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

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.