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The Medical Clinics of North America Nov 2018Infections of the head and neck are common and appropriately managed by primary care providers in most cases. However, some infections are associated with significant... (Review)
Review
Infections of the head and neck are common and appropriately managed by primary care providers in most cases. However, some infections are associated with significant morbidity and require urgent recognition and management by specialty services. These include deep neck space infections originating in the oral cavity, pharynx, and salivary glands, as well as complicated otologic and sinonasal infection. This article provides a review of these conditions, including the pathophysiology, presenting features, and initial management strategy.
Topics: Bacterial Infections; Head; Humans; Neck; Pharyngeal Diseases; Primary Health Care; Respiratory Tract Infections; Sinusitis; Tonsillitis
PubMed: 30342612
DOI: 10.1016/j.mcna.2018.06.015 -
The Journal of Laryngology and Otology Jul 2017Peritonsillar abscess is the most common deep infection of the head and neck in young adults. It is considered a purulent complication of acute tonsillitis, but other...
BACKGROUND
Peritonsillar abscess is the most common deep infection of the head and neck in young adults. It is considered a purulent complication of acute tonsillitis, but other mechanisms have been proposed. There is no consensus as to whether seasonality affects peritonsillar abscess incidence.
METHODS
This observational, descriptive, retrospective study explored the epidemiology of peritonsillar abscess and its relationship with seasonality. The cases were selected from the emergency otolaryngology service of a tertiary hospital.
RESULTS
The sample comprised 528 patients (42.61 per cent males, mean age = 26.63 years). A moderate positive correlation was found between peritonsillar abscess incidence and monthly average temperature. No associations were found with insolation, precipitation or humidity.
CONCLUSION
In this sample, peritonsillar abscess was more likely to occur in warmer months. The findings corroborate the theory that peritonsillar abscess is not a direct complication of acute tonsillitis and may improve understanding of peritonsillar abscess aetiology.
Topics: Adolescent; Adult; Age Factors; Aged; Brazil; Child; Climate; Cross-Sectional Studies; Female; Humans; Humidity; Male; Middle Aged; Peritonsillar Abscess; Retrospective Studies; Statistics as Topic; Temperature; Tropical Climate; Young Adult
PubMed: 28462728
DOI: 10.1017/S0022215117000895 -
HNO Jul 2020The number of operations for tonsillectomy have been significantly decreasing for many years in Germany. In children the number of adenotonsillectomies has decreased by...
The number of operations for tonsillectomy have been significantly decreasing for many years in Germany. In children the number of adenotonsillectomies has decreased by two thirds within a decade. This phenomenon is mirrored by a significant increase in the number of annually performed tonsillotomies, a surgical procedure which is preferably performed for volume reduction in cases of tonsillar hypertrophy. The aim of this article is to elucidate the different interventional procedures, their typical indications and risks.
Topics: Adenoids; Child; Germany; Humans; Palatine Tonsil; Tonsillectomy; Tonsillitis
PubMed: 32504114
DOI: 10.1007/s00106-020-00884-3 -
International Journal of Environmental... Jun 2020Peritonsillar abscess (PTA) is the most common complication of tonsillitis. Cultivation usually reveals a wide spectrum of aerobic and anaerobic microbiota. This...
Peritonsillar abscess (PTA) is the most common complication of tonsillitis. Cultivation usually reveals a wide spectrum of aerobic and anaerobic microbiota. This retrospective study compared PTA incidence and the spectrum of individual microbial findings in groups of patients divided by gender, age, and season. Of the 966 samples cultivated, a positive cultivation finding was detected in 606 patients (62.73%). Cultivation findings were negative in 360 (37.27%), meaning no pathogen was present or only common microbiota was cultivated. The highest incidence of PTA was found in group I patients (19-50 years) ( ≤ 0.0001) and the most frequently cultured pathogens was (36.23%). Gender seemed to have an influence on the results, with higher incidence found in males ( ≤ 0.0001). The analysis of correlation between PTA incidence and season did not yield statistically significant results ( = 0.4396) and no statistically significant differences were observed in individual pathogen frequency. PTA had a higher incidence in adult males and a slightly higher incidence in girls in childhood. The following findings are clinically significant and have implications for antibiotic treatment strategy: (1) the most frequently cultivated pathogen was (2) an increased incidence of anaerobes was proven in the oldest group (>50 years).
