From the Guidelines
Steroids, such as dexamethasone, can be effective in reducing tonsillar swelling, especially in cases where significant inflammation or airway obstruction is a concern, with a recommended dose of 0.5 mg/kg, although lower doses may be equally effective. When considering the use of steroids for tonsillar swelling, it is essential to weigh the potential benefits against the risks, particularly in children, where the evidence suggests that tonsillectomy can be effective in controlling sleep-disordered breathing (SDB) in 60%-70% of cases with significant tonsillar hypertrophy 1. The mechanism of efficacy of dexamethasone in reducing tonsillar swelling is thought to be related to its anti-inflammatory properties, which can help reduce pain and swelling, and it has also been shown to decrease throat pain after tonsillectomy and time to resumption of oral intake 1. Some key points to consider when using steroids for tonsillar swelling include:
- The dose of dexamethasone can range from 0.15 to 1.00 mg/kg, with a maximum dose range of 8 to 25 mg, although 0.5 mg/kg is commonly used 1
- Steroids should be used as an adjunct to appropriate antibiotic therapy if the tonsillar swelling is due to bacterial infection
- Potential side effects of steroids include increased appetite, mood changes, insomnia, and elevated blood glucose, although these are typically minimal with short courses
- Steroids are not recommended for routine use in uncomplicated cases and should be reserved for significant inflammation or when there's concern about airway compromise.
From the Research
Tonsilar Swelling and Steroids
- Tonsillitis, or inflammation of the tonsils, can be caused by viral or bacterial infections, with bacterial infections accounting for 5% to 15% of cases in adults and 15% to 30% of cases in children between 5 and 15 years old 2.
- The use of steroids for tonsilar swelling is not directly addressed in the provided studies, except in the context of postoperative management after tonsillectomy.
- Studies have investigated the impact of oral steroids on postoperative tonsillectomy recovery, with findings suggesting that steroids can reduce pain and nausea/vomiting in the postoperative period 3, 4.
- A study published in the Ear, Nose, & Throat Journal found that patients who received steroids after tonsillectomy experienced a decrease in pain and nausea/vomiting, with significant reductions in pain on postoperative days 2,3,4, and 6 3.
- Another study published in The Laryngoscope found that oral prednisolone may be beneficial during recovery from tonsillectomy, with improvements in pain, diet, activity, and re-epithelialization in pediatric patients, and improved re-epithelialization in both pediatric and adult patients 4.
Management of Tonsillitis
- Treatment for tonsillitis is focused on supportive care, with antibiotics prescribed only in cases of bacterial infection, such as group A beta-hemolytic streptococcus 2.
- Watchful waiting is recommended for recurrent tonsillitis, with surgical intervention considered only in cases of frequent or severe episodes 2.
- Peritonsillar infections may require antibiotic treatment, needle aspiration, or incision and drainage of an abscess, with quinsy tonsillectomy or interval tonsillectomy considered in some cases 5.