{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:49:33Z","timestamp":1791798573478,"version":"4.3.4"},"reference-count":52,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"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":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>CINAHL, Cochrane Library, PubMed, and Scopus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>Studies on nonpharmacologic interventions for pediatric posttonsillectomy pain were included in this systematic review. Extracted variables included demographics, pain scores, and postoperative bleeding. Pain scores on 0\u201010 scales (eg, Visual Analog Scale, Wong\u2010Baker, FLACC, Oucher) were analyzed, and scales using different ranges, but comparable pain markers, were standardized to 0 to 10. Data were summarized as means, proportions (%), and differences (\u0394) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI), ROBINS\u2010I, or ROB\u20102 tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010three studies (n\u2009=\u20093538) met inclusion criteria. Several nonpharmacologic intervention groups showed significant reductions in postoperative pain compared to control. At 6\u2009hours postoperatively, acupuncture (\u2206 \u22120.8, 95% CI [\u22121.17, \u22120.43],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01), ice cream (\u2206 \u22121.4, 95% CI [\u22122.28, \u22120.52],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01), cartoon distraction (\u2206 \u22121.3, 95% CI [\u22121.83, \u22120.77],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01), and lavender essence inhalation (\u2206 \u22120.9, 95% CI [\u22121.76, \u22120.04],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04), were associated with lower pain scores. By postoperative Day 7 sugar\u2010free gum was the only intervention associated with lower pain scores (\u2206 \u22122.2, 95% CI [\u22123.07, \u22121.33],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01). Salvia officinalis, cold diet, and food and effort restrictions were associated with less postoperative bleeding. Honey, intraoperative music, autologous serum, and liquid\/soft diet (among other interventions) showed no changes in postoperative pain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nonpharmacologic interventions including acupuncture, sugar\u2010free gum, distraction, and select oil essence therapies are associated with less pain, with some interventions reducing postoperative bleeding risk. This supports incorporating non\u2010pharmacologic adjuncts for pediatric posttonsillectomy pain, though further high\u2010quality studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70316","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:19:26Z","timestamp":1781709566000},"page":"777-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonpharmacologic Therapy for Pediatric Posttonsillectomy Pain: A Systematic Review"],"prefix":"10.1002","volume":"175","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3035-1983","authenticated-orcid":false,"given":"Justina T.","family":"Sargios","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8640-3178","authenticated-orcid":false,"given":"David","family":"Kayekjian","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-4571","authenticated-orcid":false,"given":"Shaun A.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pete","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarice S.","family":"Clemmens","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Pediatric Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.268"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2018.01.026"},{"issue":"5","key":"e_1_2_9_4_1","article-title":"Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: a 10\u2010year analysis","volume":"46","author":"Anwaegbu OS","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0194599810389949","article-title":"Clinical practice guideline: tonsillectomy in children","volume":"144","author":"Baugh RF","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wjorl.2021.03.004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/children7110236"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_9_9_1","unstructured":"OCEBM Levels of Evidence Working Group. 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