In general, only if they are enlarged, or otherwise have been causing problems themselves. The tonsils rarely, if ever, are associated with ear disease. However, if we are removing adenoids because they are enlarged or obstructed, we tend to be relatively aggressive with borderline enlarged tonsils. Too often, several months later, when we left such tonsils, they became enough of a problem to warrant removal. However, years of any of the problems above may be too high of a price to pay for waiting.
General anesthesia is the norm.
Occasionally, some other devices or electocautery is used. With the advent of special cautery devices, we almost always completely dry the surgical site before the patient wakes up, eliminating the low-grade bleeding that used to be associated with adenoidectomies. The procedure typically takes 5-15 minutes to complete. Complications are rare, and usually minor. We have never encountered that complication, but it has been reported by other surgeons.