(0326) Postoperative Medication Management in Adult Tonsillectomy Patients and the Risk of Oral and Oropharyngeal Candidiasis

Introduction: Oral and oropharyngeal candidiasis is an infrequent post-tonsillectomy complication, and there has been no published data on the effect of postoperative pain regimen and oral candidiasis in adults. This study aims to characterize the relationship between postoperative steroid use for pain control and the incidence of oral and oropharyngeal candidiasis.

Methods: This is a retrospective chart review of adult patients from January 2023- October 2023 who underwent tonsillectomy +/- adenoidectomy at an academic institution. Patients were reviewed by CPT code and included if they were diagnosed with tonsillar hypertrophy or recurrent tonsilitis, attended the postoperative visit, and were 18+. Information was collected about demographics, comorbidities, surgical methods, complications, and pain management regimen. Descriptive statistics and Fisher exact test analysis between patients with various pain regimens were performed.

Results: In total, 78 patients were included in the study and 6 patients experienced postoperative candidiasis. On average, patients were diagnosed with oral candidiasis on postoperative day 11, and 5 of 6 patients were diagnosed by a physician in the clinic. 100% of patients with postoperative candidiasis were prescribed steroids, and the majority were prescribed oral dexamethasone. Notably, 66.7% of patients who experienced oral candidiasis were prescribed both oral dexamethasone (12 mg taken POD3) and magic mouth wash (containing dexamethasone and nystatin) postoperatively. Patients who were prescribed this combination (n = 4) were more likely to develop oral candidiasis than those who were not prescribed both medications (p = 0.029).

Conclusions: Post-tonsillectomy pain regimens that include the use of oral and topical steroids may increase the risk of post-operative oral candidiasis in adult patients. When both oral and topical steroids are prescribed, this appears to increase the risk of oral candidiasis post-tonsillectomy. Practitioners should consider the increased risk of postoperative oral candidiasis when designing a post-tonsillectomy pain regimen protocol.