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Advanced Emergency Nursing JournalA peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor...
A peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor muscle (G. Gupta & R. McDowell, 2022). It is the most commonly occurring abscess in the head and neck region. Patient presentation usually includes odynophagia, unilateral otalgia, trismus, and voice changes. Managing a pediatric patient may be challenging, as children may not be able to describe their history of illness and symptoms. The management of a PTA can also differ between pediatric and adult patients (S. Ahmed Ali et al., 2018). It is important for practitioners to consider all aspects when providing treatment. This article describes the encounter and individualized treatment plan of an 11-year-old nonverbal autistic child who presented with fever, decreased oral intake, and left neck swelling. It also provides a general overview of PTAs and procedural steps to perform drainage through needle aspiration and incision and drainage.
Topics: Adult; Humans; Child; Peritonsillar Abscess; Palatine Tonsil; Drainage
PubMed: 37106496
DOI: 10.1097/TME.0000000000000454 -
The Journal of Emergency Medicine Mar 2021Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D),... (Review)
Review
BACKGROUND
Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses.
OBJECTIVE
This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department.
DISCUSSION
Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.
CONCLUSIONS
This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.
Topics: Breast Diseases; Drainage; Emergency Medicine; Humans; Peritonsillar Abscess; Ultrasonography
PubMed: 33298356
DOI: 10.1016/j.jemermed.2020.10.043 -
International Journal of Pediatric... Jul 2015Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis,... (Review)
Review
Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management.
Topics: Central Nervous System Infections; Child; Fusobacterium Infections; Humans; Otitis; Periodontitis; Respiratory Tract Infections; Retropharyngeal Abscess; Tonsillitis
PubMed: 25980688
DOI: 10.1016/j.ijporl.2015.04.045 -
Anaerobe Jun 2022F. necrophorum, a gram-negative obligate anaerobe, causes pharyngotonsillitis, peritonsillar abscess and the Lemierre Syndrome as well as other significant infections.... (Review)
Review
F. necrophorum, a gram-negative obligate anaerobe, causes pharyngotonsillitis, peritonsillar abscess and the Lemierre Syndrome as well as other significant infections. Clinical information on this bacterium has increased dramatically over the past 20 years, yet no standard guidance exists for treating these infections. While data support F. necrophorum as a cause of pharyngotonsillitis, no consensus exists on the clinical importance of these findings especially in the 15-30 age group. Similarly, recent data find this bacterium the most frequent and most likely to recur in peritonsillar abscess for that age group. Should this impact how we treat these patients? Finally, we have no studies of either antibiotics or anticoagulation for the Lemierre Syndrome. Thus, each physician making the diagnosis of the Lemierre Syndrome chooses antibiotics (and their duration) and whether or not to anticoagulate without guidance. Infectious disease specialists and hospitalists would benefit from consensus expert opinions based on reviewing data on these infections.
Topics: Anti-Bacterial Agents; Communicable Diseases; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Peritonsillar Abscess; Tonsillitis
PubMed: 35122953
DOI: 10.1016/j.anaerobe.2022.102532 -
Acta Otorrinolaringologica Espanola 2023This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological... (Review)
Review
INTRODUCTION
This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI).
MATERIALS AND METHODS
In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded.
RESULTS
From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases.
CONCLUSIONS
The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.
Topics: Humans; Pandemics; Retrospective Studies; Tonsillectomy; COVID-19; Communicable Disease Control; Peritonsillar Abscess; Tonsillitis; Delivery of Health Care
PubMed: 36906064
DOI: 10.1016/j.otoeng.2022.04.003 -
Medicine International 2022Coronavirus disease 2019 (COVID-19) generally presents with fever, shortness of breath and a sore throat. These symptoms are also common in oral and pharyngeal...
Coronavirus disease 2019 (COVID-19) generally presents with fever, shortness of breath and a sore throat. These symptoms are also common in oral and pharyngeal infections, such as peritonsillar abscess (PA). The present study describes a case of PA and COVID-19 co-infection. Although COVID-19 was initially suspected in the patient due to the presenting symptoms of fever, sore throat, dysgeusia and dysosmia, an oral examination and computed tomography scan detected PA. The patient was conservatively managed with intravenous antibiotics without transoral drainage of the abscess. Anti-COVID-19 medication was not administered as the COVID-19 infection in the patient was not severe. Laboratory findings revealed high levels of leukocytes, C-reactive protein (CRP) and procalcitonin. On the whole, the association between laboratory findings (including leukocyte count, CRP and procalcitonin levels) and bacterial co-infection with COVID-19 remains unclear, and further studies are warranted. Oral examinations and transoral procedures are often avoided due to the high risk of the aerosolisation of COVID-19 viral particles. However, an appropriate evaluation is essential in order to avoid the underdiagnosis of life-threatening bacterial infections that co-exist with COVID-19.