Topics: Adult; Anti-Bacterial Agents; Child; Female; Humans; Incidence; Male; Peritonsillar Abscess; Retrospective Studies; Streptococcus pyogenes
PubMed: 32516939
DOI: 10.3390/ijerph17114020 -
Genes Dec 2023Globally, oral diseases are common, pose an economic burden, and significantly decline the quality of life of affected individuals. Recently, researchers have...
BACKGROUND
Globally, oral diseases are common, pose an economic burden, and significantly decline the quality of life of affected individuals. Recently, researchers have substantially highlighted the effect of depression on oral disease incidence and development. In this study, we elucidated the correlation between depression and oral diseases.
METHODS
Using two-sample Mendelian randomization (MR), the association between depression and the risk of 17 oral diseases was evaluated. Three methods were used to perform MR analysis: the inverse variance-weighted, weighted median, and MR-Egger methods. Furthermore, Cochran's Q test, MR-Egger intercept test, MR Pleiotropy RESidual Sum and Outlier test, and leave-one-out analysis were performed to analyze sensitivity.
RESULTS
After implementing multiple test corrections, we observed that genetic susceptibility to depression was associated with an increased risk of mouth ulcers, toothache, loose teeth, bleeding gums, painful gums, chronic periodontitis, chronic tonsil and adenoid diseases, peritonsillar abscess, and excessive tooth attrition. However, a causal relationship between depression and other oral diseases was not observed. Sensitivity analysis confirmed the robustness of the results.
CONCLUSIONS
We confirmed the causal relationship between depression and several oral diseases, thereby providing a novel viewpoint on the prevention and treatment of oral diseases. Our findings suggest the integration of depression control into routine clinical care to enhance the effectiveness of oral disease treatment.
Topics: Humans; Depression; Mendelian Randomization Analysis; Quality of Life; Administration, Oral; Causality
PubMed: 38137013
DOI: 10.3390/genes14122191 -
Frontiers in Medicine 2023This study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of...
INTRODUCTION
This study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of comorbidities, complication rates, and recurrences in the largest study cohort published to date.
METHODS
We conducted a retrospective analysis of patients, both adults and children, who were treated for peritonsillar abscess between 2007 and 2019. Patient charts were analyzed to assess surgical treatment, infection and inflammation rates, risk of bleeding, recurrence rates, duration of illness, and sick certificates. Additionally, patient imaging and blood levels were compared. Postal questionnaires were sent to all patients to evaluate subjective success rates, complications, and long-term benefits of the different treatment regimens. General practitioners and ENT doctors in private practices were contacted to gather missing data on the long-term course of the disease.
RESULTS
A total of 821 patients with peritonsillar abscess were included in this study. Two patients had to be excluded due to incidental pathological findings. Of the remaining 819 patients, 180 were successfully treated with needle aspiration or incision. Among these patients, 37.7% required tonsillectomy during the same inpatient stay. Laboratory parameters such as leukocyte count or C-reactive protein levels were not indicative of the need for tonsillectomy. Furthermore, computed tomography was only necessary in cases of suspected parapharyngeal abscess, not in clear cases of peritonsillar abscess. Among the 641 patients who underwent tonsillectomy, 11.4% experienced postoperative bleeding requiring treatment. Only patients who underwent bilateral tonsillectomy reported recurrent episodes of sore throat and pharyngitis resulting in absence from work. The ipsilateral recurrence rate for peritonsillar abscess after needle aspiration or incision was 2.8%. There were no contralateral recurrences during the observation period.
CONCLUSION
Due to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay, incision and drainage are the preferable treatment for peritonsillar abscess. Additionally, patients who underwent bilateral tonsillectomy reported higher rates of work incapacity due to sore throat caused by pharyngitis. No patient met the clear indication for bilateral tonsillectomy due to recurrent acute tonsillitis. The recurrence rate after drainage without tonsillectomy was very low (2.8% ipsilaterally, no recurrence contralaterally).
PubMed: 38093972
DOI: 10.3389/fmed.2023.1282040 -
Medicine Dec 2022Climate and temperature have long been considered in relation to human diseases and mortality. In this study, we investigated whether daily temperature and humidity and...
