[1] The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA).

[10] In the United States, as of 2010, tonsillectomy is performed less frequently than in the 1970s although it remains the second-most common outpatient surgical procedure in children.

[1] It is also carried out for peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA), guttate psoriasis, nasal airway obstruction, tonsil cancer and diphtheria carrier state.

However, it is unclear whether the removal of the adenoid has any additional positive or negative effects for the treatment of recurrent sore throat.

[2] In cases of chronic tonsillitis in adults, there is strong evidence of increased quality of life, reduction of symptoms, and economic benefit.

In 2019, the American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) recommended:Caregivers and patients who meet the appropriate criteria for tonsillectomy as described here should be advised of only modest anticipated benefits of tonsillectomy, as weighed against the natural history of resolution with watchful waiting, as well as the risk of surgical morbidity and complications and the unknown risk of general anesthesia exposure in children [younger than] four years of age.

[3] It recommended that physicians and parents should weigh the benefits and risks of surgery as OSA symptoms may spontaneously resolve over time.

[21] There is no good evidence for other uses such as tonsil stones, bad breath, trouble swallowing, and an abnormal voice in children.

[1][22] In rare cases, tonsillectomy may also cause damage to the teeth (because of the clamp that is placed in the mouth during surgery), larynx and pharyngeal wall, aspiration, respiratory compromise, laryngospasm, laryngeal edema and cardiac arrest.

[25] It is estimated 1.3% of people will have a delayed discharge (of 4 to 24 hours) due to a complication, and up to 3.9% will require repeat admission to hospital.

The main reasons for either keeping a person in hospital, or readmitting them after tonsillectomy are uncontrolled pain, vomiting, fever, or bleeding.

[30] A meta-analysis published in 2020 indicated a statistically significant association between a history of tonsillectomy and the development of Hodgkin's disease.

Problems including pain and bleeding led to a recent resurgence in interest in sub-total tonsillectomy or tonsillotomy, which was popular 60 to 100 years ago, in an effort to reduce these complications.

Bleeding is stopped with electrocautery, ligation by sutures, and the topical use of thrombin, a protein that induces blood clotting.

However, there are other techniques and a brief review of each follows: A single dose of the corticosteroid drug dexamethasone may be given during surgery to prevent post-operative vomiting.

[49] A sore throat will persist approximately two weeks following surgery while pain following the procedure is significant and may necessitate a hospital stay.

[50] Recovery can take from 7 to 10 days and proper hydration is very important during this time, since dehydration can increase throat pain, leading to a circle of poor fluid intake.

[54] At some point, most commonly 7 to 11 days after the surgery (but occasionally as long as two weeks after), bleeding can occur when scabs begin sloughing off from the surgical sites.

This is to prevent any sharp foods from potentially irritating the tonsillar fossae during the healing stage and provoking a bleed.

[58] The rise in adenotonsillectomies for sleep apnea in the USA has been greater than the decline in tonsillectomies for sore throat.

[59] In 2018, a study of the medical records of 1.6 million UK children found 15,760 had sufficient sore throats to justify tonsillectomy and 13.6% (2,144) underwent surgery.

[60] The same study found 18,281 children who had undergone tonsillectomy, and of these only 11.7% (2,144) had evidence-based indications (i.e. frequent enough sore throats to justify surgery).

Source: Šumilo et al. 2018[60] According to a study from 2009, surgery rates on average increase by 78% when surgeons are paid fee-for-service reimbursements instead of a fixed salary.

[62][63] In 2009 then US President Obama remarked: Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there.

Roughly a millennium later, the Roman aristocrat Aulus Cornelius Celsus (25 BCE–50 CE) described a procedure whereby using the finger (or a blunt hook if necessary), the tonsil was separated from the neighboring tissue before being cut out.

[65] Galen (121–200 CE) was the first to advocate the use of the surgical instrument known as the snare, a practice that was to become common until Aetius (490 CE) recommended partial removal of the tonsil, writing "Those who extirpate the entire tonsil remove, at the same time, structures that are perfectly healthy, and, in this way, give rise to serious Hæmorrhage".

[65] In the 7th century Paulus Aegineta (625–690) described a detailed procedure for tonsillectomy, including dealing with the inevitable post-operative bleeding.

[65] The Middle Ages saw tonsillectomy fall into disfavor; Ambroise Pare (1509) wrote it to be "a bad operation" and suggested a procedure that involved gradual strangulation with a ligature.

Scottish physician Peter Lowe in 1600 summarized the three methods in use at the time, including the snare, the ligature, and the excision.

[66] For example, a study conducted in 1934 found that 61% of 1,000 New York schoolchildren had been tonsillectomized; doctors recommended surgery for all but 65 of the remaining children.