SRP 103 Tonsillectomy/Adenoidectomy for Recurrent Tonsillitis

Policy Number: SRP 103
Policy Name: Tonsillectomy/Adenoidectomy for Recurrent Tonsillitis
Status: Individual Funding Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026

Suspected or confirmed malignancy – should be referred via the 2 Week Wait pathway. Tonsillectomies required as part of treatment for malignancy do not need prior funding approval. Prior approval is not required for patients with tonsillar asymmetry or diagnostic tonsillectomy for suspicion of cancer.

Recurring sore throats are a very common condition that presents a large burden on healthcare; they can also impact on a person’s ability to work or attend school. It must be recognised, however, that not all sore throats are due to tonsillitis, and they can be caused by other infections of the throat. In these cases, removing the tonsils will not improve symptoms.

Mid and South Essex ICB commissions tonsillectomies for recurrent tonsillitis on a restrictive basis for patients who meet criteria listed below.

Individual Prior Approval for funding is required in all cases. GPs should not refer unless the criteria below have been met, and referrals must include objective information to demonstrate this. The impact of recurrent tonsillitis on a patient’s quality of life and ability to work or attend education should be documented.

A period of at least 6 months watchful waiting by the GP is recommended prior to consideration of referral for tonsillectomy to establish firmly the pattern of symptoms and allow the patient/parents to consider fully the implications of operation.

Before referral to secondary care, the GP should discuss with patient/parents or carers the benefits and risks of tonsillectomy vs. active monitoring. Patients should be signposted to appropriate information on coexistent issues e.g. weight loss and allergy management and reassurance given if no further treatment; or referral for tonsillectomy is deemed necessary at this stage. The NHS Recurrent Tonsillitis Decision Aid should be used, and discussion documented with appropriate follow up.

Patients must meet the following criteria: (the answers to 1 and 2 must be ‘Yes’ and then the answer to any one criterion 3-6 must be ‘Yes’):

1. Sore throats that are due to recurrent acute tonsillitis
   AND
2. Episodes of recurrent acute tonsillitis that are disabling and prevent normal functioning.
   AND
3. Seven or more well documented clinically significant, adequately treated* episodes of acute tonsillitis in the preceding year.
   OR
4. Five or more such episodes in each of the preceding two years.
   OR
5. Three or more such episodes in each of the preceding three years.

*To note: Non-prescription of antibiotics does not mean that sore throats have been inadequately treated.

OR

the patient should have one of the following conditions:

• intractable cough with a high level of streptococcal antibody for longer than one year-test results to be included with referral.
• severe halitosis for longer than one year due to tonsil crypt debris
• peritonsillar abscess not responding to antibiotics and incisional drainage.

MSE ICB commissions tonsillectomy with or without concurrent adenoidectomy for Obstructive sleep apnoea (OSA) in:

• adults who have been diagnosed by sleep study/overnight polysomnography, in the presence of large tonsils – see also SRP 169 Sleep Studies Policy.
• children where OSA is demonstrated by sleep study or diagnosed clinically in the presence of large tonsils.

Adenoidectomy as a separate procedure will not be funded. See also SRP 134 Grommets Policy.

Once a decision is made for tonsillectomy, this should be performed as soon as possible, to maximise the period of benefit before natural resolution of symptoms might occur (without tonsillectomy).

Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.

Find out more information on applying for funding in exceptional clinical circumstances.

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