PubMed: 36698911
DOI: 10.3892/mi.2022.55 -
Indian Journal of Otolaryngology and... Jun 2023Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the...
UNLABELLED
Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the larynx is atypical. Accurate diagnosis and prompt treatment are required because airway obstruction, descending mediastinitis, or thrombophlebitis may result. We evaluated surgical outcomes of inferiorly extended PTA (IEPTA) using an endoscope and a radiofrequency device for intraoral drainage. We retrospectively reviewed the medical records of 56 patients with IEPTA who underwent incisional drainage between 2013 and 2021. Two experienced surgeons performed intraoral drainage using an endoscope and a radiofrequency device (endoscopic group [EG]) or without such devices (WEG). Thirty (male: 26, female: four; mean age: 51.3 years), and 26 (male: 21, female: five; mean age: 55.9 years) patients in the EG and WEG, respectively, were evaluated. The mean hospitalization durations were 6.7 and 14.5 days for the EG and WEG, respectively (p<0.01). There were significant between-group differences regarding the number of tracheostomies conducted to secure an airway or surgical field (EG: four (13.3%); WEG: 16 (61.5%); p<0.01. The hospitalization duration for patients undergoing tracheostomy was significantly shorter in the EG than in the WEG (9.3 vs. 18.5 days, respectively; p=0.01). No significant difference in the mean hospital stay was observed for patients who did not undergo tracheostomy ([EG: 6.3, WEG: 8.2] days; p=0.081). IEPTA drainage using an endoscope and a radiofrequency instrument can reduce duration of hospitalization and tracheostomy procedures compared with the conventional method.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-022-03362-0.
PubMed: 37275022
DOI: 10.1007/s12070-022-03362-0 -
The Journal of Laryngology and Otology Dec 2014Additional high-quality evidence for predictors of peritonsillar abscess recurrence could lead to better-informed treatment decisions regarding tonsillectomy. (Review)
Review
BACKGROUND
Additional high-quality evidence for predictors of peritonsillar abscess recurrence could lead to better-informed treatment decisions regarding tonsillectomy.
METHODS
In this study, 172 patients, who had been diagnosed and treated for peritonsillar abscess, were evaluated at follow up. A retrospective review of medical records and a telephone survey were performed. The clinical characteristics analysed included underlying disease, laboratory findings and computed tomography findings. Cox proportional hazard models were used to identify risk factors for peritonsillar abscess recurrence.
RESULTS
The recurrence rate of peritonsillar abscess was 13.9 per cent. Univariate analysis indicated that extraperitonsillar spread of the abscess (beyond the peritonsillar area) on computed tomography and a history of recurrent tonsillitis were associated with recurrence. Multivariate analysis also indicated that extraperitonsillar spread (p = 0.007; hazard ratio = 3.399) and recurrent tonsillitis history (p < 0.001; hazard ratio = 11.953) were significant risk factors for recurrence.
CONCLUSION
Our results suggest that tonsillectomy may be indicated as a treatment for peritonsillar abscess in patients with a history of recurrent tonsillitis or extraperitonsillar spread on computed tomography.
Topics: Adult; Data Collection; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Peritonsillar Abscess; Recurrence; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Tonsillectomy
PubMed: 25399610
DOI: 10.1017/S002221511400259X -
Clinical and Experimental... Jun 2016Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during... (Review)
Review
Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.
PubMed: 27090283
DOI: 10.21053/ceo.2014.01851 -
The Annals of Otology, Rhinology, and... Jun 2020In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an...
INTRODUCTION
In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool.
OBJECTIVES
To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp.
METHODS
We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed.
RESULTS
There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 "very effective" or 5 "most effective."
CONCLUSION
A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.
Topics: Bronchoscopy; Cadaver; Education, Medical, Graduate; Endoscopy; Epistaxis; Female; Humans; Lacrimal Apparatus; Male; Nasal Bone; Nerve Block; Otolaryngology; Otorhinolaryngologic Surgical Procedures; Peritonsillar Abscess; Plastic Surgery Procedures; Simulation Training; Skull Fractures; Tracheostomy; Zygomatic Fractures
PubMed: 31994404
DOI: 10.1177/0003489420903067