Tonsillectomy is recommended if number of acute infections in a year exceed:

Tonsillectomy and adenoidectomy are indicated for chronic or recurrent acute infection and for obstructive hyperophy. The American Academy of Otolaryngology-Head and Neck Surgery Clinical Indicators Compendium suggests tonsillectomy after three or more infections per year despite adequate medical therapy. Some feel that tonsillectomy is indicated in children who miss 2 or more weeks of school annually secondary to tonsil infections. Ref: Schwaz's principle of surgery 9th edition, chapter 18.