Referral Criteria

Tonsillectomy will only be routinely commissioned in adults and children in Devon in the following circumstances:

• Recurrent (two or more) episodes of peritonsillar abscess (Quinsy)
  
• Tonsillar enlargement causing or contributing to acute upper airways obstruction
  
• Recurrent acute sore throat due to tonsillitis with the following criteria:
  • Documented evidence of:
    • 7 or more episodes of tonsillitis in the last year; OR
    • 5 or more such episodes per year in the preceding two years; OR
    • 3 or more such episodes per year in the preceding three years;
  AND
  • There has been significant impact on quality of life indicated by documented evidence of symptoms that act as a barrier to employment or education or carrying out carer activities
  • Failure to thrive

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:

• Acute and chronic renal disease resulting from acute bacterial tonsillitis (assessment to include renal specialist)
• As part of treatment of severe guttate psoriasis (assessment to include dermatology specialist)
• Metabolic disorders where periods of reduced oral intake could be dangerous to health (assessment to include paediatrician or endocrinologist)
• PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) (assessment to include paediatrician)
• Severe immune deficiency that would make episodes of recurrent tonsillitis dangerous (assessment to include paediatrician, or haematology or immunology specialist)

Tonsillectomy/adenotonsillectomy will be funded in children under 16 where obstruction of the airway results in obstructive sleep apnoea syndrome, and the following apply:

• A significant impact on development, behaviour and/or quality of life demonstrated by supporting evidence such as growth charts, letters from GPs; OR
• A strong clinical history (± sleep studies) suggestive of sleep apnoea

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 policy.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Publication date: July 2024