We first need to understand what is going on with the tonsils. The human pharynx is rich in lymphatic tissue. The largest pair of these is called the palatine tonsils, or what is commonly referred to as the tonsils. The surface of the tonsils has 10 to 20 crypts, which lead to the deeper part of the tonsils. The tonsils are not inflamed, but only when the body’s resistance decreases due to fatigue or cold, the bacteria in the fossa multiply and the pathogenic bacteria can cause the tonsils to become red, inflamed and septic. However, the tonsils are an immune organ of the body, which can resist various disease-causing microorganisms that invade the organism and play a certain role in fighting diseases. Especially before the age of 4, the immune function of the tonsils is strong, showing compensatory hypertrophy and becoming an important line of defense against diseases. However, tonsillitis often occurs in some children, and under the stimulation of long-term inflammation, the tonsils can lose their normal function and become a harmful “lesion”, causing the body to produce antigen-antibody complexes that cause lesions in organs far from the tonsils, such as nephritis, rheumatic heart disease, myocarditis, rheumatoid arthritis, etc. Tonsillitis is divided into two categories: acute and chronic. Acute tonsillitis is treated with antibiotics such as penicillin, cephalosporin, azithromycin and other symptomatic treatments and can be cured in about 7 to 10 days. Some children often have recurrent episodes of acute tonsillitis, 4 to 5 times a year, or even once a month. This is because each time the tonsils are inflamed the body consumes a lot, often making the child’s physique very poor, thin, resistance is reduced, as soon as the weather changes or tired, the child’s tonsils inflammation, forming a vicious circle, this frequent episodes of tonsillitis is not beneficial and harmful to the human body. Infections of the tissues and organs surrounding the tonsils (such as the nasal cavity, sinuses, and pharynx) can also complicate the disease. In children with chronic tonsillitis without acute attacks, there is usually no obvious discomfort, and a few only feel a dry, itchy pharynx with an irritating cough. The tonsils show hyperplasia, a large crypt orifice, and a yellowish-white discharge or food bolus can be seen in the crypt orifice. Lymph nodes the size of soybeans or date pits can be felt in the submandibular part of the neck, without obvious tenderness. ENT doctors often encounter parents asking whether their children need tonsil removal surgery, so what kind of tonsils should be removed? (1) Recurrent acute tonsillitis with more than 4 to 5 inflammations in a year and heavy systemic symptoms with high fever, sore throat, enlarged tonsils, congestion, pus spots on the surface and enlarged submandibular lymph nodes at each inflammation. (2) Previous peri-tonsillitis and peri-abscess. (3) Excessive enlargement of the tonsils that has interfered with breathing and sleep. Perhaps such tonsils have never been inflamed, but the hypertrophied tonsils have narrowed the pharynx so that the child eats slowly, has coarse breath when quiet, gasps for breath at the slightest activity, snores at night after falling asleep, breathes with an open mouth, holds his breath, and sometimes does not breathe for 1 to 2 minutes and experiences apnea. This long-term hypoxic condition can affect the growth and development of the child, so the tonsils should be removed to relieve the obstruction. (4) Focal tonsils. Because tonsillitis can be complicated by nephritis, rheumatic heart disease, myocarditis and rheumatoid arthritis, etc., studies in the last decade or so have found that the onset of psoriasis is also closely related to tonsillitis. These patients can have their tonsils removed during the stable phase of their disease. (5) Unexplained long-term low fever, chronic inflammation of the tonsils themselves, can be removed when other medical diseases are ruled out. (6) Tonsillar keratosis or tonsils with stones, polypoid hyperplasia, cysts and other benign masses above the tonsils. (7) In the early stage of tonsillar malignancy, tonsils can be removed when there is no lymph node metastasis, but chemotherapy or radiotherapy is required after surgery. Although tonsil removal is a minor surgery, due to its special location and function, we should listen to the advice of ENT doctors and take a cautious attitude when deciding whether to remove it surgically.