Impact of a Delayed Oral Steroid Protocol on Pediatric Post-tonsillectomy Outcomes

Sunday, October 18, 2026

11:00 AM - 11:06 AM PT

Location: 409AB

Presenting Author(s)

Ada Y. Chung, BA

Medical Student
Yale School of Medicine
New Haven, CT, United States

Co-Author(s)

AD

Alexa Denton, MD

Otolaryngology–Head and Neck Surgery Resident
Yale School of Medicine
New Haven, Connecticut, United States
HE

Hanel Eberly, MD

Otolaryngology–Head and Neck Surgery Resident
Yale School of Medicine, United States
Erik H. Waldman, MD

Associate Professor
Yale School of Medicine
New Haven, CT, United States
MW

Michael Weinstock, MD

Assistant Professor
Yale School of Medicine, United States
Sarah E. Maurrasse, MD

Assistant Professor
Yale School of Medicine
New Haven, Connecticut, United States

Senior Author(s)

Sam D. Schild, MD

Assistant Professor
Yale University
Westport, CT, United States

Disclosure(s):

Ada Y. Chung, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sam D. Schild, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Despite multiple post-tonsillectomy pain control regimens, no consensus exists on balancing pain, bleeding risk, and opioid exposure. A delayed short course of oral steroids may reduce reliance on opioids while providing multimodal pain relief. This study evaluates the post-operative effects of a short oral steroid regimen (3 days initiated on post-operative day 3) plus acetaminophen/ibuprofen compared with acetaminophen/ibuprofen alone.

Methods: Retrospective chart review of pediatric patients ( < 18 years) who underwent tonsillectomy and/or adenotonsillectomy at a tertiary care academic center between 2022-2025. Intracapsular tonsillectomies were excluded. Patient charts were reviewed to evaluate the post-operative pain regimens and outcome measures, including post-operative call volume ( < 14 days), call outcomes (bleed rate, advised ER visit), opioid use, and refills. Mann-Whitney, Poisson, and Fisher’s tests were performed.

Results: Data from 400 pediatric patients (median age 7 [IQR 4-10], 48.2% female), 90.2% underwent adenotonsillectomy and 9.8% tonsillectomy alone; 49.5% received the steroid protocol. Bleed rates did not differ between groups (overall rate: 2%). Call volume was significantly lower in the steroid group (0.27±0.55) than in the non-steroid group (0.46±0.78; p=0.026), representing a 43% call rate reduction (IRR 0.57, 95% CI 0.41–0.80; p=0.001). Post-operative opioid use decreased with the steroid protocol (11.6% vs 26.9%), corresponding to a 15.2% absolute reduction (95% CI: –22.8%-7.7%) and a 57% relative decrease (RR=0.43; χ² p=0.0002). The non-steroid group had higher rates of advised ER visits (p=0.037) and steroid refills (p=0.011).

Conclusions: Short-course oral steroids demonstrate efficacy in improving post-tonsillectomy outcomes, reducing opioids, calls, advised ER visits, and refills.