{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:11:12Z","timestamp":1789053072322,"version":"build-2803163510"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n Tonsillectomy is among the most painful otolaryngologic procedures. It is unclear whether a postoperative course of oral steroids reduces pediatric tonsillectomy pain and morbidity.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether a postoperative course of oral dexamethasone reduces postadenotonsillectomy pain in children.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a parallel-design quadruple-blinded randomized clinical trial conducted at a single tertiary academic center that enrolled pediatric patients (3-17 years of age) undergoing adenotonsillectomy from August 2021 to May 2023, with 14 days of follow-up for pain and 5 to 9 weeks for adverse events. Data were analyzed from October 2023 to May 2026.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Oral dexamethasone (0.5 mg\/kg; maximum dose, 20 mg) or placebo on postoperative days 2, 4, and 6.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Mean (SD) pain score before medication administered during days 2 to 8 postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 763 children screened, 209 participants (median [IQR] age, 7.1 [5.8] years; 99 females [47.4%] and 110 males [52.6%]) were included (104 to the steroid arm and 105 to placebo) in analyses of adverse events and health care utilization. Of these, 131 (61 steroid arm and 70 placebo) completed pain diaries and were included in primary outcome (pain) analysis. Mean (SD) pain before acetaminophen or ibuprofen on days 2 to 8 was 0.72 (95% CI, 0-1.44) points lower in the dexamethasone group (4.12 [2.00]) than placebo (4.84 [2.15]), but wide 95% CIs and differences in pain prior to taking the study medication prevented making definitive conclusions. The dexamethasone group had less pre- and postanalgesic pain on postoperative days 12 and 13 (mean difference, 0.96-2.37 points) and a considerable decrease in odds of receiving an opioid prescription (odds ratio [OR], 0.23; 95% CI, 0.06-0.84) or having an emergency department visit for pain (OR, 0.12; 95% CI, 0.003-0.91). However, the precision of these estimates limits interpretability. Differences in readmissions, nursing telephone calls, posttonsillectomy hemorrhage, and return to normal diet between groups were small and clinically meaningless.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, postoperative oral dexamethasone was associated with a modest reduction in pain after pediatric adenotonsillectomy, a considerable reduction in opioid prescriptions, and no increase in complications, supporting its use as an analgesic adjunct.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04879823<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.1910","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:30:36Z","timestamp":1784820636000},"page":"885","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity"],"prefix":"10.1001","volume":"152","author":[{"given":"Amber D.","family":"Shaffer","sequence":"first","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Omar","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"},{"name":"Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond C.","family":"Maguire","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Dohar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis J.","family":"Kitsko","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison B. J.","family":"Tobey","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reema","family":"Padia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Simons","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Whelan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"UPMC Health Plan, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina V.","family":"Rushchak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khoa","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise M.","family":"Hall-Burton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Chi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"ooi260042r1","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"issue":"1","key":"ooi260042r2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024-065814","article-title":"Pediatric surgical opioid prescribing by procedure, 2020-2021.","volume":"154","author":"Chua","year":"2024","journal-title":"Pediatrics"},{"issue":"9","key":"ooi260042r3","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1001\/jamaoto.2017.0845","article-title":"Control of pain after tonsillectomy in children: A review.","volume":"143","author":"Tan","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"12","key":"ooi260042r4","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.3390\/children12121619","article-title":"Perioperative pain relief in pediatric tonsillectomy: current strategies and future directions.","volume":"12","author":"Medikondu","year":"2025","journal-title":"Children (Basel)"},{"issue":"11","key":"ooi260042r5","doi-asserted-by":"publisher","first-page":"3231","DOI":"10.1007\/s00405-019-05571-w","article-title":"Postoperative pain and bleeding after adenotonsillectomy versus adenotonsillotomy in pediatric obstructive sleep apnea: an RCT.","volume":"276","author":"Borgstr\u00f6m","year":"2019","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"ooi260042r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2025.112361","article-title":"Randomized clinical trial of non-opioid pain medications after intracapsular adenotonsillectomy.","volume":"193","author":"Lu","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"3","key":"ooi260042r7","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s00405-020-06178-2","article-title":"Intracapsular coblation tonsillectomy versus extracapsular coblation tonsillectomy: a systematic review and a meta-analysis.","volume":"278","author":"Daskalakis","year":"2021","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"10","key":"ooi260042r8","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1097\/MLG.0b013e318123ee40","article-title":"Intracapsular