Climate and temperature have long been considered in relation to human diseases and mortality. In this study, we investigated whether daily temperature and humidity and patients' personal history affect the volume of peritonsillar abscesses (PTAs). We included 52 patients with PTAs who were admitted to the emergency department of the study hospital; their computed tomography data were analyzed, and PTA volume was measured. We investigated the possible correlation between PTA volume and mean/minimum/maximum temperature and humidity. Furthermore, we obtained personal history data, including information on drinking status, smoking status, dental problems, and patients' treatment experiences at local clinics before visiting the emergency department. The mean PTA volume was 3.93 mL, which was significantly correlated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization (P < .05) and also with a lack of treatment experience at local clinics (P < .001). However, no significant correlation was noted between PTA volume and the mean/minimum/maximum temperature and humidity on the day of hospitalization (P > .05). Similar findings were obtained for drinking status, smoking status, and dental problems (P > .1). PTA volume appears to be strongly associated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization. Patients with treatment experience at local clinics exhibited substantial increases in PTA volume. Thus, an increased PTA volume may be observed in patients who visit the emergency department without any treatment experience at local clinics or from environments that differ considerably from their current environment in terms of temperature.
Topics: Humans; Peritonsillar Abscess
PubMed: 36482583
DOI: 10.1097/MD.0000000000031881 -
European Archives of... May 2022Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy.
METHODS
The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively.
RESULTS
Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively).
CONCLUSIONS
This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.
Topics: Blood Loss, Surgical; Humans; Operative Time; Peritonsillar Abscess; Postoperative Hemorrhage; Tonsillectomy
PubMed: 35169892
DOI: 10.1007/s00405-022-07294-x -
The American Journal of Emergency... Apr 2015Peritonsillar abscess (PTA) is one of the most common deep neck space infections that can potentially have life-threatening complications if inadequately diagnosed and... (Review)
Review
Peritonsillar abscess (PTA) is one of the most common deep neck space infections that can potentially have life-threatening complications if inadequately diagnosed and not treated promptly. The ability of clinicians to reliably differentiate PTA from peritonsillar cellulitis by physical examination alone is limited and blind needle aspiration, the typical method of diagnosis of PTA, is also unreliable. We review the available evidence supporting the use of ultrasound, either intraoral ultrasound or transcutaneous ultrasound to be the initial imaging modality of choice for evaluation of PTA and be used for real-time needle guidance.
Topics: Diagnosis, Differential; Humans; Peritonsillar Abscess; Ultrasonography
PubMed: 25737413
DOI: 10.1016/j.ajem.2015.01.031 -
Current Pediatric Reviews Jul 2023Group A ß-hemolytic streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide.
BACKGROUND
Group A ß-hemolytic streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide.
OBJECTIVE
This article aims to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of GABHS pharyngitis.
METHODS
A search was conducted in December 2022 in PubMed Clinical Queries using the key term "group A β-hemolytic streptococcal pharyngitis". This review covers mainly literature published in the previous ten years.
RESULTS
Children with GABHS pharyngitis typically present with an abrupt onset of fever, intense pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, a red and swollen uvula, enlarged tender anterior cervical lymph nodes. As clinical manifestations may not be specific, even experienced clinicians may have difficulties diagnosing GABHS pharyngitis solely based on epidemiologic or clinical grounds alone. Patients suspected of having GABHS pharyngitis should be confirmed by microbiologic testing (e.g., culture, rapid antigen detection test, molecular point-of-care test) of a throat swab specimen prior to the initiation of antimicrobial therapy. Microbiologic testing is generally unnecessary in patients with pharyngitis whose clinical and epidemiologic findings do not suggest GABHS. Clinical score systems such as the Centor score and McIssac score have been developed to help clinicians decide which patients should undergo diagnostic testing and reduce the unnecessary use of antimicrobials. Antimicrobial therapy should be initiated without delay once the diagnosis is confirmed. Oral penicillin V and amoxicillin remain the drugs of choice. For patients who have a non-anaphylactic allergy to penicillin, oral cephalosporin is an acceptable alternative. For patients with a history of immediate, anaphylactic-type hypersensitivity to penicillin, oral clindamycin, clarithromycin, and azithromycin are acceptable alternatives.
CONCLUSION
Early diagnosis and antimicrobial treatment are recommended to prevent suppurative complications (e.g., cervical lymphadenitis, peritonsillar abscess) and non-suppurative complications (particularly rheumatic fever) as well as to reduce the severity of symptoms, to shorten the duration of the illness and to reduce disease transmission.
PubMed: 37493159
DOI: 10.2174/1573396320666230726145436