Tonsillectomy & Adenoidectomy

Leicestershire Policy Tonsil Removal: Tonsils are located on the sides of the throat and are part of the immune system. They are needed for the first year of our life, but after that they are redundant. In some people they are over-reactive and become too large. This may cause snoring, mouth-breathing, and even obstructive sleep apnoea. They can also trap bacteria such as strep and cause recurrent strep throat.

The most common reason for tonsil removal is obstructive sleep apnoea due to large tonsil size. Other reasons to remove tonsils are recurrent strep throat infections, peri-tonsillar abscess, chronic throat pain, or, in adults, suspicion of cancer. Removing the tonsils does not weaken the immune system.

Adenoids are similar to tonsils. They are located at the back of the throat above the palate. They are usually removed in children at the same time as the tonsils because they can also cause blockage of breathing.

LLR CCGs will fund a tonsillectomy if the following clinical indicators are present:

  • Peri- tonsillar abscess
  • Acute upper airway obstruction
  • Recurrent sore throat where one of the following has been documented
  • 7 or more episodes in the last year
  • 5 or more episodes in the last two years
  • or more episodes in each of the last three years
    • AND
  • Significant severe impact on quality of life indicated by
  • Absence from work or school
  • Failure to thrive
    • AND one of the following
  • Aural temperature of at least 38.3C o Tender anterior cervical lymph nodes o Tonsillar exudates
  • Positive culture of group A beta haemolytic streptococci o Episodes are disabling and prevent normal function
  • Tonsillar enlargement leading to symptoms of obstruction

The LLR CCGs will fund tonsillectomy in sleep apnoea syndrome in children when one or more of the following apply

  • Positive sleep study
  • Significant impact on quality of life demonstrated
  • Strong clinical history suggestive of sleep apnoea

Adenoidectomy

The LLR CCGs will fund adenoidectomy in children where one of the following clinical indications are met

  • Children with Otitis Media with Effusion (OME) who meet the NICE recommendations for ventilation tubes (grommets) in the presence of persistent and/or frequent upper respiratory tract infections
  • For sleep disordered breathing in children which is diagnosed clinically. The following impact on development must be documented
  • behaviour e.g. hyperactivity, daytime somnolence
  • quality of life e.g. height and weight
  • nasal obstruction
  • size of adenoids
  • sleep study (in the presence of excessively large adenoids)