As otolaryngologists we are inundated with guidelines and revised guidelines discussing the medical and surgical treatment of adenotonsillar disease and are bombarded with new technologic options-coblation, intracapsular tonsillotomy, microdebrider tonsillectomy, ultrasonic harmonic dissection, electrocautery tonsil removal, bipolar radio frequency ablation, and the time honored and hallowed cold steel approach. Sorely missing are discussions of what to do when sore throat is not Group A streptococcus, GERD, or Mono. Also missing is a practical evidence-based discussion reaching beyond the guidelines which, by design limit topics to the most common defined etiology. All patients must be seen by the front line providers and many such patients do not neatly fit into a narrowly defined guideline box and have real symptoms never once confirmed as Group A streptococcus. Via an interactive case-oriented approach during which several cases will be presented, audience response will be solicited for consensus of diagnostic, medical, or surgicalopinions. Less common entities specifically excluded by guidelines such as PFAPA and PANDAS will be included as will common questions such as the significance of atypical mycobaterial pharyngotonsillitis, Group B, C & G streptococcus, often discounted as "normal flora" but relevant and warranting treatment. Disagreements between surgical guidelines such as IDSA (Infectious Disease Society of America) and AAO-HNS guidelines will be explained. Many who refer patients to us are more influenced by guidelines from their medical vs. our surgical academy. This expert series will be a comprehensive compliment to the more common discussion in order to empower otolaryngologists and advanced practice providers to understand that "all that is sore is not strep throat!"