Referral Criteria for Paediatric ENT department

The paediatric ENT department at Great Ormond Street hospital is a tertiary / quaternary service and accepts referrals from secondary / other tertiary centres for complex paediatric ENT issues. It does not accept GP referrals. 
 
The conditions below represent the majority of our accepted referrals:
 
1. Congenital and Acquired Laryngeal / Tracheal anomalies
- For assessment and surgical intervention
 
2. Congenital Head and Neck Anomalies 
- Branchial arch malformations
- Thyroglossal duct cysts
- Nasal dermoids
 
3. Acquired Head and Neck Anomalies
- Lymph node pathology
- Chronic neck infections (including atypical mycobacteria)
 
4. Lymphatic / Vascular Anomalies Head and Neck
- Lymphatic malformations
- Juvenile angiofibromas
 
5. Head and Neck Tumours
 
6. Salivary Gland Pathology
- Drooling requiring surgical intervention
- Recurrent parotitis
 
7. Thyroid Pathology
 
8. Choanal Atresia – unilateral and bilateral
 
9. Osseo-Integrated Techniques (Bone-Anchored Hearing Aids and Prostheses for Congenital Ear Atresia)
 
10. Tympanomastoid Surgery
 
11. Cochlear Implantation
 
12. Paediatric Rhinology
- Functional Endoscopic sinus surgery
- Limited septoplasty
 
 
The department also undertakes adenotonsillectomy and grommet insertion in children with significant comorbidities for whom the other services provided at GOS are required. These referrals must meet the appropriate criteria as defined by NHSE. The referrer must ensure that a referral for a tonsillectomy or adenotonsillectomy meets their criteria to ensure it is a procedure of clinical effectiveness. The criteria are noted below and can be found in NHS North Central London Policy for Procedures of Limited Clinical Effectiveness (PoLCE)*.
 

Treatment:
(Adenoidectomy) Tonsillectomy

Criteria

Tonsillectomy is a clinically effective and cost-effective procedure when performed for appropriate indications. It should be approved for funding if the criteria below are met and evidenced. These criteria refer to tonsillectomies with or without adenoidectomies. Adenoidectomies alone, for clinical reasons, are routinely funded.

Criteria for eligibility

Recurrent acute tonsillitis:

  1. FIVE or more episodes in the last year

Or

  1. FOUR or more episodes in each of the last two successive years

Or

  1. THREE or more episodes in each of the last three years

AND

  1. With significant impact on quality of life indicated by absence from school, work or playgroup or failure to thrive.

OR

Obstructive sleep apnoea in children

The diagnosis may be based on a clear parental history of snoring, obstructed, laboured breathing, apnoeas and disturbed sleep, together with anatomical evidence of upper airway obstruction.

N.B. Daytime neurobehavioural abnormalities or sleepiness are not always present in children with significant OSA.

A lower threshold for considering surgery if the patient has habitual snoring with laboured breathing and falls into one of the following complex high risk categories for sleep apnoea:

  • Down’s syndrome
  • Cerebral palsy
  • Craniofacial disorders
  • Chronic lung disease
  • Sickle cell disease

Neuromuscular disorders

  • Genetic/metabolic/storage disease
  • Central hyperventilation syndromes

OR

  1. ONE quinsy or ONE or more episodes of tonsillitis requiring admission to hospital where there has been a previous history of recurrent tonsillitis

OR

  1. One year or more of chronic tonsillitis with tonsoliths causing halitosis and significant social embarrassment

OR

  1. Tonsillitis exacerbating existing disease such as febrile convulsions, guttate psoriasis, glomerulonephritis or rheumatic fever.

NB. Suspected tonsil neoplasms are not to be considered by this process

* NHS (2016), “The NCL Procedures of Limited Clinical Effectiveness (PoLCE), P36

Please Note: Referrals that do not meet the detailed criteria, where appropriate will be sent back to the referring hospital for local treatment.