Introduction
Complications and morbidities associated with tonsillectomy with or without adenoidectomy include throat pain, nausea and vomiting, delayed feeding resulting in dehydration, voice changes and hemorrhage. The most common postoperative morbidity is throat pain, which persists for 4 days postoperatively. Although studies support the use of perioperative single dose of intravenous dexamethasone in children to reduce postoperative pain, nausea and vomiting, there is lack of data on the role of oral steroids in the postoperative period.
Aim
To evaluate the efficacy of oral steroids on postoperative complications and morbidities following tonsillectomy with or without adenoidectomy.
Method
Study Design
- Prospective study
Treatment Strategy
- This is an institutional review board approved prospective study with retrospective analysis of tonsillectomy patients with or without adenoidectomy in private practice setting
- Patients were asked to fill in a questionnaire which recorded the pain, nausea and vomiting in the 14 days postoperatively
- The study population was divided into 2 groups: patients who received postoperative steroids (POS) and those who did not (PONS)
- Oral steroids were either dexamethasone or prednisolone for 3 days
Endpoints
- Nausea and vomiting (N/V), bleeding and pain from recovery room to postoperative day (POD)14
- Number of emergency department (ED) visits
Results
- The response rate was 27.3% (254/931)
- Nine of the 254 responses were disqualified for lack of information; resulting in the total number of responses of 245; 115 and 130 in the POS and PONS groups respectively
- The baseline demographics of both groups were similar
- Pain and N/V reduced in the POS group as seen in Table 1.
- There was no significant difference in the rate of bleeding
Table 1. Comparison of postoperative complications
POS group
PONS group
P value
Pain
4.0+3.0
4.3+3.1
0.0007
N/V (%)
9.4
13.0
0.0007
Bleeding (%)
2.9
3.9
0.12
- The pain was worst among both the groups in the 1st postoperative week and started to decline only after day 6 to 7
- There was a significant reduction in pain (p < .05) from POD 2, 3, 4, and 6 in the POS group, with the POS group at 1.4 points less than the PONS group
- No notable differences in the pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of ED or clinic visit (p > .05)
Conclusion
- Administration of oral corticosteroids postoperatively significantly decrease the pain scores and the rate of nausea and vomiting in the first week following tonsillectomy with or without adenoidectomy.
- There were no significant differences in pain, daily nausea and vomiting and bleeding during the second postoperative week and in the rate of emergency department or clinic visit between the groups.
Ear, Nose Throat J. 2023;102(5):NP206-NP211. Doi:10.1177/01455613211000832
