- The classic B symptoms (lymphoma) such as night time fevers/night sweats or, weight loss, loss of appetite with or without tonsillar enlargement should also be considered for urgent referral.
- Significant tonsillar enlargement, bleeding, ulceration with or without asymmetry especially in adult /adolescent population require further investigation.
- Good history for obstructive sleep apnoea, severe habitual snoring and other associated symptoms such as daytime somnolence, hyperactivity, poor concentration, behavioural difficulties, swallowing and voice changes along with clinical examination findings of enlarged adenoids/or tonsillar tissue (grade 3/4 or 4 /4 tonsils) along with ESS –Epworth sleep score>10 or paediatric sleep questionnaire score > 8/21 should be referred.
- Patient’s with less severe obstructive symptoms but has a history of frequent upper respiratory tract infections, a snotty nose, sinusitis recurrent sore throats should be also considered for referral.
- Recurrent tonsillitis–7 episodes per year, 5 episodes for 2 consecutive years, and 3 episodes per year for the last 3 years are indications for referral.
- History of recurrent quinsy (peritonsillar abscess or cellulitis) along with a history of tonsillitis and painful chronic tonsillar stones should also be referred. 7. Our Maori and Pacific Island children and adolescent with a history suggestive of recurrent strep throat (GABHS) who are at risk group for rheumatic fever and glomerulonephritis, should be referred.
- Children with a history of recurrent sore throat/pharyngitis with history of scarlet fever, glandular fever, PAFA syndrome should also be referred.
Photos and Examples