Tonsillectomy is the most common major surgery performed on children in the United States. Recurrent throat infections of either bacterial or viral etiology can cause significant morbidity and decreased quality of life, and potentially lead to life-threatening complications. When performed in the proper patient, tonsillectomy can be a highly effective procedure. Recent clinical trials have sought to better define the appropriate infectious indications for surgery. Despite the improved understanding gained from these studies, the decision to operate always must be made on an individual basis with the primary care physician, surgeon, patient, and family all involved in the decision-making process.