Tonsillitis is one of the most common paediatric ailments. The current recommended indications for paediatric tonsillectomy is that patients should fulfil all of the following criteria: sore throats are due to tonsillitis; five or more episodes of sore throat per year; symptoms for at least a year; the episodes of sore throat are disabling and prevent normal functioning. In addition to these infective indications the other indications for tonsillectomy are obstructive sleep apnoea, or suspicion of malignancy.

This prospective study conducted at the outpatient department of the Royal Liverpool Childrens' Hospital was designed to identify important clinical features in patients with recurrent acute tonsillitis. A total of 195 consecutive children aged from 1 to 16 years were examined and a history of recurrent acute tonsillitis or peritonsillar abscess and previous admission to hospital due to tonsil infection was recorded. Signs recorded were the presence of hyperaemia on the anterior pillars, crypt debris, intratonsillar abscess, asymmetry of the tonsils, clinical size (according to Brodsky Grade) (Fig. 1), and presence of cervical lymph nodes. Patients with obstructive sleep apnoea or recent acute tonsillitis were excluded.