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Primary Care Liaison

Obstructive adenotonsillar hyperplasia

  • This pre-referral guideline covers obstructive adenotonsillar hyperplasia in children from 1-16 years of age.

    Initial work-up

    Symptoms include:

    • Sx – snoring +/- apnoea
    • History - parental observations and description of sleep patterns
    • Snoring alone - this does not require surgical management
    • Sleep disturbance characterised by laboured respiration, restlessness and waking at night with daytime somnolence or chronic mouth breathing by day
    • Observed episodes of
    • Complications i.e. failure to thrive

    Pre-referral treatment

    When to refer

    Child presents with:

    • Sleep disturbance => 3 months
    • Snoring
    • Sleep apnoea >5–10 seconds
    • Mouth breathing all the time
    • Tonsils meeting in the midline +/- trouble swallowing from large tonsils

    Referral form (pdf)

    Parent handout (pdf)


    Kids Connect (RCH Primary Care Liaison)

    Kids Health Info (Parent fact sheets online)

    Contact information

    Clinical advice

    Switchboard – ask for ENT specialist consultant or registrar on-call    (03) 9345 5522
    RCH Emergency Department (03) 9345 6477


    Booking enquiries and appointment rescheduling (parents) (03) 9345 6180 
    Rural doctors only (03) 9345 6789 

    Admission enquiries

    General admission enquiries  (03) 9345 6172

    ED admission enquiries 

    (03) 9345 6477
    After hours/switchboard

    (03) 9345 5522


    Seriously unwell child (03) 9345 7007

    RCH Drug info-line 

    (03) 9345 5208


    Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia

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