***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 Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants . The study objective was to assess /s/-articulation , perceptually and acoustically , in children with tonsillar hypertrophy and compare effects of two types of surgery , total tonsillectomy and tonsillotomy .  Sixty-seven children , aged 50–65 months , on the waiting list for surgery , were r and omized to tonsillectomy or tonsillotomy .  The speech material was collected preoperatively and 6 months postoperatively . Two groups of age-matched children were  controls . /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery , in comparison to controls . After surgery /s/-articulation was normalized perceptually , but acoustic differences remained . No significant differences between surgical methods were found Tonsillectomy is one of the most frequent surgical procedures carried out on children . Obstructive sleep apnea syndrome , caused by tonsillar hypertrophy , has been attracting increasing interest and tonsillectomy is often performed as a result of this indication . Regardless of the indication , the main aim of tonsillectomy has always been to remove the tonsils completely . The present study was undertaken in order to investigate the effect of two different surgical techniques , tonsillectomy and tonsillotomy , on clinical symptoms in children with symptoms of obstructive sleep apnea syndrome due to tonsillar hypertophy . The study was conducted as a prospect i ve , r and omized trial comparing the clinical effects of st and ard tonsillectomy and tonsillotomy using a CO2 laser .  Forty-three children aged 2 - 9 years were included . Both groups of patients experienced comparable relief from symptoms of snoring and apneas at follow-up after 3 months and 2 years . There was no significant statistical difference between the two groups of patients in terms of both short- and long-term effects on clinical symptoms . Tonsillotomy caused no measurable bleeding during surgery . Postoperative pain and distress were less pronounced in the tonsillotomy group according to visual analog scale evaluations made by patients , parents and nursing staff . In conclusion tonsillotomy appears to be the less traumatic surgical method in cases of upper airway obstruction in children caused by tonsillar hypertrophy Abstract Conclusions : Coblation was seen to be a much safer method for tonsil reduction surgery with less morbidity and with a higher efficacy in early and long-term follow-up . Objective : The objective was to compare the efficacy , morbidity and safety of three techniques for reduction of tonsil size in tonsillar hypertrophy in children . Methods : This was a prospect i ve , r and omized clinical study . Seventy-nine children aged 4–13 years with symptoms of tonsillar hypertrophy were included in the study . They were r and omized to the coblator ( group A ) , laser tonsillotomy ( group B ) or radiofrequency ( group C ) technique for tonsil reduction . The efficacy was evaluated by assessing tonsillar size after surgery . Morbidity was evauated by assessing by postoperative pain and return to normal diet and activity . Results : Pain on the first day was significantly higher for children in group B ( p = 0.0001 ) . The mean values for analgesic usage and number of days until return to normal diet and normal activity were lower in group A. At 1-year postoperative follow-up , the mean tonsil size was higher in group C ( p < 0.05 ) . None of the children in group A , two of the children ( 8.3 % ) in group B and six of the children ( 21.4 % ) in group C need reoperation for tonsillary hypertrophy Objectives To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months . Method Children , age 4 - 5 with Sleep Disordered Breathing ( SDB ) and tonsil hyperplasia , were r and omized to TE ( 32 ) or TT ( 35 ) . TT was performed ad modum Hultcrantz with radiofrequency technique ( Ellman ) . An adenoidectomy with cold steel was performed in the same session for 80 % of cases . The patients were assessed prior to surgery , at six and 24 months postoperatively . Effects of surgery were evaluated clinical ly , through question naire ( general health/snoring/ENT-infections ) , Quality of Life ( QoL ) , survey of pediatric obstructive sleep apnea with OSA-18 , and children ’s behavior with the Child Behavior Checklist . Results After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections . Both TT and TE had result ed in large improvement in short and long term QoL and behavior . Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems , the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy . Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches , but with no need for surgery . Conclusion Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT . For the majority , the positive effect on snoring , infections , behavior and quality of life remain and is similar to TE OBJECTIVES To determine if temperature-controlled radiofrequency ( TCRF ) tonsil reduction and adenoidectomy ( TCRF&A ) and conventional tonsillectomy and adenoidectomy ( T&A ) are statistically similar in outcome and to compare morbidity between TCRF&A and conventional T&A. DESIGN R and omized control trial . SETTING Tertiary care children 's hospital . PARTICIPANTS The study population comprised 23 patients aged 2.6 to 12.5 years with symptoms of obstructive sleep apnea , hypertrophic tonsils with no other areas of upper airway obstruction with the exception of hypertrophic adenoids , and a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of less than 30 . INTERVENTION Temperature-controlled radiofrequency tonsil reduction ( mean + /- SD , 12.6 + /- 1.5 ablations per patient and 994.68 + /- 91.88 J per insertion ) and adenoidectomy or traditional bovie T&A. MAIN OUTCOME MEASURES Primary outcomes were respiratory distress index and total volume reduction . Secondary outcomes include postoperative pain , daytime sleepiness , speech and swallowing problems , weight and diet , narcotic use , and analogue snoring scale . RESULTS The respiratory distress index difference for TCRF&A was 5.63 vs 6.56 for st and ard T&A. On postoperative day 1 for the 13 patients who underwent TCRF&A , 0 reported severe pain , 11 ( 85 % ) had mild to moderate pain , and 2 ( 15 % ) had no pain . In the 10 patients