Severely affected children who undergo surgery on average have one fewer sore throat per year in the subsequent one or two years, compared to those who do not. Specifically one review found a decrease from 3.6 to 3.0 episodes in the year following surgery. In less severely affected children, surgery results in an increase, rather than a decrease of sore throats when the sore throat directly following surgery is included. Surgery results in a reduction in school absence in the year after surgery, but the strength of evidence is low. Surgery does not result in an improvement in quality of life. Benefits of surgery do not persist over time. Those with frequent throat infections often spontaneously improve over a year without surgery. Therefore, a certain number of people who undergo surgery will do so unnecessarily as they would not have had further episodes of tonsillitis had they not had surgery. Evidence in adults is unclear. In 2019, the American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) recommonded:Caregivers and patients who meet the appropriate criteria for tonsillectomy as described here should be advised of only modest anticipated benefits of tonsillectomy, as weighed against the natural history of resolution with watchful waiting, as well as the risk of surgical morbidity and complications and the unknown risk of general anesthesia exposure in children <4 years of age. In considering the potential harms, the guideline panel agreed that there was not a clear preponderance of benefit over harm for tonsillectomy, even for children meeting the Paradise criteria [7 episodes in the past year, 5 episodes per year in the past 2 years, or 3 episodes per year in the past 3 years]. Instead, the group felt there to be a balance that allows either tonsillectomy or watchful waiting as an appropriate management option for these children and does not imply that all qualifying children should have surgery. The role of tonsillectomy as an option in managing children with recurrent throat infection means that there is a substantial role for shared decision making with the child’s caregiver and primary care clinician.Many cases of sore throat have other causes than tonsillitis and tonsillectomy is therefore not indicated for those cases. The diagnosis of tonsillitis is often made without testing for bacteria. The UK National Health Service states, that it's very rare that someone needs to have their tonsils taken out, and it is usually only necessary in case of severe tonsillitis that keeps coming back. Tonsillectomy improves obstructive sleep apnea (OSA) in most children.