***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Conclusion : Patients operated with tonsillar surgery  report a high degree of symptom relief 6 months after surgery . Objective : The purpose of this study was to analyze symptom relief 6 months after  tonsil surgery  in relation to age , indication , surgical procedure , primary bleeding and unplanned postoperative visits . The National Tonsil Surgery Register in Sweden offers data from 54 696 patients registered during 1997–2008 . Methods : This was a prospect i ve assessment by question naire . Data were collected using three question naires , two completed by professionals and one 6 months postoperatively by the parents/ patients . Results : Among 54 696 patients , the most common surgical indications were obstruction ( 49.7 % ) , followed by recurrent tonsillitis ( 35.2 % ) . Symptom relief 6 months after surgery was high in all indication groups ( > 92 % ) , and highest for patients operated on the indication peritonsillitis ( > 98 % ) . The indications obstruction , recurrent tonsillitis or chronic tonsillitis reported a high degree ( > 96 % ) of symptom relief . Of the patients who underwent tonsillectomy with adenoidectomy , 97.5 % were symptom-free compared to 96 % of patients who had tonsillectomy alone and 96.1 % who underwent tonsillotomy ( p < 0.0001 ) . In all , 13.9 % of patients required an unplanned visit to the clinic postoperatively . Only 148 of 54 696 patients reported worsening of symptoms after surgery OBJECTIVE To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy . DESIGN Open , r and omised controlled trial . SETTING 21 general hospitals and three academic centres in the Netherl and s. PARTICIPANTS 300 children aged 2 - 8 years requiring adenotonsillectomy .  INTERVENTION Adenotonsillectomy compared with watchful waiting . MAIN OUTCOME MEASURES Episodes of fever , throat infections , upper respiratory tract infections , and health related quality of life . RESULTS During the median follow up period of 22 months , children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group ( difference -0.21 , 95 % confidence interval -0.54 to 0.12 ) , 0.56 throat infections per person year compared with 0.77 ( -0.21 , -0.36 to -0.06 ) , and 5.47 upper respiratory tract infections per person year compared with 6.00 ( -0.53 , -0.97 to -0.08 ) . No clinical ly relevant differences were found for health related quality of life . Adenotonsillectomy  was more effective in children with a history of three to six throat infections than in those with none to two . 12 children had complications related to surgery . CONCLUSION Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy OBJECTIVE To compare the estimated cost-effectiveness of  childhood (adeno)tonsillectomy vs medical therapy  for  recurrent sore throats  from the intention-to-treat ( ITT ) analysis of a r and omized controlled trial ( RCT ) with that modeled on the recorded timing of surgical interventions as observed in all participants irrespective of their original group allocation . STUDY DESIGN A pragmatic RCT ( trial ) with a parallel nonr and omized patient preference group ( cohort ) of (adeno)tonsillectomy vs medical therapy . SETTING Five secondary care UK otolaryngology departments . SUBJECTS AND METHODS Eligible children , aged 4 to 15 years , were enrolled to the trial ( 268 ) or cohort ( 461 ) groups . Outcomes included sore throat diaries , quality of life , and general practice consultations . The RCT protocol ITT analysis was compared with an as-treated analysis incorporating the cohort group , modeled to reflect the timing of tonsillectomy and the differential switch rates among the original groups . RESULTS In the RCT ITT analysis , tonsillectomy saved 3.5 sore throats , whereas the as-treated model suggested an average reduction of more than 8 sore throats in 2 years for surgery within 10 weeks of consultation , falling to only 3.5 twelve months later due to the spontaneous improvement in the medical therapy group . CONCLUSION In eligible UK school-age children , tonsillectomy can save up to 8 sore throats at a reasonable cost , if performed promptly . Further prospect i ve data collection , accounting for baseline and per-trial preferences and choice , is urgently needed Abstract Objective To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy . Design Open , r and omised controlled trial . Setting 21 general hospitals and three academic centres in the Netherl and s. Participants 300 children aged 2 - 8 years requiring adenotonsillectomy . Intervention Adenotonsillectomy compared with watchful waiting . Main outcome measures Episodes of fever , throat infections , upper respiratory tract infections , and health related quality of life . Results During the median follow up period of 22 months , children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group ( difference −0.21 , 95 % confidence interval −0.54 to 0.12 ) , 0.56 throat infections per person year compared with 0.77 ( −0.21 , −0.36 to −0.06 ) , and 5.47 upper respiratory tract infections per person year compared with 6.00 ( −0.53 , −0.97 to −0.08 ) . No clinical ly relevant differences were found for health related quality of life . Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two . 12 children had complications related to surgery . Conclusion Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy We studied the efficacy of  tonsillectomy , or tonsillectomy with adenoidectomy , in 187 children severely affected with recurrent throat infection . Ninety-one of the children were assigned r and omly to either surgical or nonsurgical treatment groups , and 96 were assigned according to parental preference . In both the r and omized and nonr and omized trials , the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar . By various measures , the incidence of throat infection during the first two years of follow-up was significantly lower ( P less than or equal to 0.05 ) in the surgical groups than in the corresponding nonsurgical groups . Third-year differences , although in most cases not significant , also consistently favored the surgical groups . On the other h and , in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection , and most episodes among subjects in the nonsurgical groups were mild . Of the 95 subjects treated with surgery , 13 ( 14 per cent ) had surgery-related complications , all of which were readily managed or self-limited . These results warrant the election of tonsillectomy for children meeting the trials ' stringent eligibility criteria , but also provide support for nonsurgical management . Treatment for such children must therefore be individualized A clinical trial to study the effects of adenotonsillectomy showed that children with a marked susceptibility to respiratory tract infection benefited from the operation , especially by a reduction in throat illness . They did not reach the state of health of the " normal " child so far as respiratory tract and nonrespiratory diseases were concerned even after two years , but the difference was lessened in the second year as the first-year improvement was increased in the second year . The difference between the hospitalized and the normal children could be due to an immunological defect in the former . The decision to operate should be made in the light of a documented history of the child 's illnesses following a vigorous course of nasal hygiene which can alter the clinical state due to the removal of a source of infection OBJECTIVES To examine the clinical effectiveness and cost-effectiveness of tonsillectomy/adeno-tonsillectomy in children aged 4 - 15 years with recurrent sore throats in comparison with st and ard non-surgical management . DESIGN A pragmatic r and omised controlled trial with economic analysis comparing surgical intervention with conventional medical treatment in children with recurrent sore throats ( trial ) and a parallel non-r and omised cohort study ( cohort study ) . SETTING Five secondary care otolaryngology departments located in the north of Engl and or west of Scotl and . PARTICIPANTS 268 ( trial : 131 allocated to surgical management ; 137 allocated to medical management ) and 461 ( cohort study : 387 elected to have surgical management ; 74 elected to have medical management ) children aged between 4 and 15 years on their last birthday with recurrent sore throats . Participants were stratified by age ( 4 - 7 years , 8 - 11 years , 12 - 15 years ) . INTERVENTIONS Treatment was tonsillectomy and adeno-tonsillectomy with adenoid curettage and tonsillectomy by dissection or bipolar diathermy according to surgical preference within 12 weeks of r and omisation . The control was non-surgical conventional medical treatment only . MAIN OUTCOME MEASURES The primary clinical outcome was the reported number of episodes of sore throat in the 2 years after entry into the study . Secondary clinical outcomes included : the reported number of episodes of sore throat ; number of sore throat-related GP consultations ; reported number of symptom-free days ; reported severity of sore throats ; and surgical and anaesthetic morbidity . In addition to the measurement of these clinical outcomes , the impact of the treatment on costs and quality of life was assessed . RESULTS Of the 1546 children assessed for eligibility , 817 were excluded ( 531 