A spoonful of honey may help reduce the pain of tonsillectomy
Myron Yaster MD, Melissa Brooks Peterson, and Lynne G. Maxwell MD
This PAAD was first posted on September 30, 2024. New PAADs will begin to appear next week. Myron Yaster MD
There are a lot of ways to drink tea: straight up, with lemon, sugar, cream, milk and/or honey to name just a few. Since I was a little kid, whenever I had a sore throat, invariably, my mother Sally of blessed memory, would always treat me with hot tea loaded with honey. And it pretty much always works including during my bout of COVID last year when I had the worst sore throat of my life (I thought I had epiglottitis!). Was it the hot liquid or the honey? After reading today’s PAAD it is the honey! Yeoh et al.1 wondered if honey would it be useful in treating post tonsillectomy pain. Today’s PAAD is a literature review investigating published papers on the use and medicinal properties of honey, particularly in treating post-tonsillectomy pain. The senior author, Britta S. von Ungern-Sternberg, is one of the most productive clinical researchers and leaders in pediatric anesthesia, and as regular readers of the PAAD know, I’m always excited about posting the results of her research in the PAAD. Myron Yaster MD
Original article
Yeoh MF, Sommerfield A, Sommerfield D, von Ungern-Sternberg BS. The use of honey in the perioperative care of tonsillectomy patients—A narrative review. Pediatr Anesth. 2024; 34: 988-998. doi:10.1111/pan.14938
Tonsillectomy with or without adenoidectomy is amongst the common surgical procedures performed in children. Because of the intense pain that this surgery produces, it is often “associated with a difficult early recovery phase with poor oral intake, dehydration, difficult or painful swallowing, postoperative bleeding, infection and/or otalgia.”1 “Postoperative pain is thought to be largely the result of trauma to and exposure of the extracapsular muscle leading to sensitization of vagal and glossopharyngeal nerve fibers. Healing is by secondary intention, characterized by slough formation that is later replaced by re-epithelialization and pain eventually subsides. Complete healing of the tonsillar fossa is expected to take place between Days 14–21 after surgery. Post-tonsillectomy pain is manifested in a biphasic nature with a second peak around Days 3–7 coinciding with inflammation and production of a thick fibrin layer which increases in size at Day 3.2”1 Multi-modal analgesia with NSAIDs, acetaminophen, and opioids has become the most common method of providing pain relief.
OK, here’s the key: “Honey is a delectable liquid with anti-inflammatory and anti-bacterial properties.3 Honey enhances the process of healing via a stimulation of inflammatory cytokines from monocytic cells and via promoting angiogenesis and fibroblast proliferation. Studies in burns patients have shown faster healing compared with conventional dressings.4,5 This suggests that honey could promote quicker healing post tonsillectomy when electrocautery is used. The method of application of honey varies. It includes injection into the peritonsillar fossa intraoperatively, applied onto the fossa, swallowed and gargled. There has been no consistent correlation between method of application and dose with reported outcome measures.”1
Yeoh et al found that “the majority of studies show that giving honey post-tonsillectomy is associated with reduced pain scores, analgesic consumption, and perhaps reduced night awaking. However, there are a number of caveats and limitations across the evidence base/literature to consider including type of honey used, mode of application and patient factors, to name a few.”1 In addition to the study discussed in today’s PAAD, prior studies and meta-analysis have suggested that honey is effective to reduce cough frequency and severity in children with upper respiratory tract infections.6,7
Not all honeys are the same. “Different honeys possess differing bioactivities; most notably antimicrobial, accelerated wound healing and antioxidant properties. Independent of their floral source, all honeys display antimicrobial properties associated with their high osmolarity (up to 21% water content and 60%–85% sugar content) and low pH.6,7 The medicinal potential of any one honey including potency against individual microorganisms is dependent on the biological bioactive compounds within it, which can vary widely between the more than 320 types of honey available. There are approximately 200 compounds of interest in honey including, hydrogen peroxide, flavonoids, and polyphenols. The presence and concentration of these compounds in honey are dependent on factors including bee species, floral source, and environmental and processing factors.”1
The authors conclude that honey may be beneficial and much more formal research is needed to investigate these effects of honey in post tonsillectomy pain because most of the current publications are from poor quality studies that were not double blinded, randomized nor controlled.
Even with its limitations, this is a wonderful and timely paper and we would urge all of you to read it in its entirety. Also consider that the risk of using honey orally after tonsillectomy is nil to low. So, why not go for it? Do you use honey therapeutically in your personal or professional role? And if so can you tell us which variety you recommend? Send your thoughts and comments to Myron who will post in a Friday reader response.
References
1. Yeoh MF, Sommerfield A, Sommerfield D, von Ungern-Sternberg BS. The use of honey in the perioperative care of tonsillectomy patients—A narrative review. Pediatric Anesthesia 2024;34(10):988-998. DOI: https://doi.org/10.1111/pan.14938.
2. Isaacson G. Tonsillectomy healing. Ann Otol Rhinol Laryngol 2012;121(10):645-9. (In eng). DOI: 10.1177/000348941212101004.
3. Hwang SH, Song JN, Jeong YM, Lee YJ, Kang JM. The efficacy of honey for ameliorating pain after tonsillectomy: a meta-analysis. Eur Arch Otorhinolaryngol 2016;273(4):811-8. (In eng). DOI: 10.1007/s00405-014-3433-4.
4. Molan PC. Potential of honey in the treatment of wounds and burns. American journal of clinical dermatology 2001;2(1):13-9. (In eng). DOI: 10.2165/00128071-200102010-00003.
5. Zbuchea A. Up-to-date use of honey for burns treatment. Ann Burns Fire Disasters 2014;27(1):22-30. (In eng).
6. Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed 2011;1(2):154-60. (In eng). DOI: 10.1016/s2221-1691(11)60016-6.
7. Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ Evid Based Med 2021;26(2):57-64. (In eng). DOI: 10.1136/bmjebm-2020-111336.