• Episodes of sore throats are disabling and prevent normal functioning (documented absence from school or work)

AND

• Seven or more documented, clinically significant, adequately treated sore throats in the previous year* OR five or more such episodes in each of the preceding two years*OR three or more such episodes in each of the preceding three years* (Paradise Criteria) OR severe recurrent tonsillitis in adults that results in two or more hospital admissions.

*Each of the episodes must of a debilitating nature (for example documented absence from school or work >3 days + visit to GP) and be well documented in the patient’s notes.

Detailed documentation of the criteria that are fulfilled is required in the GP’s referral letter, where available; clinically appropriate referrals will be sent to the GPs.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.