not meeting inclusion criteria , 286 refused ) and 729 enrolled to the trial ( 268 ) or cohort study ( 461 ) . The mean ( st and ard deviation ) episode of sore throats per month was in year 1 - cohort medical 0.59 ( 0.44 ) , cohort surgical 0.71 ( 0.50 ) , trial medical 0.64 ( 0.49 ) , trial surgical 0.50 ( 0.43 ) ; and in year 2 - cohort medical 0.38 ( 0.34 ) , cohort surgical 0.19 ( 0.36 ) , trial medical 0.33 ( 0.43 ) , trial surgical 0.13 ( 0.21 ) . During both years of follow-up , children r and omised to surgical management were less likely to record episodes of sore throat than those r and omised to medical management  ;  the incidence rate ratios in years 1 and 2 were 0.70 [ 95 % confidence interval ( CI ) 0.61 to 0.80 ] and 0.54 ( 95 % CI 0.42 to 0.70 ) respectively . The incremental cost-effectiveness ratio was estimated as 261 pounds per sore throat avoided ( 95 % confidence interval 161 pounds to 586 pounds ) . Parents were willing to pay for the successful treatment of their child 's recurrent sore throat ( mean 8059 pounds ) . The estimated incremental cost per quality -adjusted life-year ( QALY ) ranged from 3129 pounds to 6904 pounds per QALY gained . CONCLUSIONS Children and parents exhibited strong preferences for the surgical management of recurrent sore throats . The health of all children with recurrent sore throat improves over time , but trial participants r and omised to surgical management tended to experience better outcomes than those r and omised to medical management . The limitations of the study due to poor response at follow-up support the continuing careful use of ' watchful waiting ' and medical management in both primary and secondary care in line with current clinical guidelines until clear-cut evidence of clinical effectiveness and cost-effectiveness is available . TRIAL REGISTRATION Current Controlled Trials IS RCT N47891548 OBJECTIVE In previous clinical trials involving children severely affected with recurrent throat infection ( 7 or more well-documented , clinical ly important , adequately treated episodes of throat infection in the preceding year , or 5 or more such episodes in each of the 2 preceding years , or 3 or more such episodes in each of the 3 preceding years ) , we found tonsillectomy efficacious in reducing the number and severity of subsequent episodes of throat infection for at least 2 years . The results seemed to warrant the election of tonsillectomy in children meeting the trials ' stringent eligibility criteria but also provided support for nonsurgical management . We undertook the present trials to determine 1 ) whether tonsillectomy would afford equivalent benefit in children who were less severely affected than those in our earlier trials but who nonetheless had indications for tonsillectomy comparable to those in general use , and 2 ) whether , in such children , the addition of adenoidectomy would confer additional benefit . METHODS We conducted 2 parallel r and omized , controlled trials in the Ambulatory Care Center of Children 's Hospital of Pittsburgh . To be eligible , children were required to have had a history of recurrent episodes of 
    Output:
    
We found no evidence for prescription of antibiotics .
Adeno-/tonsillectomy leads to a reduction in the number of episodes of sore throat and days with sore throat in children in the first year after surgery compared to ( initial ) non-surgical treatment .
Children who were more severely affected were more likely to benefit as they had a small reduction in moderate/severe sore throat episodes .
The size of the effect is very modest , but there may be a benefit to knowing the precise timing of one episode of pain lasting several days - it occurs immediately after surgery as a direct consequence of the procedure .
It is clear that some children get better without any surgery , and that whilst removing the tonsils will always prevent ' tonsillitis ' , the impact of the procedure on ' sore throats ' due to pharyngitis is much less predictable .
Insufficient information is available on the effectiveness of adeno-/tonsillectomy versus non-surgical treatment in adults to draw a firm conclusion .The impact of surgery , as demonstrated in the included studies , is modest .
Many participants in the non-surgical group improve spontaneously ( although some people r and omised to this group do in fact undergo surgery ) .
The potential ' benefit ' of surgery must be weighed against the risks of the procedure as adeno-/tonsillectomy is associated with a small but significant degree of morbidity in the form of primary and secondary haemorrhage and , even with good analgesia , is particularly uncomfortable for adults