vs. extracapsular tonsillectomy: a comparison of pain.","volume":"117","author":"Cohen","year":"2007","journal-title":"Laryngoscope"},{"issue":"6","key":"ooi260042r9","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1111\/coa.13790","article-title":"Coblation intracapsular tonsillectomy in children: a prospective study of 1257 consecutive cases with long-term follow-up.","volume":"46","author":"Amin","year":"2021","journal-title":"Clin Otolaryngol"},{"issue":"6","key":"ooi260042r10","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1002\/lary.27614","article-title":"Opioid prescription and postoperative outcomes in pediatric patients.","volume":"129","author":"Whelan","year":"2019","journal-title":"Laryngoscope"},{"issue":"6","key":"ooi260042r11","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1007\/s00540-025-03505-x","article-title":"Impact of intraoperative ketorolac on postoperative pain in children undergoing adenotonsillectomy: a double blind, placebo-control trial.","volume":"39","author":"Zepeda","year":"2025","journal-title":"J Anesth"},{"issue":"2","key":"ooi260042r12","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1111\/coa.70076","article-title":"The effects of pain controlling agents on paediatric tonsillectomy: a systematic review and network meta-analysis.","volume":"51","author":"Kim","year":"2026","journal-title":"Clin Otolaryngol"},{"issue":"10","key":"ooi260042r13","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1177\/0003489415583685","article-title":"Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children.","volume":"124","author":"Liu","year":"2015","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"8","key":"ooi260042r14","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003997.pub2","article-title":"Steroids for improving recovery following tonsillectomy in children.","volume":"2011","author":"Steward","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"ooi260042r15","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1038\/s41598-024-85008-5","article-title":"Systematic review and meta-analysis of pain management after tonsillectomy.","volume":"15","author":"Gei\u00dfler","year":"2025","journal-title":"Sci Rep"},{"issue":"2","key":"ooi260042r16","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.otohns.2005.11.010","article-title":"Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials.","volume":"134","author":"Afman","year":"2006","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi260042r17","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1111\/pan.70046","article-title":"Seeking a viable alternative: a prospective, randomized, controlled, double-blind non-inferiority study of oral versus IV dexamethasone in children undergoing tonsillectomy.","volume":"35","author":"Brooks Peterson","year":"2025","journal-title":"Paediatr Anaesth"},{"key":"ooi260042r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2025.112584","article-title":"Steroid use after pediatric tonsillectomy: a systematic review and meta-analysis.","volume":"198","author":"Puyo","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"12","key":"ooi260042r19","doi-asserted-by":"publisher","first-page":"2000","DOI":"10.1097\/00005537-200012000-00003","article-title":"Evaluating the effects of oral prednisolone on recovery after tonsillectomy: a prospective, double-blind, randomized trial.","volume":"110","author":"Palme","year":"2000","journal-title":"Laryngoscope"},{"issue":"3","key":"ooi260042r20","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1177\/0194599812447776","article-title":"The effect of a postoperative course of oral prednisone on postoperative morbidity following childhood tonsillectomy.","volume":"147","author":"Macassey","year":"2012","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"ooi260042r21","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1002\/ohn.1318","article-title":"Steroids for pediatric adenotonsillectomy pain-a prospective multicenter randomized trial.","volume":"173","author":"Pereira","year":"2025","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"9","key":"ooi260042r22","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1002\/lary.27167","article-title":"The effect of postoperative steroids on post-tonsillectomy pain and need for postoperative physician contact.","volume":"128","author":"Redmann","year":"2018","journal-title":"Laryngoscope"},{"issue":"1","key":"ooi260042r23","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1177\/0194599820973250","article-title":"Recovery after adenotonsillectomy-do steroids help? Outcomes from a randomized controlled trial.","volume":"165","author":"Greenwell","year":"2021","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"ooi260042r24","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1111\/j.1553-2712.2009.00620.x","article-title":"Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients.","volume":"17","author":"Garra","year":"2010","journal-title":"Acad Emerg Med"},{"key":"ooi260042r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners.","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"2","key":"ooi260042r26","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"2","key":"ooi260042r28","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1213\/ANE.0b013e318203f495","article-title":"Do 0-10 numeric rating scores translate into clinically meaningful pain measures for children?","volume":"112","author":"Voepel-Lewis","year":"2011","journal-title":"Anesth Analg"},{"issue":"1","key":"ooi260042r29","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1007\/s12630-024-02817-y","article-title":"Effects of dexamethasone on opioid consumption in pediatric tonsillectomy: a systematic review with meta-analysis.","volume":"72","author":"Niimi","year":"2025","journal-title":"Can J Anaesth"},{"issue":"1","key":"ooi260042r30","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-2439","article-title":"Persistent opioid use among pediatric patients after surgery.","volume":"141","author":"Harbaugh","year":"2018","journal-title":"Pediatrics"},{"issue":"4","key":"ooi260042r31","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/j.surg.2019.04.016","article-title":"New