1.  Patients with 3 or more infections of tonsils and/or adenoids per year despite adequate medical therapy.
2.  Hypertrophy (enlargement) causing dental malocclusion or adversely affecting oral-facial (mouth-face) growth documented by orthodontist.
3.  Hypertrophy causing upper airway obstruction (sleep apnea) View Abstract   View Abstract, severe dysphagia (trouble swallowing), sleep disorders, or cardiopulmonary complications.
4.  Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage.  View Tonsillectomy Surgery Video   View Drainage Surgery Video
5.  Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy.
6.  Chronic or recurrent tonsillitis associated with the streptococcal carrier state and not responding to beta-lactamase-resistant antibiotics. 
7.  Unilateral tonsil hypertrophy presumed euplastic.  Although without other indications (abnormal appearance, physical examination, symptoms or history) most asymmetries can be followed conservatively.  View Abstract
8.  Recurrent acute otitis media or chronic serous otitis media.  Adenoidectomy should not be performed with the insertion of the first set of myringotomy (ear) tubes unless there is another indication for adenoidectomy besides chronic otitis media.  However, repeat surgery for chronic otitis media should consist of adenoidectomy with myringotomy (with or without myringotomy (ear) tube placement.)  View Abstract

The above Indications for adenotonsillectomy and management vary widely and the above are only guidelines. 

In a 2003 survey of otolaryngologist a little over half would perform an adenoidectomy alone in children with small tonsils, large adenoids and obstructive sleep apnea (severe airway obstruction) and about half would take out both the tonsils and adenoids.  In children with symptomatic ( snoring, mouth breathing ) large adenoids having incidental asymptomatic large adenoids, most otolarygnolgists would remove only the adenoid but a little under half would remove both the adenoid and tonsils.   View Abstract

Adenoidectomy for the treatment of otitis media in children under the age of 2 years has not been found to be beneficial by Mattila et al.  View Abstract 
  
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