What criteria should I use to determine if a patient with recurrent tonsillitis requires referral for tonsillectomy?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Criteria for referral for tonsillectomy in patients with recurrent tonsillitis:

  • Referral to an ear, nose, and throat (ENT) specialist is advised for people with severe recurrent tonsillitis defined as:
    • More than 7 episodes in 1 year, or
    • 5 episodes per year for 2 consecutive years, or
    • 3 episodes per year for 3 consecutive years
  • There should be no other explanation for the recurrent symptoms.
  • Tonsillectomy may benefit this cohort by reducing the number of sore throat episodes and improving quality of life.

These criteria are based on expert opinion and supported by guidelines including BMJ Best Practice, the American Academy of Otolaryngology–Head and Neck Surgery guidelines, and NICE recommendations.

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