Impact Of Combined Antacid And Proton Pump Inhibitor Therapy Versus Proton Pump Inhibitor Alone On Post-Tonsillectomy Recovery In Adults With Laryngopharyngeal Reflux

Abstract

Introduction: Laryngopharyngeal reflux (LPR) is implicated in delayed mucosal healing and increased postoperative morbidity after tonsillectomy. Proton pump inhibitors (PPIs) are standard treatment; however, combined acid suppression using PPIs plus antacid therapy may offer enhanced benefits.

Objective: To evaluate the effects of combined pantoprazole and antacid syrup therapy versus pantoprazole alone on postoperative pain, mucosal healing, and swallowing/voice function in adults aged 18–40 years with confirmed LPR undergoing tonsillectomy.

Methods: In this prospective observational study, 100 adults with LPR (RSI ≥13, RFS ≥7) undergoing elective tonsillectomy were divided into two groups: Group A (pantoprazole 40 mg once daily + antacid syrup post meals, n=50) and Group B (pantoprazole 40 mg once daily only, n=50). Outcomes were recorded for pain (numeric scale, days 1–7), mucosal healing (slough grading, days 7 and 14), and swallowing/voice function (standardized questionnaire, 2 weeks). Statistical analyses included repeated measures ANOVA and independent t-tests; significance at p<0.05.

Results: Both groups had comparable demographics and compliance. Group A demonstrated significantly faster pain reduction (mean day 7 pain 1.8 ± 0.6 vs. 2.4 ± 0.8, p=0.002), improved mucosal healing (day 7 score 0.9 ± 0.3 vs. 1.3 ± 0.5, p=0.005; day 14 score 0.3 ± 0.1 vs. 0.6 ± 0.2, p=0.003), and superior swallowing/voice function (9.5 ± 0.3 vs. 9.0 ± 0.4, p=0.004).

Conclusion: Combined PPI and antacid therapy results in better postoperative recovery than PPI monotherapy in adults with LPR undergoing tonsillectomy. This suggests that dual acid suppression may optimize healing and functional outcomes in this population.