The effect of Tualang honey in enhancing post tonsillectomy healing process. An open labelled prospective clinical trial Norhafiza Mat Lazim *, Baharudin Abdullah, Rosdan Salim Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia 1. Introduction Tonsillectomy is commonly performed by an otolaryngologist for cases of hypertrophy of tonsillar lymphoid tissues complicated with recurrent tonsillitis. Tonsillectomy is a simple surgical procedure, yet it carries several complications if not properly managed which include post tonsillectomy bleeding, post tonsil- lectomy pain, post tonsillectomy infection, poor wound healing, vellopharyngeal insufficiency, nasal regurgitation and otalgia [1]. Healing process in post tonsillectomy is by secondary intention with characterization of slough formation which ultimately will be replaced by reepitheliazation. The degree of slough formation and reepitheliazation would depend on patient’s factors, surgeon factors and operative theatre environment. According to Sertal et al. [2] complete healing of tonsillar fossa has been documented to take place at 14–21 days after operation. As evidenced by the research by Tonks et al. honey stimulates monocytes to release cytokines, TNFa, IL-1B and IL-6 [3]. These mediators are involved in the regulation of the inflammatory process in healing [4]. TNFa has also been suggested to stimulate angiogenesis and fibroblast proliferation [5]. By promoting granulation tissue development and reepitheliazation, honey could possibly accelerate wound healing post operatively. Use of honey in post operative period can promote faster healing, reduce post operative wound dehiscence and produce a very good cosmetic of healing [6]. It has been shown to reduce complications such as post operative infection, pain and excessive fibrosis. Aysan et al. [7] showed that honey application reduce the peritoneal adhesion in post operative period of abdominal surgery. Growth of bacteria such as staphylococcus, streptococcus and fungi like candida albican can be reduced by application of honey, thus lessen risk of infections [6,8]. Currently, there are sparse literatures that describe the effects of Tualang honey on healing process especially in post tonsillecto- my patients. It is therefore the aim of the present study is to International Journal of Pediatric Otorhinolaryngology xxx (2012) xxx–xxx A R T I C L E I N F O Article history: Received 7 June 2012 Received in revised form 25 November 2012 Accepted 26 November 2012 Available online xxx Keywords: Tonsillectomy Post operative wound Honey Healing A B S T R A C T Introduction: Tonsillectomy is a common operative procedure performed for tonsillar hypertrophy complicates with recurrent tonsillitis. Among the post tonsillectomy morbidities, post operative wound healing is of utmost importance to be effectively managed as it will interfere with patient recuperation from surgery. Tualang honey has been shown to accelerate wound healing in postoperative patients. Objective: The aim of this study was to investigate the effect of Tualang honey in enhancing healing process in post tonsillectomy patients. Methodology: In this open labelled prospective study, the selected paediatric patients were randomized into two groups. The 35 subjects in the Tualang honey–antibiotic group received 3 mls of Tualang honey intraoperatively followed by 4 mls of oral Tualang honey three times daily for seven days. Concurrently, 25 mg/kg of intravenous Sultamicillin was given three times daily for two days followed by oral Sultamicillin twice daily for five days. The 28 subjects in the antibiotic only group received intravenous at 25 mg/kg Sultamicillin kg for two days followed by oral Sultamicillin twice daily for five days. The healing process was assessed at day 1, day 3, day 7 and day 14 postoperatively by semiquantitative endoscopic photograph examination of both tonsillar fossae. Results: The average ages for the treatment group and the control groups were 9 and 11 years old respectively. Wound healing was significantly faster in the treatment group in both tonsillar fossae compared to the control group (left: p-value = <0.001; right: p-value = <0.001). Conclusion: Tualang honey has positive effect in enhancing healing process in post tonsillectomy patient. It is easy to use topically, safe to consume orally and available at low cost locally. Overall it can be used as an excellent adjunct therapy for post operative patients. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +60 19 9442664; fax: +60 9 7653370. E-mail addresses: norhafiza@kck.usm.my (N. Mat Lazim), baharudin@kb.usm.my (B. Abdullah), rosdan@kb.usm.my (R. Salim). G Model PEDOT-6465; No. of Pages 5 Please cite this article in press as: N. Mat Lazim, et al., The effect of Tualang honey in enhancing post tonsillectomy healing process. An open labelled prospective clinical trial, Int. J. Pediatr. Otorhinolaryngol. (2012), http://dx.doi.org/10.1016/j.ijporl.2012.11.036 Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l 0165-5876/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2012.11.036