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Wang Y, Zhao L, Wang J, Li X. The efficacy of perioperative antibiotic therapy in adenotonsillectomy children. Eur Arch Otorhinolaryngol 2024; 281:267-272. [PMID: 37737873 DOI: 10.1007/s00405-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To evaluate the role of perioperative antibiotics use in children after adenotonsillectomy. METHODS SPSS 27.0 was used for statistical analysis. Two independent samples mean T test was used to evaluate the throat pain scores consecutive 3 days after the surgery, the time to resume to normal diet, and the wound healing time. Logistic regression analysis was used to evaluate the independent risk factors of the two groups. The generalized estimation model was used to evaluate the correlation between age and postoperative pain scores, and the relationship between different tonsillar bed gradings and postoperative pain scores. RESULTS The pain scores were 5.83 ± 1.879, 5.20 ± 1.933, and 4.02 ± 1.936 in the observation group; and 6.83 ± 1.892, 6.17 ± 2.001, and 5.29 ± 2.068 in the control group on days 1-3 after surgery, respectively. The time of pain disappearance was 6.24 ± 2.121 days in the observation group and 7.73 ± 2.210 days in the control group. The wound repair time was 18.66 ± 2.200 days in the observation group and 18.70 ± 2.468 days in the control group. Logistic regression analysis showed that fever was an independent risk factor for the two groups and was negatively correlated (B = - 1.237, P < 0.001, OR = 0.290). Generalized estimation model showed that there was a positive correlation between age and pain scores (P < 0.001), and with the increasing grading of tonsillar bed, the higher the pain scores was (P < 0.001). CONCLUSIONS Perioperative use of antibiotics in children with adenotonsillectomy can effectively reduce postoperative fever, throat pain symptoms, and shorten the pain time. With the increasing of tonsillar bed grading, perioperative antibiotic therapy was more necessary.
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Affiliation(s)
- Ying Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Limin Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Jing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China.
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Faramarzi M, Shishegar M, Kazemi T, Tavakolpour Saleh H, Roosta S. The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding. Eur Arch Otorhinolaryngol 2020; 278:485-492. [PMID: 32601919 DOI: 10.1007/s00405-020-06173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Pain and hemorrhage are common morbidities after tonsillectomy. Although many studies have focused on post-tonsillectomy pain, inadequate researches are available on wound healing. Hence, there is a definite need for a novel technique to facilitate the healing process and thereby improving the post-tonsillectomy recovery. METHODS This prospective and randomized study was conducted on 60 adult patients who underwent tonsillectomy. They were divided into two groups of control and amniotic membrane (AM). Human amniotic membrane was applied over the tonsillar bed as a biologic dressing. Post-tonsillectomy pain and bleeding were evaluated. Also, the healing rate was assessed on days 5, 10 and 15 post-operatively. RESULTS The pain score in the AM group was lower than that in the control group during the first week after surgery (P < 0.0001). Moreover, the AM group returned faster to their normal diet in comparison with the control group (P < 0.0001). With respect to the healing rate, there were no significant differences between the groups on day 5 (P > 0.05), whereas a significant difference was seen on days 10 and 15 post-surgery (P < 0.0001). There was no significant difference between the two groups in terms of post-operative bleeding (P ≅ 1). CONCLUSION We observed that the use of AM graft as a biologic dressing might be beneficial in reducing post-operative pain and promoting the wound healing process. The results represent a further step toward developing a new technique for coverage of tonsillar fossa with sheeting or wearing grafts.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Shishegar
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Tayebeh Kazemi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Tavakolpour Saleh
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wound healing after tonsillectomy - a review of the literature. The Journal of Laryngology & Otology 2018; 132:764-770. [PMID: 30289104 DOI: 10.1017/s002221511800155x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To summarise the available literature related to wound healing post tonsillectomy, including the stages of healing, experimental models for assessing healing (in animals and humans) and the various factors that affect wound healing. METHODS A search of the English literature was conducted using the Ovid Medline database, with the search terms 'tonsillectomy' or 'tonsil' and 'wound healing'. Thirty-one articles that objectively assessed tonsillectomy wound healing were included for analysis. RESULTS The majority of assessments in humans investigating tonsillectomy wound healing involve serial direct clinical examinations of the oral cavity. Many patient and surgical factors have been shown to affect wound healing after tonsillectomy. There is some research to suggest that the administration of adjunctive treatment in the post-operative period may be beneficial to tonsillectomy wound healing. CONCLUSION Wound healing post tonsillectomy has been poorly researched. Having a better understanding of the process of wound healing would allow surgeons to potentially prevent, anticipate and manage complications from the surgery that arise as part of the healing process.
