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Tonsils and Adenoids

Checked: 23-05-2023 by Rob Adams Next Review: 23-05-2025

Tonsils

Referral for tonsillectomy for all ages is subject to the BNSSG Tonsillectomy - Referral for Assessment. This policy has both Prior Approval and Criteria Based Access sections. If prior approval is required then this must be obtained and the referral submitted via eRS.

This policy also has a CBA section regarding referral of children with obstructive sleep apnoea. See Respiratory section for further advice on Sleep Apnoea in Children.

Adenoids

Adenoids are lymphoid (glandular) tissue, much the same as tonsils. They are part of a ring of lymphoid tissue (Waldeyer’s ring), which also includes tonsils.

Adenoids are located at the back of the nose, at the roof of the throat, above and behind the soft palate. These lymphoid tissues are supposed to trap and destroy viruses and bacteria entering the breathing passages.

Adenoids are only present in children. They start to grow from birth and are biggest when your child is approximately three to five years old.

By the age seven to eight they start to shrink and by the late teens, are barely visible. By adulthood, the adenoids will have disappeared completely.

Adenoidectomy is a surgical procedure performed to remove the adenoids. In general, adenoidectomy is not warranted unless the effect on the child of large adenoids is considerable and persists.

No form of medical treatment (decongestants, nasal sprays etc) has been proved to have any helpful effect on large adenoids.

Removal of adenoids is not routinely funded. Adenoids may be removed as part of a tonsillectomy or grommet procedure for which separate prior approval funding policies apply.

Adenoidectomy Criteria Based Access (CBA) Policy - mainly for use in secondary care. Only applies to children where prior approval has already been approved under the tonsillectomy or insertion of grommets policy.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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