persistent opioid use among older patients following surgery: a Medicare claims analysis.","volume":"167","author":"Santosa","year":"2020","journal-title":"Surgery"},{"issue":"4","key":"ooi260042r32","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1097\/SLA.0000000000003549","article-title":"Postsurgical opioid prescriptions and risk of long-term use: an observational cohort study across the United States.","volume":"273","author":"Young","year":"2021","journal-title":"Ann Surg"},{"issue":"6","key":"ooi260042r33","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in us adults.","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg"},{"issue":"3","key":"ooi260042r34","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1213\/00000539-200103000-00015","article-title":"The effect of dexamethasone on postoperative vomiting after tonsillectomy.","volume":"92","author":"Aouad","year":"2001","journal-title":"Anesth Analg"},{"issue":"4","key":"ooi260042r35","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/BF03021038","article-title":"Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy.","volume":"50","author":"Elhakim","year":"2003","journal-title":"Can J Anaesth"},{"issue":"5","key":"ooi260042r36","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1213\/00000539-199611000-00004","article-title":"Dexamethasone decreases vomiting by children after tonsillectomy.","volume":"83","author":"Splinter","year":"1996","journal-title":"Anesth Analg"},{"issue":"1","key":"ooi260042r37","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.ijporl.2005.05.013","article-title":"The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy.","volume":"70","author":"Kaan","year":"2006","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"11","key":"ooi260042r38","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1093\/aje\/153.11.1089","article-title":"Steroids and risk of upper gastrointestinal complications.","volume":"153","author":"Hern\u00e1ndez-D\u00edaz","year":"2001","journal-title":"Am J Epidemiol"},{"issue":"5","key":"ooi260042r39","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004587","article-title":"Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis.","volume":"4","author":"Narum","year":"2014","journal-title":"BMJ Open"},{"issue":"10","key":"ooi260042r40","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.1016\/j.ijporl.2015.07.002","article-title":"Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.","volume":"79","author":"Duval","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"12","key":"ooi260042r41","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1177\/000348941212101202","article-title":"Significant post-tonsillectomy pain is associated with increased risk of hemorrhage.","volume":"121","author":"Sarny","year":"2012","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"1","key":"ooi260042r42","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/S0165-5876(97)00107-9","article-title":"Post-tonsillectomy pain: the difference between younger and older patients.","volume":"42","author":"Lavy","year":"1997","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"ooi260042r44","first-page":"9","article-title":"Pain in children: comparison of assessment scales.","volume":"14","author":"Wong","year":"1988","journal-title":"Pediatr Nurs"},{"issue":"3","key":"ooi260042r45","doi-asserted-by":"publisher","first-page":"365","DOI":"10.17219\/acem\/112600","article-title":"Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children.","volume":"29","author":"Zielinski","year":"2020","journal-title":"Adv Clin Exp Med"},{"issue":"5","key":"ooi260042r46","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000001029","article-title":"Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression.","volume":"7","author":"Zhou","year":"2022","journal-title":"Pain Rep"},{"issue":"3","key":"ooi260042r48","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1046\/j.1526-4637.2003.03034.x","article-title":"The unequal burden of pain: confronting racial and ethnic disparities in pain.","volume":"4","author":"Green","year":"2003","journal-title":"Pain Med"},{"issue":"3","key":"ooi260042r49","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.jopan.2022.09.004","article-title":"A Systematic review of race, sex, and socioeconomic status differences in postoperative pain and pain management.","volume":"38","author":"Thurston","year":"2023","journal-title":"J Perianesth Nurs"},{"issue":"3","key":"ooi260042r50","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.jpain.2011.10.014","article-title":"The perception of pain in others: how gender, race, and age influence pain expectations.","volume":"13","author":"Wandner","year":"2012","journal-title":"J Pain"},{"key":"ooi260042r27","unstructured":"Schimmer? BP, Funder? W. Adrenocorticotropic Hormone, Adrenal Steroids, and the Adrenal Cortex. In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman\u2019s: The Pharmacological Basis of Therapeutics. McGraw-Hill Education; 2017. Accessed February 2, 2026. https:\/\/accesspharmacy.mhmedical.com\/content.aspx?bookid=2189§ionid=172482605"},{"key":"ooi260042r43","unstructured":"Wong-Baker FACES Foundation. History of the Wong-Baker FACES Pain Rating Scale. Accessed February 2, 2026. https:\/\/wongbakerfaces.org\/us\/wong-baker-faces-history\/"},{"key":"ooi260042r47","unstructured":"US Census Bureau. Selected Characteristics of the Native and Foreign-Born Populations. American Community Survey, 1-Year Estimates Subject Table S0501. Accessed February 2, 2026. https:\/\/data.census.gov\/table\/ACSST1Y2022.S0501?q=2022+allegheny+county"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2851924\/jamaotolaryngology_shaffer_2026_oi_260042_1787849052.24658.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:00:30Z","timestamp":1789052430000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2851924"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":50,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2026.1910","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}