Many patients and parents are confused about surgical removal of tonsils and adenoids and have some misconceptions about them. Some patients and parents are very squeamish about surgery and strongly disagree with surgical removal of tonsils, while others are very casual and think they have frequent sore throat and cough, which is “tonsillitis”, and ask to have their tonsils cut. The scientific name for the tonsils should be palatine tonsils, which are the largest lymphatic tissue in the pharynx and an important immune organ, especially for children. When stimulated by external inflammation, it is involved in cellular and humoral immunity, and the immunoglobulins produced by the tonsils are immune and can deal with various disease-causing microorganisms that invade the body and play an anti-disease role, known as the body’s “health guardian”. The adenoids are also the lymphatic tissue of the pharynx, also known as the pharyngeal tonsils, which play a relatively minor role. In fact, there are two sides to everything, and so are the tonsils, which have both benefits and drawbacks. When the tonsils are not inflamed, it is positive for the body, but if they are always inflamed, forming “foci”, harboring Weiwei bacteria, and even causing systemic complications, it is harmful and not beneficial. One expert made a very graphic analogy: the tonsils are like the gatekeeper of a company or an institution, playing a defensive role; but if the tonsils form “foci” and harbor pathogenic bacteria, as if the gatekeeper has become a traitor, not only to defend the company, but also to collude with outside thieves to steal company goods, should such a gatekeeper be removed? Therefore, doctors often recommend that patients have their tonsils removed in the following cases: 1. When any kind of complication is caused by chronic tonsillitis, it must be removed. Without removal, such complications are difficult to get better or repeatedly aggravate the complications. These complications include: psoriasis, rheumatic fever, rheumatoid arthritis, rheumatic heart disease, nephritis, long-term unexplained hypothermia, etc. 2.Recurrent acute inflammation of the tonsils. To what extent can it be called “recurrent”? There is no specific conclusion in various books and journals, and it is usually considered that 3-5 attacks per year should be removed. In fact, it is necessary for doctors and patients to weigh the pain caused by recurrent attacks, the damage to the body, the impact on life and work, and the economic loss to be worth the surgery. Some patients with acute inflammation of the tonsils require 2-3 weeks of antibiotics, levels up to third-generation cephalosporins to control the inflammation, and take several leaves of absence. In such patients, I believe that 2-3 episodes per year should be surgically removed. Do not assume that all sore throat and fever is acute inflammation of tonsils, but it can also be acute pharyngitis and epiglottis. Its diagnosis should be made by an otolaryngologist in a regular hospital. In addition, the size of the tonsils is not the main basis for the diagnosis of chronic tonsillitis. In general, most preschoolers have physiological tonsillar hypertrophy, and second-degree size is common. However, excessive hypertrophy up to the third degree (both tonsils close to each other or leaning together, affecting breathing, preventing swallowing, and slurring speech, should be surgically removed. These children are often accompanied by adenoid hypertrophy, which can be removed together. The main problem of adenoids is that the hypertrophy causes ventilation disorders. Excessive snoring, breath-holding during sleep, open-mouth breathing, excessive sweating, chronic hypoxia can lead to morning headache, daytime drowsiness, and learning difficulties; adenoid hypertrophy blocking the posterior nostril is often complicated by rhinitis and sinusitis; obstruction of the pharyngeal opening of the eustachian tube will be complicated by secretory otitis media, and children with this problem often turn up the volume when watching TV, indicating hearing impairment. In severe cases, the child may have poor general development, waking up easily from sleep with dreams, teeth grinding, slow reaction, inattentiveness; due to long-term open mouth breathing, resulting in impaired facial bone development, long jaws, high arched palate, uneven teeth, prominent upper incisors, thick lips, lack of expression, the so-called “adenoid face”. Therefore, before an experienced dentist can give orthodontic treatment to a child with misaligned teeth and protruding upper incisors, he or she must first relieve the adenoid problem. To what extent should the adenoids be removed? If the adenoids occupy 60-70% of the width of the nasopharyngeal airway, or if the nasal endoscopy shows that the nasopharyngeal space is largely occupied by adenoids, a decision to operate can be made in conjunction with the child’s presentation. Surgery is usually performed under general anesthesia. The traditional tonsil peeling and adenoids scraping methods, the more advanced ultrasonic knife tonsillectomy method, and endoscopic adenoids aspiration and excision methods are available.