Role of Laryngopharyngeal Reflux in Complications of Tonsillectomy in Pediatric Patients

Abstract

Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice. Gastroesophageal reflux was identified as a risk factor for complications in tonsillectomy. This prospective study was designed to assess the role of reflux in the development of complications following tonsillectomy in pediatric patients. Children (n = 60) who underwent tonsillectomy with adenoidectomy were divided into two groups, i.e., the laryngopharyngeal reflux (LPR) group and control group. Patients with LPR were identified by reflux symptom index and reflux finding score. Pain, hemorrhage, fever, nausea, vomiting, fever, dehydration, infection, and pulmonary problems were evaluated post operatively. The mean lengths of hospital stay were 2.11 days in the reflux group and 1.05 days in the control group. The difference was statistically significant. Visual analogue scores of both groups were similar on day 1 but it was significantly higher on day 7 and 14 in LPR group. Nausea and vomiting rates were 11.1 and 9.5 % for the patients in the LPR group and the controls, respectively. The difference between the two groups was not significant. The mean fever was 37.6 °C in the reflux group and 37.3 °C in the controls, which were not significantly different. 19 % of the controls and 22 % of the LPR group patients were readmitted. This difference was not statistically significant. There were two cases of bleeding in the reflux group, while no bleeding occurred in the control group. This difference was significant statistically. LPR is a risk factor for complications following tonsillectomy.

Predictive Pediatric Characteristics for Revision Tonsillectomy After Intracapsular Tonsillectomy

“…Patients with GERD undergoing tonsillectomy have been known to have higher rates of complications, such as desaturations requiring supplemental oxygen or reintubation, pulmonary edema, posttonsillectomy bleed, and dehydration 22 . Other studies have claimed significantly more extended hospital stays, higher pain measures, and increased bleeding rates after tonsillectomy 23 , 24 . Gastroesophageal reflux may contribute to lymphoid hyperplasia, as 1 study saw an association between lymphoid hypertrophy of the base of the tongue and GERD 25 .…”

Reflux as a Risk Factor for Morbidity after Pediatric Tonsillectomy: A National Cohort of Inpatients

“…Post-tonsillectomy pain was significantly higher on postoperative days 7 and 14 in children with laryngopharyngeal reflux (LPR) leading to a delay in resuming a normal diet. 11 Further, adults with LPR had more pain and slower mucosalization of the tonsillar fossa after tonsillectomy. 19 Irritative effects of gastric contents on the exposed nerve endings 19 might explain why adults given liquid alginate for 1 week had improved pain scores on the second postoperative day after tonsillectomy.…”

“…Previous groups found longer admissions after tonsillectomy among children with reflux. 11,13 In another study, admissions over 24 hours occurred more frequently for children who were on preoperative anti-reflux medications. 14 Prolonged admissions could be attributed to increased pain and reduced oral intake.…”

“…Previous work, however, has correlated reflux with a significantly higher rate of posttonsillectomy hemorrhage. 11 The anti-hemostatic effect of hydrochloric acid and pepsin could likely contribute to a higher rate of post-tonsillectomy hemorrhage in children with GER. 21 Additionally, in theory, it is possible that the increased pain with resultant dehydration as well as inflammation from the refluxate could potentially contribute to postoperative bleeding in the setting of GER.…”

“…10 A growing amount of evidence has correlated poorer post-tonsillectomy outcomes among children diagnosed with reflux. Specifically, reflux has been shown to predict worse pain and more frequent bleeding, 11 early airway complications, 12,13 and increased length of hospitalization. 12,14 However, these studies have been limited by the lack of prospective design and small sample size precluding a robust analysis of rare post-tonsillectomy events.…”