I. Evidence-based medical recommendations for children with throat infections 1. Watchful waiting for children with frequent throat infections Clinicians should recommend watchful waiting for children who have had <7 throat infections in the past 1 year or <5 and <3 throat infections per year on average in the past 2 and 3 years, respectively. Studies of randomized controlled trials have confirmed that the benefits of observational waiting outweigh the harms in this situation. This is to avoid unnecessary interventions in children with recurrent throat infections, so that they have a good natural history and can potentially improve their quality of life without surgery. Watchful waiting means that the child should be closely monitored and that episodes of tonsillitis should be accurately recorded. The primary care physician and the child's guardian should document and compile a history of the child's throat infection and health history. For children with a history of less than 12 months, there should be at least a 12-month observation period, as throat infections tend to improve on their own after 12 months of history, until then tonsillectomy should be used only as an intervention. However, tonsillectomy is not an absolute contraindication and can be considered in children with recurrent severe infections requiring hospitalization, complications (e.g., peri-tonsil abscess, family history of internal jugular vein thrombophlebitis or rheumatic heart valve disease, or a large number of recurrent infections) even if the history is less than 12 months. For children with a history of more than 12 months, surgery is not an absolute indication and may not be necessary if the child improves on his or her own during follow-up and no longer meets Paradise criteria. 1. (1) The minimum frequency of episodes of pharyngeal infection was equal to or greater than 7 in the past 1 year, or ≥5 pharyngeal infections in the past 2 years on average, or ≥3 pharyngeal infections in the past 3 years on average; (2) Clinical features included temperature >38.3°C, enlarged cervical lymph nodes (lymph nodes >2 cm in diameter), or exudate from the tonsils, or Group A Group B hemolytic positive streptococcal culture; (3) confirmed or suspected treatment with antibiotics in regular doses; (4) medical records with streptococcal infection, with documentation of clinical symptoms of the condition at the time of each infection; if there is no medical record, the number of episodes of throat infection observed subsequently was two and the history was consistent with the clinical features. 2. Tonsillectomy was recommended for children with medical records of frequent throat infections who had medical records of each episode of sore throat and one of the findings of temperature >38.3°C, cervical lymphadenitis, pus overflowing from the tonsil surface or positive test for group A beta-hemolytic streptococcus, if they had at least 7 throat infections in the past 1 year, or at least 5 or 3 throat infections in each of the past 2 or 3 years, respectively, on average Tonsillectomy may be considered for recurrent throat infections if they have had at least 7 throat infections in the past 1 year or at least 5 or 3 throat infections in each of the past 2 or 3 years, respectively. The recommendation is based on a randomized controlled trial in which the benefits of surgical treatment outweighed the harms. It is important to ensure that the severity of disease in children with recurrent throat infections meets the description of the indications for surgery. It is incumbent upon the clinician to accurately describe the number of individual pharyngeal infections and to document the frequency of these events to aid in medical decision-making for surgical treatment. However, many guardians may not visit a medical facility for every throat infection, and therefore medical records are incomplete. However, even if the medical record is incomplete, the child should still be treated surgically as long as all other criteria for tonsillectomy are met. 3. Studies of randomized controlled trials of corrective factors for tonsillectomy for recurrent infections have confirmed that tonsillectomy can be performed on children with recurrent throat infections who do not meet the above indications for tonsillectomy, provided that the following corrective factors are met. Modifying factors include: multiple antibiotic allergy and/or intolerance; periodic fever-aphthous stomatitis-pharyngitis-adenitissyndrome (PFAPA syndrome); and peri-tonsillar abscesses. PFAPA and recurrent peri-tonsillar abscesses may be indications for tonsillectomy in children with multiple antibiotic allergies and/or intolerances when they meet Paradise criteria for frequent pharyngitis infections and are effective in reducing the number and extent of infections for at least 2 years after tonsillectomy. The role of tonsillectomy for peri-tonsillar abscesses remains controversial, but the threshold for peri-tonsillar abscesses decreases when a child has recurrent throat infections or a history of previous throat infections; also, the role of tonsillectomy in the treatment of autoimmune neuropsychiatric disorders associated with streptococcal infections in children is not proven. Impractical indications for tonsillectomy include chronic tonsillitis, febrile convulsions, low speech, halitosis, dental malocclusion, tonsillar hypertrophy, unexplained tonsillitis, or chronic throat infection. Clinicians should thoroughly evaluate the pros and cons of surgery before deciding whether to perform surgical treatment. Evidence-based medical recommendations for SDB-related tonsillectomy in children with SDB The physician should ask the child’s guardian whether the child has comorbidities such as growth retardation, poor academic performance, enuresis, and behavioral problems that could be improved by tonsillectomy. The purpose of the study, based on pre- and post-operative clinical observations, is to help clinicians and guardians make informed decisions about whether to perform tonsillectomy in children with SDB and to emphasize the importance of taking a history related to comorbidities. decreased quality of life, enuresis and growth retardation. These concomitant symptoms improve or resolve after tonsillectomy in children with SDB, and there is a significant increase in height, body mass, and biomarkers of growth, so sDB, secondary tonsillar and/or adenoid hypertrophy should be taken into account when screening, diagnosing, and treating children with growth retardation. Tonsil and/or adenoidectomy results in significant improvement compared to non-surgical treatment. In children with asymmetrically enlarged tonsils, the need for surgery needs to be determined in conjunction with relevant medical history, physical examination and laboratory tests. Asymmetrically enlarged tonsils require surgery if they are tumors, especially lymphomas on the tonsils, while simple asymmetrical enlargement of the tonsils does not require tonsillectomy.