who underwent st and ard T&A , 1 ( 10 % ) had severe pain and 9 ( 90 % ) had mild to moderate pain . By postoperative week 1 , all TCRF&A patients experienced mild or no pain , whereas 1 ( 10 % ) of the st and ard T&A patients still had moderate pain . Mean visual analogue snore scores ( 0 - 10 ) 4 weeks after surgery were less than 1 for both groups . The mean + /- SD weight loss at postoperative week 1 for TCRF tonsil reduction patients was 1.0 + /- 3.5 lb ( 0.45 + /- 1.58 kg ) vs 4.6 + /- 3.9 lb ( 2.07 + /- 1.76 kg ) for st and ard T&A patients . Return to normal diet at postoperative week 1 occurred in 11 TCRF&A patients ( 85 % ) and 0 st and ard T&A patients . CONCLUSIONS The respiratory distress indexes were similar for TCRF&A patients and st and ard T&A patients . In addition , there were similar analog snoring scales , decreased pain , and weight loss OBJECTIVE To evaluate outcome of two types of tonsil surgery ( tonsillectomy [TE]+adenoidectomy or tonsillotomy [TT]+adenoidectomy ) on vocal function perceptually and acoustically . STUDY DESIGN Sixty-seven children , aged 50 - 65 months , on waiting list for tonsil surgery were r and omized to TE ( n=33 ) or TT ( n=34 ) . Fifty-seven age- and gender-matched healthy preschool children were controls . Twenty-eight of them , aged 48 - 59 months , served as control group before surgery , and 29 , aged 60 - 71 months , served as control group after surgery . METHODS Before surgery and 6 months postoperatively , the children were recorded producing three sustained vowels ( /ɑ/ , /u/ , and /i/ ) and 14 words . The control groups were recorded only once . Three trained speech and language pathologists performed the perceptual analysis using visual analog scale for eight voice quality parameters . Acoustic analysis from sustained vowels included average fundamental frequency , jitter percent , shimmer percent , noise-to-harmonic ratio , and the center frequencies of formants 1 - 3 . RESULTS Before surgery , the children were rated to have more hyponasality and compressed/throaty voice ( P<0.05 ) and lower mean pitch ( P<0.01 ) in comparison to the control group . They also had higher perturbation measures and lower frequencies of the second and third formants . After surgery , there were no differences perceptually . Perturbation measures decreased but were still higher compared with those of control group ( P<0.05 ) . Differences in formant frequencies for /i/ and /u/ remained . No differences were found between the two surgical methods . CONCLUSION Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy . After surgery , the voice is perceptually normalized but acoustic differences remain . Outcome was equal for both surgical methods OBJECTIVES Investigation of the occurrence of  postoperative hemorrhage after tonsillectomy  and risk factors for these complications . STUDY DESIGN Prospect i ve National Audit with electronic web-based data collection from the National Health Service and independent hospitals in Engl and and Northern Irel and . METHODS Consenting patients undergoing tonsillectomy between July 2003 and September 2004 were included . A central data base of patient and surgical variables was developed for analysis of primary and secondary postoperative hemorrhage and development of risk models for tonsillectomy complications . RESULTS The Audit received data from 277 hospitals in Engl and and Northern Irel and on 40,514 patients . Analysis was conducted on 33,921 ( 84 % ) who gave consent . Over the whole Audit 1,197 ( 3.5 % ) postoperative hemorrhages were recorded . One hundred eighty-eight ( 0.6 % ) patients sustained a primary hemorrhage and 1,033 ( 3 % ) a secondary hemorrhage ( 24 had both ) . Elevated hemorrhage rates were observed in tonsillectomies performed using diathermy for dissection and hemostasis compared with cold steel dissection and ties for hemostasis . National guidance issued midway through the Audit influenced practice and reduced hemorrhage rates . Risk models for postoperative hemorrhage were developed incorporating the effect of the guidance . For hemorrhage , compared with the cold steel group , bipolar diathermy tonsillectomy had an odds ratio of 2.47 ( 1.81 - 3.36 ) , P < .0001 , and bipolar diathermy scissors tonsillectomy an odds ratio of 3.20 ( 2.09 - 4.90 ) , P < .0001 . Use of bipolar diathermy for hemostasis only after cold steel dissection carried an intermediate risk , odds ratio 1.57 ( 1.16 - 2.13 ) , P = .004 . CONCLUSIONS The results confirm that " hot " tonsillectomy techniques carry a substantially elevated risk of postoperative hemorrhage when diathermy is used as a dissection tool in tonsillectomy OBJECTIVE To compare postoperative pain of  partial tonsillectomy ( PT )  with scalpel and total classical tonsillectomy ( TT ) . METHODS Prospect i ve , r and omized study at a tertiary care institution . Ninety-six children who were diagnosed with obstructive tonsillar hypertrophy were included to the study . Children 's tonsils were removed totally ( Group TT ) by classical dissection tonsillectomy or partially ( Group PT ) using scalpel and tissue scissors . The parents were instructed to fill out a form daily for nine postoperative days ; recording total amount of analgesics administered that day and a Visual Analog Scale ( VAS ) each day assessing child 's life quality and daily activities . RESULTS Eighty-one children ( 2 - 14 years old ) who completed the study were included in the analysis . Total tonsillectomy group ( Group TT ) consisted of 41 patients and partial tonsillectomy group ( Group PT ) consisted of 40 patients . There was no difference between two groups ' operative parameters such as operation time [ 21.3 min ( PT ) and 22.3 min ( TT ) ] and blood loss [ 44.2 ml ( PT ) and 46.0 ml ( TT ) ] ( p>0.05 ) . PT group received significantly less dosage of analgesics per day ; 1.18+/-1.27 vs. 2. 
    Output:
    
Return to normal activity Tonsillotomy probably results in a faster return to normal activity .
For children with oSDB selected for tonsil surgery , tonsillotomy probably results in a faster return to normal activity ( four days ) and in a slight reduction in postoperative complications requiring medical intervention in the first week after surgery .
This should be balanced against the clinical effectiveness of one operation over the other .