الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Tonsillectomy is the most common throat surgery performed during childhood. Although being a generally safe operation, it results in an almost open wound and causes postoperative pain that may last up to 2 to 3 weeks. This pain is a major morbidity factor after tonsillectomy, leading to malnutrition, dysphagia, dehydration, and delayed return to work or school. NSAIDs, codeine, and acetaminophen are commonly used to relieve pain after tonsillectomy. Opioids are associated with respiratory depression, nausea, vomiting, cough reflex depression, and sedation. So safer opoid and non-opioid analgesics are used to relieve pain and discomfort after tonsillectomy operation. The American Academy of Otolaryngology -head and neck surgery now recommends ibuprofen for pain relief after tonsillectomy. Optimal pain relief after tonsillectomy operation is challenging for many ENT physicians. Many researchers use different options for pain reduction whether systemic or topical like bupivacaine, lignocaine, dexamethasone and sucralfate. Hyaluronic acid is a high molecular weight hydrophilic glycosaminoglycan that is a natural component of connective tissue, especially found in the extracellular matrix of skin and the synovial fluid of joints. It plays a role in wound healing, and its secretion during the proliferative phase stimulates the migration and proliferation of fibroblasts. Its inhibitory effect on inflammatory mediators and tissue responses to trauma makes it safe to use as an anti-inflammatory factor. Hyaluronic acid is a growth-stimulating lubricant, so widely used because it is often non-immunogenic, biocompatible and anti-inflammatory biomaterial for dressings. Hyaluronic acid is reported to decrease pain and inflammation and stimulate wound healing in pressure ulcers. It is used in the treatment of osteoarthritis and tendon problems, burns and chronic wounds. Aim of the study: The aim of our study was evaluation of the outcomes of application of topical Hyaluronic Acid after tonsillectomy operation. Methodology: This prospective study was carried out in Otorhinolaryngology Department, Tanta University Hospitals. Seventy patients in need for tonsillectomy operations were recruited for the study. In each patient hyaluronic acid in a gel form was used only on one side (application side) and the other side was considered as a control (control side). The application side was randomly allocated, and started firstly intra operative then at the 3rd, 5th, and 8th post-operative days then assessment was done at the 3rd, 5th, 8th, and 14th post-operative days using Arabic numerical pain rating scale and visual analogue scale so the result was 70 application sides (38 right sides and 32 left sides). Results The Pain scores at the 3rd, 5th, 8th, and 14th post-operative days were less on the hyaluronic acid application sides rather than control sides in all patients with a significant P value<0.001,and mucosal recovery was noted to be better in the hyaluronic acid application side when compared to the control side and this is documented at the 5th, 8th and 14th post-operative days as in 53 of the studied cases (75.7%) healing was complete in the hyaluronic acid application side and in 17 studied cases (24.3%) there was no difference in the healing in both sides. So hyaluronic acid had better results in controlling post tonsillectomy pain than other topical substance including bupivacaine, lignocaine, Dexamethasone and sucralfate that had short acting effect pounced mainly in the 1st post-operative day but hyaluronic acid topical application caused significant pain reduction mainly in the 1st post-operative week between 3rd and 7th post-operative days the time of highest pain perception also it is safe with no systemic side effect and easily applied.