Significant postoperative pain and discomfort continues to be associated with a tonsillectomy procedure. Various instruments have been used over the years, but in an attempt to simplify the surgical procedure and minimize the postoperative morbidity, the ultrasonic (harmonic) scalpel uses high frequency piezoelectric technology to create intracellular pressure waves that lyse cellular connections while creating a protein coagulum that maintains hemostasis. Minimal introperative blood loss is achieved with no change in delayed postoperative hemorrhage rates when compared with electrocautery tonsillectomy. The harmonic scalpel allows patients to sleep more comfortably during the first 5 postoperative nights, correlating with reports of less pain on those days when compared with electrocautery techniques. This pain reduction, however, did not reduce the time to resumption of normal activities of the child, nor normal work activities of the parent. The harmonic scalpel can reduce postoperative pain, but significant discomfort remains.