Date	Event	Description
31 March 2014	New search has been performed	New searches run and update completed. Summary of key changes: New outcomes added to protocol. A 'Summary of findings' table is now presented. Quality of evidence is now described based on the GRADE framework. New data were available from Renko 2007: number with immediate and complete symptom resolution. Analysis 1.1 now pools this outcome. This change has not altered our conclusions. Two new authors joined in July 2013 (Roderick Venekamp and Lee Yee Chong).
30 March 2014	New citation required but conclusions have not changed	As no additional trials were identified, the conclusions and recommendations regarding the effectiveness of tonsillectomy versus non‐surgical treatment in children with PFAPA syndrome remain unchanged. The effectiveness of tonsillectomy in children with PFAPA syndrome finding is derived from two small RCTs. These trials reported significant beneficial effects of surgery as compared to no surgery on immediate and complete symptom resolution (NNTB = 2) and a substantial reduction in the frequency and severity (length of episode) of any further symptoms experienced. However, the evidence is of moderate quality (further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate) due to the relatively small sample sizes of the studies and some concerns about the applicability of the results. Therefore, the parents and carers of children with PFAPA syndrome must weigh the risks and consequences of surgery against the alternative of using medication, as it is well established that children with PFAPA syndrome recover spontaneously and medication can be administered to try and reduce the severity of individual episodes. It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone.