Purpose: This review aims to highlight key advances in surgical techniques and public health shifts influencing tonsillectomy practices, evolving from a painful operation to a streamlined outpatient procedure. Methodology: A literature review summarised the historical development of tonsillectomy, focussing on surgical methods. Results: Tonsillectomy began with blunt removal techniques described by Cornelius Celsus in Ancient Rome, using a finger, followed by vinegar wash and medication pastes to reduce bleeding. By the sixth century, Aetius of Amida introduced a hook and knife for greater precision. In 1564, European surgeons improved techniques by placing a thread around the uvula and cutting it off by strangulation. Improved understanding of asepsis in the early 20th century led to new tools. Samuel Whillis and Frederick Pybus described the enucleation of tonsils using the reverse guillotine in 1910. During this era, tonsillectomy significantly increased in popularity, driven by beliefs that removing tonsils improved general health, with emerging epidemiological evidence in the 1940s linking tonsillectomy and bulbar poliomyelitis. Calls for “universal tonsillectomy” were met with resistance from surgeons including T.B. “Tubby” Layton, who emphasised conservative clinical judgement. Tonsillectomy rates declined as antibiotic management improved. Samuel Crowe further developed the Crowe-Davis mouth gag, to retract the tongue and direct anaesthetic agent to the laryngopharynx. In the late 20th century, electrocautery and coblation significantly improved precision. Conclusion: The extensive history of tonsillectomy demonstrates the evolvement of surgical techniques and shifting medical perspectives over centuries.