The current controversial issue is focused on pediatric tonsillectomy, a surgical procedure that is learned early during specialist training and performed by almost all otolaryngologists worldwide. Besides being the most frequent ENT surgery, it is also one of the most frequently performed pediatric surgeries. Having said this, it becomes clear that tonsillectomy must be a simple procedure not reserved only for experienced academic surgeons. At first glance it is not clear if there are any controversial issues to discuss. However, surgery is not restricted to the technical procedure within the operating theater but is part of a larger concept including indication for, and success of this surgery. Analyses of complications as well as long-term results are further cornerstones to evaluate the utility of a surgical procedure. Having a closer look at the history of tonsillectomy, it becomes quickly clear that barely any other ENT surgery has undergone so many changes regarding the frequency, indication and technique as tonsillectomy did. Regarding technique and indications, a very nice overview is given in two of the articles in this issue by Hultcrantz and Ericsson [1] and Gysin [2] . While tonsillectomy started to be a surgery for recurrent infections, it has meanwhile become mainly indicated to treat sleep apnea. However, new entities such as idiopathic fever syndromes like PFAPA syndrome [3] or as recently reported even neuropsychological syndromes emerge as possible indications [4] . More interestingly, besides medical indications, specialist training [5] and geosocioeconomic factors seem to influence the indication for tonsillectomy [6] . Tonsillectomy rates are sometimes dramatically divergent from one country to the other [7] . Being a physician’s or lawyer’s child decreases, whereas having elevated insurance status or parents who had tonsillectomy increases the child’s risk for this surgery [8, 9] . Soft interpretation of surgical indications is not a problem restricted to tonsillectomy and can be found in most medical specialties [10] . However, pediatric tonsillectomy is particular in that it is an almost exclusive elective surgery, the decision is not taken by the patient himself and it holds a yet still debated rate of fatal or even lethal complications [11, 12] . Recent events in Austria, where several young children died from postoperative hemorrhage within a few months, showed how Published online: August 22, 2013 www.karger.com/orl DOI: 10.1159/000348659