***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: OBJECTIVE To evaluate the cost-effectiveness of adenotonsillectomy compared with watchful waiting in Dutch children . DESIGN Economic evaluation along with an open , r and omized , controlled trial . SETTING Multicenter , including 21 general and 3 university hospitals in the Netherl and s. PARTICIPANTS Three hundred children aged 2 to 8 years were selected for adenotonsillectomy according to routine medical practice . Excluded were children who had frequent throat infections and those with suspected obstructive sleep apnea . MAIN OUTCOME MEASURES Incremental cost-effectiveness in terms of costs per episode of fever , throat infection , and upper respiratory tract infection avoided . RESULTS Annual costs incurred in the adenotonsillectomy group were euro803 ( the average exchange rate for the US dollar in 2002 was $ 1.00 = euro1.1 , except toward the end of 2002 when $ 0.95 = euro100 ) and euro551 in the watchful waiting group ( 46 % increase ) . During a median follow-up of 22 months , surgery compared with watchful waiting reduced the number of episodes of fever and throat infections by 0.21 per person-year ( 95 % confidence interval , -0.12 to 0.54 and 0.06 to 0.36 , respectively ) and upper respiratory tract infections by 0.53 ( 95 % confidence interval , 0.08 to 0.97 ) episodes . The incremental costs per episode avoided were euro1136 , euro1187 , and euro465 , respectively . CONCLUSIONS In children undergoing adenotonsillectomy  because of mild to moderate symptoms of  throat infections or  adenotonsillar hypertrophy , surgery result ed in a significant increase in costs without realizing relevant clinical benefit . Subgroups of children in whom surgery would be cost-effective may be identified in further research . 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 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 throat infection that met st and ards slightly less stringent than the st and ards used in our earlier trials regarding either the frequency of previous episodes or their clinical features or their degree of documentation , but not regarding > 1 of those parameters . These reduced st and ards were nonetheless more stringent than those in current official guidelines , which list " 3 or more infections of tonsils and /or adenoids per year despite adequate medical therapy " as an indication for tonsillectomy or adenotonsillectomy . Of 2174 children referred by physicians or parents , 373 met the current trials ' eligibility criteria and 328 were enrolled . Of these , 177 children without obstructing adenoids or recurrent or persistent otitis media were r and omized to either a tonsillectomy group , an adenotonsillectomy group , or a control group ( the 3-way trial ) , and 151 children who had 1 or more such conditions were r and omized to either an adenotonsillectomy group or a control group ( the 2-way trial ) . Outcome measures were the occurrence of episodes of throat infection during the 3 years of follow-up ; other , indirect measures of morbidity ; and complications of surgery . RESULTS By various measures , the incidence of throat infection was significantly lower in surgical groups than in corresponding control groups during each of the 3 follow-up years . However , even among control children , mean rates of moderate or severe episodes were low , ranging from 0.16 to 0.43 per year . Adenotonsillectomy was no more efficacious than tonsillectomy alone . Of 203 children treated with surgery , 16 ( 7.9 % ) had surgery-related complications of varying types and severity . CONCLUSIONS The modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks , morbidity , and cost of the operations . We conclude that , under ordinary circumstances , neither eligibility criteria such as those used for the present trials nor the criterion for surgery in current official guidelines are sufficiently stringent for use in clinical practice A prospect i ve study comparing surgical and antibiotic treatment for recurrent tonsillitis in adults suggests that , whilst tonsillectomy is very effective , adequate medical treatment provides an equally good alternative in the majority of patients 
    Output:
    
Conclusion : Tonsillectomy reduces the incidence of recurrent pharyngitis  to a modest degree