الفهرس 
Introduction.Only 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Tonsillectomy is one of the most commonly performed surgeries especially in children and adolescents that has been a known procedure for more than 2,000 years. The early post-operative morbidity is very stressful and difficult for both patients and parents.
Symptoms of post-tonsillectomy tonsillectomy morbidity include fever, bleeding, throat pain, prolonged time to return to normal diet, bad mouth odor (halitosis), otalgia and infection of the tonsillar beds . Many studies have addressed various factors that can influence post-tonsillectomy morbidity such as the surgical techniques, methods of hemostasis, the experience of the surgeon, and management protocols; but no dramatic improvement was achieved in recovery after this common surgery.
For the past 18years investigators have analyzed the use of antibiotic and oral steroids to reduce postoperative morbidity showings no clear consensus. Results from randomized studies have demonstrated conflicting results with some showing a clinical benefits, where as others demonstrated no benefits.
In this clinical trial we try to evaluate the role of post-operative oral steroids (prednisolone) and/or antibiotic (amoxicillin and clavulanic acid) in reduction of post tonsillectomy morbidity (fever, nausea, vomiting, degree of throat pain, presence of halitosis, presence of pharyngeal bleeding and, daily analgesic dose required and time required returning to normal diet.).
Summary
100
Patients were randomly allocated into 4 groups by random calculation, computer generated numbers obtained from graph pad software.
Group A :( placebo group-control group):75 patients received a five days of placebo only
Group B :( antibiotic group): 64 patients received a five days of postoperative oral antibiotic and placebo.
Group C: (antibiotic steroid group) : 61 patients received a five days of postoperative oral antibiotic and oral steroid
Group D: (steroid group): 65 patients received a five days of postoperative oral steroid and placebo for a period of 5 days.
The study was double blinded, so none of the patients, their parents or the surgeon knew what the group of the allocated child
Prior to discharge home, dairy was given to the parents of the operated child. This charted the daily postoperative course for the seven days immediately after discharge. The parents were asked to note :-Incidence of fever, presence of nausea and vomiting, degree of throat pain, presence of halitosis, presence of pharyngeal bleeding and, if so, its severity and timing, daily analgesic dose required and time required returning to normal diet.
There were significant differences between groups in the mean pain score, Paracetamol consumption (mg/kg/d), fever, halitosis, post-operative bleeding and time taken to return to normal diet in a pattern that , the morbidity was the least in group C (antibiotic steroid group) then group B (antibiotic group) then group D (steroid group) then group A (placebo group).
Summary
101
Postoperative fever occurrence- from 3rd day till 7th day- differed significantly among groups. The differences were between groups A and D from one side and groups B and C from other side.
from our results we concluded that combined prophylactic oral steroids (Prednisolone) and antibiotic (amoxicillin and clavulanic acid) for five days after tonsillectomy can reduces the postoperative morbidities. We didn’t record any adverse effects from its use.