What criteria should I use to decide whether to refer a patient with recurrent sore throats to an ENT specialist?

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

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

Refer a patient with recurrent sore throats to an ear, nose, and throat (ENT) specialist if they have severe recurrent tonsillitis defined as:

  • More than 7 episodes in 1 year,
  • 5 episodes per year for 2 consecutive years, or
  • 3 episodes per year for 3 consecutive years,

and there is no other explanation for the recurrent symptoms. This group may benefit from tonsillectomy.

Additionally, urgent referral should be considered if there are signs of serious complications such as difficulty swallowing saliva or liquids, breathing difficulties, one-sided neck or throat swelling, or if symptoms do not improve after 3 to 4 days of antibiotic therapy.

Educational content only. Always verify information and use clinical judgement.