A history of recurrent tonsillitis in recent months increases the likelihood of further episodes. The illness can have a rapid onset and may impair or incapacitate an individual within hours. This is of some concern, particularly for the long haul pilot. Tonsillectomy is a treatment option that the ENT surgeons consider based on best clinical practice guidelines that include frequency per unit of time. In NZ, a commonly used rule of thumb for deciding to proceed to tonsillectomy in the clinical setting is ~ seven episodes in one year, five episodes a year for two years and three episodes a year for three years. For pilots, given the vocational consequences, a lower trigger threshold may be appropriate. A history of two episodes of peritonsillar abscess is also an indication for tonsillectomy, without delay.
Once tonsillectomy has been performed, a licence holder should not return to duty until full recovery has occurred. The tonsillar bed should have healed well, with no potential for secondary haemorrhage which can be life threatening. This generally requires a down period of three weeks.
An applicant with a history of recurrent tonsillitis can generally be considered as having a history that is not of aeromedical significance if: