when to refer repeat tonsillitis

Referral for specialist assessment for recurrent tonsillitis is generally considered when conservative management has failed or when specific red flags are present. While the provided context does not directly address recurrent tonsillitis, it outlines referral criteria for related conditions that may inform practice.

General Referral Considerations (based on related conditions):

• Hearing Loss: For adults with hearing loss not explained by acute external or middle ear causes, consider referral to an ear, nose and throat (ENT), audiovestibular medicine, or specialist audiology service if the hearing loss is unilateral or asymmetric, fluctuates without an upper respiratory tract infection, is associated with hyperacusis, persistent tinnitus, or vertigo, or is not age-related NICE NG98. Referral is also indicated if there is pain lasting over a week unresponsive to treatment, persistent ear discharge, abnormal ear canal appearance, or a middle ear effusion persisting after an upper respiratory tract infection NICE NG98.
• Suspected Cancer: In children and young people, consider a very urgent referral (within 48 hours) for specialist assessment if they have unexplained lymphadenopathy with fever, night sweats, shortness of breath, pruritus, or weight loss, or unexplained splenomegaly with night sweats or pruritus NICE NG12.
• Otitis Media with Effusion (OME): If OME is clinically suspected based on history and presenting features, refer for formal assessment, which should include clinical examination (otoscopy, upper respiratory health, developmental status), hearing testing, and tympanometry NICE NG233.

Note: The specific criteria for referral for recurrent tonsillitis would typically be found in guidelines related to ENT conditions, which are not fully detailed in the provided context. However, the principles of referral for persistent or concerning symptoms, or when initial treatments are ineffective, are generally applicable.