A postal survey was undertaken to assess otolaryngologists’ awareness, implementation and perceived weaknesses of the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline for the Management of Sore Throat and Indications for Tonsillectomy. The reply rate was 77 per cent. There was high awareness of the guideline and while 84 per cent of the correspondents felt that they followed the guideline, or a guideline based on it, only 35 per cent were able to accurately recall the four main criteria recommended for listing for tonsillectomy. Twenty-five per cent of the surgeons were in departments that had ongoing implementation programmes for these guidelines but only 10 per cent of surgeons were in departments that had audited their compliance. The most common criticism of the guideline (22 per cent) was that it failed to consider the impact of the disease process on the patient’s quality of life. Suggestions made to improve the guideline are included.