In this week's BMJ, a randomised controlled trial by Alho and colleagues assesses the effectiveness and safety of tonsillectomy compared with watchful waiting in adults with recurrent streptococcal pharyngo-tonsillitis (three episodes of pharyngitis in six months or four in 12 months).1 Although the minority of patients presenting to general practitioners with tonsillitis have recurrent tonsillitis, about 12% of the population has recurrent tonsillitis at some stage,2 and a substantial familial element exists.2 The trial found that tonsillectomy significantly reduced the recurrence of the principal outcome, streptococcal pharyngitis, at 90 days (1/36 (3%) v 8/34 (21%); adjusted relative risk 21%, 95% confidence interval 6% to 36%; number needed to treat 5, 3 to 16). A systematic review of tonsillectomy for chronic tonsillitis found limited data to support tonsillectomy in children and no data …