Tonsillectomy for recurrent tonsillitis

For the treatment of

Recurrent sore throats in adults and children.

Commissioning position

This intervention is commissioned if the following criteria are met:

sore throats are due to acute tonsillitis AND
the episodes are disabling and prevent normal functioning AND there have been
seven or more, documented, clinically significant, adequately treated sore throats in the preceding 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.

Exception to the above fixed number of episodes can be made for adults with severe or uncontrolled symptoms, or if complications (e.g. quinsy) have developed.

A lower threshold than the above may be appropriate, subject to specialist assessment, if one or more of the following conditions is present, which can make episodes of tonsillitis more damaging to health:

Acute and chronic renal disease resulting from acute bacterial tonsillitis
as part of the treatment of severe guttate psoriasis
metabolic disorders where periods of reduced oral intake could be dangerous to health
PFAPA (Periodic fever, Aphthous stomatitis, Pharyngitis, Cervical adenitis)
severe immune deficiency that would make episodes of recurrent tonsillitis dangerous.

This policy does not apply to treatment of Obstructive Sleep apnoea in children or adolescents or due to Recurrent Quinsy, for which tonsillectomy is commissioned.

Summary of rationale

Recurrent sore throats are a very common condition that presents a considerable health burden. In most cases they can be treated with conservative measures. In some cases, where there are recurrent, documented episodes of acute tonsillitis that are disabling to normal function, then tonsillectomy may be beneficial.

Tonsillectomy surgery carries a small risk of complications, including bleeding, pain and infection, which may require readmission to hospital (3.5%).

There is no alternative treatment for recurrent sore throats that is known to be beneficial, however sometimes symptoms improve with a period of observation.