Tonsillitis, an acute or chronic inflammation of the tonsils in the pharynx, is a common disease of childhood, especially when the seasons change and the weather is more variable, the tonsils are more likely to become inflamed, and some children even have recurrent inflammation of the tonsils. The tonsils are usually referred to as the palatine tonsils, which are located deep in the mouth under the palatal arch on both sides of the unattractive flat conical “meatball”. In fact, the tonsils have three brothers, as well as the pharyngeal tonsils, also known as adenoids, and the tongue tonsils two little brothers. The tonsils are an important part of the lymphatic ring in the pharynx and an immune response organ that can hold back and stop bacteria, viruses and harmful substances from the respiratory and digestive tracts, providing an important barrier and defense, just like a soccer goalkeeper. A child’s tonsils generally begin to develop at 6 months of age, reach their peak at 4-6 years of age, and begin to shrink at 14-15 years of age. Therefore, tonsillitis is less likely to occur in infants under one year of age. At the age of 4-10, the tonsils are at their peak of development, but because children’s body resistance is relatively weak, they are susceptible to various bacteria and viruses, so tonsillitis can easily occur during childhood. However, this situation will slowly decrease as the child’s immune system continues to improve and the tonsils gradually shrink during adolescence. If the tonsils become inflamed repeatedly, or if tonsillitis is not treated thoroughly, the tonsils are transformed from an initially immune protective organ into a focus of infection and can lead to various serious complications, such as myocarditis and nephritis. Extreme hypertrophy of the tonsils can affect the physiology of breathing, sleeping, swallowing and speech. Repeated inflammation of the tonsils is so harmful, but the tonsils are the body’s first line of defense against disease and play an important role in preventing disease and maintaining good health. To cut or not to cut? In general, removal is not considered for tonsils without lesions. However, tonsils should be removed in the following 5 cases: repeated tonsillitis, at least 4 times a year, repeated inflammation, which destroys a large amount of functional tonsil tissue and reduces the defensive capacity of the tonsils to the point where they become the culprit of systemic diseases. Consider removing the tonsils. The tonsils are so enlarged that they interfere with breathing, sleeping, swallowing and speech. The inflammation of the tonsils is so severe that it has caused inflammation of adjacent organs, such as otitis media and paranasal sinusitis. If rheumatoid arthritis, myocarditis, nephritis, and other systemic complications occur as a result of recurrent tonsillitis, surgery should be performed.