{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:33:29Z","timestamp":1791387209845,"version":"4.3.3"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare surgical versus medical treatment approaches for periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and Cochrane.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>We followed the Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses\u2010Network Meta\u2010analyses checklist. Two authors independently reviewed the studies. Inclusion criteria comprised randomized controlled trials and cohort studies. Non\u2010English studies, along with case series and review articles, were excluded. The primary outcome was the incidence of persistent symptoms following surgery, compared to medical treatment. Secondary outcomes included complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The search identified 693 publications. After applying the inclusion and exclusion criteria, nine studies were included (three randomized controlled trials and six cohort studies), comprising a total of 691 patients (256 [37%] females, mean age: 2.97 years, and interquartile range: 2.3\u20103.3). Patients were treated with either tonsillectomy (n\u2009=\u2009201), intracapsular tonsillectomy (IT, n\u2009=\u200924), or medical treatment (n\u2009=\u2009466). Surgery was associated with a higher likelihood of symptom resolution compared to medical treatment (odds ratio [OR]: 11.7, 95% CI: 2.14\u201063.94). However, heterogeneity was observed across studies (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980.8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01). A sensitivity analysis was performed, including randomized controlled trials. Both tonsillectomy (OR: 34.15, 95% CI: 3.77\u2010308.95) and IT (OR: 21, 95% CI: 1.5\u2010293.25) were associated with a greater likelihood of symptom resolution. The pooled complication rate was 6.6%, with a higher incidence in patients who underwent tonsillectomy versus IT (46\/201 vs 0\/24,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.008). The pooled rate of symptom recurrence was 13.6% in patients following tonsillectomy and 37.5% in IT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Surgical management of PFAPA with tonsillectomy was superior to medical treatment. Tonsillectomy resulted in a lower recurrence rate of symptoms compared to IT, with a comparable incidence of complications to existing literature. However, given the limited number of patients in the IT group, these findings should be interpreted with caution, and further randomized studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.1371","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T10:43:26Z","timestamp":1753958606000},"page":"1092-1098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Surgical Treatments for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome: Systematic Review and Network Meta\u2010analysis"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7333-6854","authenticated-orcid":false,"given":"Roee","family":"Noy","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rambam Health Care Campus Haifa Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roni","family":"Barzilai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rambam Health Care Campus Haifa Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob T.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rambam Health Care Campus Haifa Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie","family":"Gordin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rambam Health Care Campus Haifa Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen B.","family":"Zur","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology: Head &amp; Neck Surgery The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine The University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-022-00737-z"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-022-00733-3"},{"issue":"12","key":"e_1_2_10_4_1","article-title":"Tonsillectomy for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA)","volume":"12","author":"Burton MJ","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamaoto.313"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818807917"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2010.02.019"},{"issue":"4","key":"e_1_2_10_8_1","article-title":"Tonsillectomy versus tonsillotomy for obstructive sleep\u2010disordered breathing in children","volume":"4","author":"Blackshaw H","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anorl.2024.07.010"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30863"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2007.03.015"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2009.02.038"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2009.56"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2009.01554.x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.06.004"},{"issue":"4","key":"e_1_2_10_16_1","first-page":"156","article-title":"Tonsillectomy efficacy in children with PFAPA syndrome is comparable to the standard medical treatment: a long\u2010term observational study","volume":"32","author":"Vigo G","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1179\/2046905515Y.0000000051"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.3634"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1371","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.1371","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1371","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:14:55Z","timestamp":1790244895000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/ohn.1371"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1371","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]},"assertion":[{"value":"2025-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}