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Moon JH, Lee MY, Chung YJ, Rhee CK, Lee SJ. Effect of Topical Propolis on Wound Healing Process After Tonsillectomy: Randomized Controlled Study. Clin Exp Otorhinolaryngol 2017; 11:146-150. [PMID: 29665628 PMCID: PMC5951064 DOI: 10.21053/ceo.2017.00647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/24/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The post-tonsillectomy pain and post-tonsillectomy hemorrhage are the two main problems after tonsillectomy. The aim of this study was to investigate the beneficial effects of water soluble ethanol extract propolis on post-tonsillectomy patient. METHODS One hundred and thirty patients who underwent tonsillectomy or adenotonsillectomy were randomly divided into the control and propolis groups, each including 65 patients. The propolis group was applied with propolis orally immediately after surgery and by gargle. The pain scores were assessed on post-tonsillectomy 0, 1st, 2nd, 3rd, and 7th-10th day using a visual analogue scale score. Postoperative wound healing was evaluated by scoring pinkish membrane of tonsillar fossae on postoperative days 3 and 7-10. The incidence of post-tonsillectomy bleeding was examined in each group. RESULTS Post-tonsillectomy pain was significantly less in propolis group compared to control group on postoperative days 3 and 7-10. Post-tonsillectomy hemorrhage was significantly less in the propolis group compared to the control group (P<0.05). The wound healing was significantly better in the propolis group compared to the control group on postoperative day 7-10 (P=0.002). CONCLUSION Applying the propolis to post-tonsillectomy wound showed beneficial effect of reducing postoperative pain, preventing hemorrhage, and accelerating of wound healing of tonsillar fossae.
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Affiliation(s)
- Jeong Hwan Moon
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.,Laser Translational Clinical Trial Center, Dankook University, Cheonan, Korea
| | - Min Young Lee
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.,Laser Translational Clinical Trial Center, Dankook University, Cheonan, Korea
| | - Young-Jun Chung
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.,Laser Translational Clinical Trial Center, Dankook University, Cheonan, Korea
| | - Chung-Ku Rhee
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.,Medical Laser Research Center, Cheonan, Korea
| | - Sang Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.,Beckman Laser Institute Korea, Cheonan, Korea.,Laser Translational Clinical Trial Center, Dankook University, Cheonan, Korea
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Lal A, Chohan K, Chohan A, Chakravarti A. Role of honey after tonsillectomy: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2016; 42:651-660. [PMID: 27863042 DOI: 10.1111/coa.12792] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Honey reduced post-tonsillectomy pain, but its effects on awakening at night, inflammation and healing of the tonsillar fossa were controversial. OBJECTIVES 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.
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Affiliation(s)
- A Lal
- Department of Anesthesia and Perioperative Medicine, University Hospital, London, ON, Canada
| | - K Chohan
- Department of Biomedical Science, University of Ottawa, Ottawa, ON, Canada
| | - A Chohan
- Department of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - A Chakravarti
- Department of Otorhinolaryngology- Head and Neck Surgery, Lady Hardinge Medical College, New Delhi, India
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Manyes L, Escrivá L, Serrano AB, Rodríguez-Carrasco Y, Tolosa J, Meca G, Font G. A preliminary study in Wistar rats with enniatin A contaminated feed. Toxicol Mech Methods 2014; 24:179-90. [DOI: 10.3109/15376516.2013.876135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Boroumand P, Zamani MM, Saeedi M, Rouhbakhshfar O, Hosseini Motlagh SR, Aarabi Moghaddam F. Post tonsillectomy pain: can honey reduce the analgesic requirements? Anesth Pain Med 2013; 3:198-202. [PMID: 24223362 PMCID: PMC3821146 DOI: 10.5812/aapm.9246] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/21/2013] [Accepted: 02/24/2013] [Indexed: 01/22/2023] Open
Abstract
Background Tonsillectomy with or without adenoidectomy is one of the most common surgical
procedures performed worldwide, especially for children. Oral honey administration
following tonsillectomy in pediatric cases may reduce the need for analgesics via
relieving postoperative pain. Objectives The aim of this study was to evaluate the effects of honey on the incidence and
severity of postoperative pain in patients undergoing tonsillectomy. Patients and Methods A randomized, double blind, placebo controlled study was performed. One hundred and
four patients, who were older than eight, and were scheduled for tonsillectomy, were
divided into two equal groups, honey and placebo. Standardized general anesthesia, and
postoperative usual analgesic, and antibiotic regimen were administrated for all
patients. Acetaminophen plus honey for the honey group, and acetaminophen plus placebo
for the placebo group were given daily. They began to receive honey or placebo when the
patients established oral intake. Results The difference between acetaminophen and acetaminophen plus honey groups was
statistically significant both for visual analogue scale (VAS), and number of
painkillers taken within the first three postoperative days. The consumption of
painkillers differed significantly in every five postoperative days. No significant
difference was found between groups regarding the number of awaking at night. Conclusions Postoperative honey administration reduces postoperative pain and analgesic
requirements in patients after tonsillectomy. As the side effects of honey appear to be
negligible, consideration of its routine usage seems to be beneficial along with routine
analgesics.
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Affiliation(s)
- Peyman Boroumand
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | - Mohammad Mahdi Zamani
- Department of Anesthesiology, Firoozgar Hospital, Iran
University of Medical Sciences (IUMS), Tehran, Iran
| | - Masoumeh Saeedi
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | - Omid Rouhbakhshfar
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | | | - Fatemeh Aarabi Moghaddam
- Students’ Scientific Research Center, School of
Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Fatemeh Aarabi Moghaddam,
Students’ Scientific Research Center, School of Medicine, Tehran University of
Medical Sciences, 3rd floor, Poorsina St., Tehran, Iran. Tel/Fax: +98-2166418588, E-mail:
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008 and previously updated in 2010.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 20 March 2012. SELECTION CRITERIA All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. MAIN RESULTS Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (risk ratio (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of patients with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). The limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence, therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Kovai Medical Center and Hospital (KMCH), KMCH Comprehensive Cancer Center, Coimbatore, India.
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Antibiotics do not reduce post-tonsillectomy morbidity in children. Eur Arch Otorhinolaryngol 2012; 270:367-70. [DOI: 10.1007/s00405-012-2119-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
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10
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In vitro phase I metabolism of the depsipeptide enniatin B. Anal Bioanal Chem 2011; 400:2889-901. [DOI: 10.1007/s00216-011-4964-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/25/2011] [Accepted: 03/26/2011] [Indexed: 11/26/2022]
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Lavonas EJ, Reynolds KM, Dart RC. Therapeutic acetaminophen is not associated with liver injury in children: a systematic review. Pediatrics 2010; 126:e1430-44. [PMID: 21098156 DOI: 10.1542/peds.2009-3352] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Concern exists about the potential for liver injury with therapeutic dosing of acetaminophen in children. OBJECTIVE We systematically reviewed the medical literature to determine the rate at which liver injury has been reported for children prescribed therapeutic doses of acetaminophen (≤75 mg/kg per day orally or intravenously or ≤100 mg/kg per day rectally). METHODS We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials to locate all studies in which acetaminophen was administered to a defined pediatric population for ≥24 hours and for all case reports of liver injury after therapeutic acetaminophen dosing. Trained reviewers extracted data from each report. Major and minor hepatic adverse events (AEs) were defined prospectively. Causality was assessed by using the Naranjo algorithm. RESULTS A total of 62 studies that enrolled 32,414 children were included. No child (0% [95% confidence interval: 0.000-0.009]) was reported to have exhibited signs or symptoms of liver disease, to have received an antidote or transplantation, or to have died. Major or minor hepatic AEs were reported for 10 children (0.031% [95% confidence interval: 0.015-0.057]). The highest transaminase value reported was 600 IU/L. Naranjo scores (2-3) suggested "possible" causation. Twenty-two case reports were identified. In 9 cases, the Naranjo score suggested "probable" causation (5-6). CONCLUSIONS Hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies. Case reports suggest that this phenomenon may occur, but few reports contain sufficient data to support a probable causal relationship.
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Affiliation(s)
- Eric J Lavonas
- Rocky Mountain Poison & Drug Center, 777 Bannock St, MC 0180, Denver, CO 80204, USA.
