Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Tonsillitis and Tonsillectomy

Tonsillitis and Tonsillectomy

Pathway Publish Date: February 2024
Next Review Date: February 2026

Tonsillectomy is usually only funded for recurrent tonsillitis as described below.  Referral should usually only be made if patient meets criteria: 


  • Recurrent tonsillitis* (documented to be disabling and prevent normal functioning) 
    • seven or more well documented, clinically significant, adequately treated sore throats in the preceding year


  • Five or more such episodes in each of the preceding two years


  • Three or more such episodes in each of the preceding three years
  • Recent history of peri-tonsillar abscess (quinsy)
  • Guttate psoriasis which is exacerbated by recurrent tonsillitis
  • Suspected obstructive sleep apnoea due to enlarged tonsils
  • 2 previous hospitalisations for tonsillitis
  • Chronic tonsillitis with a significant impact on quality of life characterised by persistent soreness
  • Patient and clinician have engaged in shared decision making process and patient requests referral.  NHS Rightcare ‘Recurrent sore throat decision aid’ (attached)

NB. funding for tonsillectomy will only be routinely approved when the above criteria have been met (see Priorities Forum Statement Tonsillectomy in Adults and Children)

RED FLAGS and reasons for immediate admission - see pathway

* NB: Centor criteria should be used to guide antibiotic therapy (Centor score 3 or 4 antibiotics may be required).  Eash point below scores one

  • Presence of tonsillar exudate
  • Presence of tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever
  • Absence of cough