Tonsillar enlargement is easy to diagnose. However, the decision on whether or not surgery will be beneficial is more complex. Just because your child’s tonsils are enlarged does not mean that surgery is necessary to remove them. It is normal for the tonsils to have significant growth between the ages of 3-6 and sometimes even before or beyond these ages. However, most children will not ultimately need their tonsils taken out. In the present day by far the most common reason to perform an adenotonsillectomy (T/A) is to relieve upper airway obstruction. Dr. Shirley will conduct a thorough history and physical exam to determine if your child is having problems related to the tonsils. Over the last ten years a large amount of research has looked into and documented the often detrimental effects of chronic sleep disruption caused by tonsil and adenoid related upper airway obstruction. If your child is regularly snoring, having chronically restless and disturbed sleep, waking frequently, pausing or gasping at night, having difficulty awakening in the morning, appearing tired and grumpy in the morning in spite of adequate sleep hours, having increased daytime tiredness, still taking long naps unusual for his age, having increased mood problems or problems paying attention in school, or falling asleep easily in the car or at school, then an evaluation for upper airway obstruction by an experienced Ear Nose and Throat physician is highly recommended. Chronic tonsillitis is the other main reason to consider tonsillectomy but it is a far less common reason than it was twenty to thirty years ago. This decrease is due to the fact that experience and large studies have shown that although many kids will have episodes of tonsillitis, most of the time these infections will be sporadic, will subside with time and with appropriate treatment will not cause any long lasting effects. However, a T/A can be indicated when a child is having a large number of infections where it begins to significantly affect his school attendance, is having large periods of time where he or she is ill, febrile, having difficulty eating, and having significant periods of chronic throat pain and discomfort. In short when the infections are so frequent that they are clearly reducing the child’s quality of life, a tonsillectomy is indicated. This decision is a somewhat subjective but large studies have helped translate these assessments to numbers. General recommendations for the number of infections that suggest tonsillectomy will be beneficial are 6 or more infections in one year, 4-5 infections a year for 2 consecutive years, or three or more infections a year for three years. Although these numbers are a good guide, they are not hard and fast and there may be instances where it would be recommended to proceed with fewer numbers, for example if a child was having constant infections that are not being controlled adequately with medications, complications from tonsillitis such as a peritonsillar abscess, severe illness requiring hospitalization, or an infection that leads to such hypertrophy of the tonsils that now the child is having sleep obstruction.