title: Role of honey after tonsillectomy: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Honey reduced post-tonsillectomy pain, but its effects on awakening at night, inflammation and healing of the tonsillar fossa were controversial.
  
  
  OBJECTIVE
  This systematic review and meta-analysis of randomised controlled trials (RCTs) evaluated the effect of oral honey on pain, consumption of painkillers, awakening at night, healing of tonsillar fossa and adverse effects in children after tonsillectomy.
  
  
  METHODS
  A search of MEDLINE, EMBASE, Scopus, CINAHL and Cochrane Collaboration Library databases was performed without any restriction of publication year. The end date of search was 30 June 2016. The search was supplemented by search from Google, hand search of cross-references of selected articles and reviews, and contacting the authors of different studies. The inclusion criteria were RCTs comparing the effect of honey with control on different outcomes, in children after tonsillectomy.
  
  
  RESULTS
  Our search generated 64 studies, and eight RCTs met our inclusion criteria. The methodological quality of RCTs was poor. Compared to control, honey significantly decreased postoperative pain from day 1 to day 7 (P = 0.05 to <0.0001); consumption of painkillers from days 1 to 5 (P = 0.03 to 0.003) and on day 10 (P = 0.002); and number of awakening at night due to pain on days 2 and 4 after tonsillectomy (P = 0.0001, 0.004). The healing of tonsillar fossa was significantly greater with honey compared to control on days 3-4 (P = 0.02) and days ≥9 (P = 0.01) after tonsillectomy. The adverse effects were not significantly different between honey and control groups. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) of the evidence for different outcomes varied from 'low' to 'very low'.
  
  
  CONCLUSIONS
  Honey improved pain, requirement of painkillers and awakening at night due to pain in children after tonsillectomy. There was little improvement in healing of tonsillar fossa. The GRADE of the evidence varied from 'low' to 'very low'. A good-quality, placebo-controlled RCT of different doses and durations of administration of honey is required to evaluate its clear efficacy and safety in children after tonsillectomy.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, University Hospital, London, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lal
authors.affiliation: Department of Biomedical Science, University of Ottawa, Ottawa, ON, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Chohan
authors.affiliation: Department of Psychology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Chohan
authors.affiliation: Department of Otorhinolaryngology- Head and Neck Surgery, Lady Hardinge Medical College, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Chakravarti
mesh_terms: D006722:Honey; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014068:Tonsillectomy / Q000009:adverse effects*; D016896:Treatment Outcome