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH STRATEGY We searched the Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to 2009) and EMBASE (1974 to 2009). The date of the last search was 30 October 2009. SELECTION CRITERIA All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. MAIN RESULTS Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (relative risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). Limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Department of Otolaryngology - Head & Neck Surgery, University of Edinburgh Hospitals, Edinburgh, UK
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Profilaxis antibiótica en cirugía otorrinolaringológica. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:54-68. [DOI: 10.1016/j.otorri.2008.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
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Obeso S, Rodrigo JP, Sánchez R, López F, Díaz JP, Suárez C. Antibiotic prophylaxis in otolaryngologic surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
BACKGROUND Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH STRATEGY Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2007), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007) were searched. The date of the last search was March 2007. SELECTION CRITERIA All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total if any documented haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, summary measures were generated using random-effects models. MAIN RESULTS Nine trials met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (Relative Risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.92, 95% CI 0.45 to 1.87, P = 0.81). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS The present review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates). They do however appear to reduce fever. Some important methodological shortcomings exist in the included trials which are likely to have produced bias favouring antibiotics. We therefore advocate caution when prescribing antibiotics routinely to all patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.
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Affiliation(s)
- M Dhiwakar
- Raigmore Hospital, Department of Otolaryngology, Inverness, UK, IV2 3UJ.
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Ozlugedik S, Genc S, Unal A, Elhan AH, Tezer M, Titiz A. Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study. Int J Pediatr Otorhinolaryngol 2006; 70:1929-34. [PMID: 16914210 DOI: 10.1016/j.ijporl.2006.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 07/03/2006] [Accepted: 07/06/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the effectiveness of acetaminophen versus acetaminophen-plus-honey following pediatric tonsillectomy and adenoidectomy. DESIGN Prospective, randomized, and placebo controlled clinical trial. SETTING Tertiary care facility in Ankara, Turkey. PATIENTS Sixty consecutive tonsillectomy patients randomized to two groups. INTERVENTIONS The acetaminophen group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen and placebo, acetaminophen-plus-honey group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen, and honey. Visual analogue scale (VAS) was applied for subjective assessment of postoperative pains, while the number of painkillers taken daily and awakening at night due to pain were used for objective assessment. The amount of epithelization was used for assessment of tonsillary fossa recovery. OUTCOME MEASURES The difference between acetaminophen and acetaminophen-plus-honey groups was statistically significant both in terms of VAS and number of painkillers taken within the first 2 postoperative days (p<0.001). Although there was no statistically significant difference between groups regarding the VAS scores on the 3rd postoperative day and after, the number of painkillers taken differed significantly until the 8th postoperative day (p<0.001 for first 7 postoperative days; p=0.003 for 8th day). No significant difference was found between groups regarding the number of awakening at night (p=0.36). Tonsillary fossa epithelization was more rapid in the acetaminophen-plus-honey group (p<0.001). CONCLUSION Oral administration of honey following pediatric tonsillectomy may relieve postoperative pain and may decrease the need for analgesics. Prospective, randomized, and double-blind studies should further be conducted in order to confirm the data obtained in this study and develop a standard protocol to achieve maximum clinical efficiency.
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Affiliation(s)
- Samet Ozlugedik
- First Otorhinolaryngology Clinic, Numune Education and Research Hospital, Sihhiye, 06100 Ankara, Turkey.
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Yuca K, Cankaya H, Bayram I, Ozbek H, Kiris M. Local irritant effects of topical oral sprays on oral mucosa in mice. Adv Ther 2006; 23:98-106. [PMID: 16644611 DOI: 10.1007/bf02850351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Topical oral sprays are frequently used to prevent and manage oropharyngeal inflammation and lesions. This study investigated the histopathologic changes noted in the oral mucosa of mice after topical application of 3 widely prescribed antibacterial products. The 25 animals were divided into 5 groups and treated for 10 days with 2 sprays daily, as follows: group 1-chlorhexidine gluconate 0.12% + benzydamine hydrochloride 0.15%; group 2-benzydamine 0.27 mg/0.18 mL x 30 mL; group 3-chlorhexidine 0.2%; group 4-fusafungine 1%; and group 5 (cohort)-physiologic serum. On day 10 after drug administration, biopsy specimens were taken from the oropharyngeal mucosa of the tongue, the cheek mucosa, and the tongue base; these were examined under a light microscope and were classified as normal or pathologic. All topical oral sprays produced some degree of histopathologic change, such as hyperplasia, fibrosis, low-grade dysplasia, congestion, or edema. The local irritant effects of topical oral sprays should be considered when treatment is selected for patients with oropharyngeal disorder.
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Affiliation(s)
- Köksal Yuca
- Department of Otorhinolaryngology, Yüzüncü Yil University, Faculty of Medicine, Van, Turkey
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