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Does laryngopharyngeal reflux affect healing and recovery after tonsillectomy?

Published online by Cambridge University Press:  11 July 2007

S Elwany ,
Y A Nour  and
E A Magdy
S Elwany
Affiliation:
Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Alexandria University, Egypt
Y A Nour
Affiliation:
Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Alexandria University, Egypt
E A Magdy*
Affiliation:
Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Alexandria University, Egypt
*
Address for correspondence: Dr Emad A Magdy, 4 Omar Lotfy Street, Camp Shezar, Suite 2, Alexandria, Egypt 21321. Fax: +203 4273506 E-mail: emad.magdy@yahoo.com
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Abstract

Introduction:

Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders.

Aims:

To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings.

Materials and methods:

A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux.

Results:

Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found.

Conclusions:

Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

Keywords

Gastro-oesophageal RefluxTonsillectomyPost-operative PainWound Healing
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 6 , June 2008 , pp. 603 - 608
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Timms, MS, Temple, RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:450–2CrossRefGoogle ScholarPubMed
2 Back, L, Paloheimo, M, Ylikoski, J. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study. Arch Otolaryngol Head Neck Surg 2001;127:1106–12CrossRefGoogle ScholarPubMed
3 Volk, MS, Wang, Z, Pankratov, MM, Perrault, DF Jr, Ingrams, DR, Shapshay, SM. Mucosal intact laser tonsillar ablation. Arch Otolaryngol Head Neck Surg 1996;122:1355–9CrossRefGoogle ScholarPubMed
4 Wexler, DB. Recovery after tonsillectomy: electrodissection vs. sharp dissection techniques. Otolaryngol Head Neck Surg 1996;114:576–81CrossRefGoogle ScholarPubMed
5 Dempster, JH. Post-tonsillectomy analgesia: the use of benzocaine lozenges. J Laryngol Otol 1988;102:813–14CrossRefGoogle ScholarPubMed
6 Telian, SA, Handler, SD, Fleisher, GR, Baranak, CC, Wetmore, RF, Potsic, WP. The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study. Arch Otolaryngol Head Neck Surg 1986;112:610–15CrossRefGoogle Scholar
7 Gillis, TM, Strong, MS. Surgical lasers and soft tissue interactions. Otolaryngol Clin North Am 1983;16:775–84CrossRefGoogle ScholarPubMed
8 Vincent, DA Jr, Garrett, JD, Radionoff, SL, Reussner, LA, Stasney, CR. The proximal probe in esophageal pH monitoring: development of a normative database. J Voice 2000;14:247–54CrossRefGoogle ScholarPubMed
9 Witte, MB, Barbul, A. General principles of wound healing. Surg Clin North Am 1997;77:509–28CrossRefGoogle ScholarPubMed
10 Noordzij, JP, Affleck, BD. Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients. Laryngoscope 2006;116:1303–9CrossRefGoogle ScholarPubMed
11 Koufman, JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101(suppl 53):1–78CrossRefGoogle Scholar
12 Koufman, JA, Amin, MR, Panetti, M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000;123:385–8CrossRefGoogle ScholarPubMed
13 Toohill, RJ, Kuhn, JC. Role of refluxed acid in pathogenesis of laryngeal disorders. Am J Med 1997;103 (suppl 1):100S–106SCrossRefGoogle ScholarPubMed
14 Kleemann, D, Nofz, S, Plank, I, Schlottmann, A. Prolonged healing process after endonasal nasal sinus surgery. Gastroesophageal reflux as a cause? HNO 2005;53:333–6CrossRefGoogle ScholarPubMed
15 Roh, JL, Lee, YW, Park, HT. Effect of acid, pepsin, and bile acid on the stenotic progression of traumatized subglottis. Am J Gastroenterol 2006;101:1186–92CrossRefGoogle ScholarPubMed
16 Johnston, N, Bulmer, D, Gill, GA, Panetti, M, Ross, PE, Pearson, JP et al. Cell biology of laryngeal epithelial defences in health and disease: further studies. Ann Otol Rhinol Laryngol 2003;112:481–91CrossRefGoogle ScholarPubMed
17 Tobey, NA, Hosseini, SS, Caymaz-Bor, C, Wyatt, HR, Orlando, GS, Orlando, RC. The role of pepsin in acid injury to esophageal epithelium. Am J Gastroenterol 2001;96:3062–70CrossRefGoogle ScholarPubMed
18 Freeman, SB, Markwell, JK. Sucralfate in alleviating post-tonsillectomy pain. Laryngoscope 1992;102:1242–6CrossRefGoogle ScholarPubMed
19 Kyrmizakis, DE, Papadakis, CE, Bizakis, JG, Velegrakis, GA, Siafakas, NM, Helidonis, ES. Sucralfate alleviating post-laser-assisted uvulopalatoplasty pain. Am J Otolaryngol 2001;22:55–8CrossRefGoogle ScholarPubMed
20 Green, FW Jr, Kaplan, MM, Curtis, LE, Levine, PH. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology 1978;74:38–43CrossRefGoogle ScholarPubMed
21 Moraes-Filho, J, Cecconello, I, Gama-Rodrigues, J, Castro, L, Henry, MA, Meneghelli, UG et al. Brazilian consensus on gastroesophageal reflux disease: proposals for assessment, classification, and management. Am J Gastroenterol 2002;97:241–8CrossRefGoogle ScholarPubMed
22 Park, W, Hicks, DM, Khandwala, F, Richter, JE, Abelson, TI, Milstein, C et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 2005;115:1230–8CrossRefGoogle ScholarPubMed
23 Sato, K. Laryngopharyngeal reflux disease with nocturnal gastric acid breakthrough while on proton pump inhibitor therapy. Eur Arch Otorhinolaryngol 2006;263:1121–6CrossRefGoogle ScholarPubMed