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The Laryngoscope Aug 20171) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare...
OBJECTIVES
1) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not.
STUDY DESIGN
Retrospective analysis between two cohorts: ultrasound protocol group and control group.
METHODS
Children with peritonsillar abscess (PTA) diagnosed in the emergency department (ED) were enrolled during a 2-year period for transcervical ultrasound evaluation of bilateral tonsillar fossae. Data from a cohort of patients with PTA prior to ultrasound screening were also collected from retrospective chart review. Outcome variables were analyzed using multivariate logistic regression.
RESULTS
Seventy-eight children (mean 12.3 years) were enrolled in the ultrasound protocol, compared to 101 children (mean 13.6 years) evaluated using traditional methods of examination and/or computed tomography (CT) imaging. Demographics between the two groups were not significantly different. Only one-third of patients presumed to have PTA by ED staff had ultrasound findings consistent with abscess. Overall treatment failure rate was 8%, requiring readmission or surgical intervention for abscess. Length of stay, surgical drainage, and radiation exposure from CT scans were reduced significantly in the ultrasound group (P < 0.006). Differences in readmission rates and mean charges between the two groups did not reach significance.
CONCLUSION
Peritonsillar abscess is a common infection in the pediatric population, but diagnosis can be challenging. Transcervical ultrasound is a safe, cost-effective, and accurate modality to help stratify patients into medical and surgical treatment arms.
LEVEL OF EVIDENCE
3b. Laryngoscope, 127:1924-1929, 2017.
Topics: Adolescent; Child; Child, Preschool; Cost Savings; Female; Humans; Infant; Male; Peritonsillar Abscess; Retrospective Studies; Treatment Outcome; Ultrasonography; Young Adult
PubMed: 28092120
DOI: 10.1002/lary.26470 -
Anaerobe Dec 2016Fusobacterium necrophorum is a gram-negative anaerobic bacterium that is the causative agent of the invasive disease Lemierre's syndrome. In addition, it is also... (Review)
Review
Fusobacterium necrophorum is a gram-negative anaerobic bacterium that is the causative agent of the invasive disease Lemierre's syndrome. In addition, it is also associated with peritonsillar abscess formation and otitis media in small children. Recent research has shown that F. necrophorum may be involved in pharyngotonsillitis especially in adolescent and young adults and that it may be the second most common bacterial cause of pharyngotonsillitis after Streptococcus pyogenes (Group A streptococci). Peritonsillar abscesses and Lemierre's syndrome due to F. necrophorum are also found in this age group, suggesting that they may be complications of F. necrophorum pharyngotonsillitis. In this review we present the present knowledge about the role of F. necrophorum in pharyngotonsillitis with special emphasis on the age distribution. We argue that F. necrophorum is an important pathogen involved in pharyngotonsillitis in the age group of 13-40 years of age and we urge clinical microbiology labs to set up the appropriate techniques to be able to detect F. necrophorum from throat swabs.
Topics: Adolescent; Adult; Age Distribution; Age Factors; Anti-Bacterial Agents; Child; Female; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Male; Oropharynx; Otitis Media; Peritonsillar Abscess; Pharyngitis; Sex Factors; Tonsillitis
PubMed: 27693542
DOI: 10.1016/j.anaerobe.2016.09.006 -
The Annals of Otology, Rhinology, and... Jul 2024To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees'...
OBJECTIVES
To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees' confidence.
METHODS
The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin's palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants' confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included.
RESULTS
Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores ( < .001).
CONCLUSIONS
Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.
Topics: Humans; Peritonsillar Abscess; Internship and Residency; Drainage; Clinical Competence; Otolaryngology; Simulation Training; Manikins; Models, Anatomic; Education, Medical, Graduate
PubMed: 38682302
DOI: 10.1177/00034894241249611 -
Emergency Medicine Clinics of North... Aug 2021Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities... (Review)
Review
Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.
Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Decision Support Techniques; Diagnosis, Differential; Drainage; Epiglottitis; Humans; Pediatric Emergency Medicine; Peritonsillar Abscess; Postoperative Hemorrhage; Retropharyngeal Abscess; Tonsillectomy; Tracheitis
PubMed: 34215408
DOI: 10.1016/j.emc.2021.04.012 -
Laryngo- Rhino- Otologie Nov 2022In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative...
OBJECTIVE
In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative bleeding after abscesstonsillectomy (ABTE) is this surgery's most feared complication which can rarely lead to patients' deaths. The objective of this study was to compare bleeding complications of ABTE with and without contralateral tonsillectomy (TE) and to analyze the occurrence of a metachronous PTA at the contralateral side.
METHODS
Retrospective study of n= 655 patients undergoing ABTE with and without TE of the contralateral side from 2004 to 2019. Bleeding complications needing surgical hemostasis were analyzed regarding demographic and surgical parameters. In addition, occurrence of PTA and need for ABTE of the contralateral side after unilateral ABTE were evaluated.
RESULTS
Overall, 10/655 (1.5 %) patients presented with postoperative bleeding after ABTE. In 404/655 an ABTE with contralateral TE was performed. Here, 8/404 (1.98 %) patients showed contra- or bilateral bleeding. Only in 2/251 (0.7 %) patients occurred a bleeding complication after unilateral ABTE. Therefore, bleeding after unilateral ABTE was significantly lower than ABTE with contralateral TE (1.98 % vs. 0.7 %, p= 0.001). In 0.8 % of the patients a contralateral ABTE was necessary due to a metachronous PTA.
CONCLUSION
Overall, the rate of postoperative bleeding after ABTE (1.5 %) was low. Unilateral ABTE showed significantly lower postoperative bleeding rates compared to ABTE with contralateral TE. Consequently, the indication of a contralateral TE must be very strict.
Topics: Humans; Retrospective Studies; Peritonsillar Abscess; Tonsillectomy; Postoperative Hemorrhage; Drainage
PubMed: 35605964
DOI: 10.1055/a-1841-6419 -
The Laryngoscope Jun 2024To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation. (Review)
Review
OBJECTIVES
To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation.
DATA SOURCES
PubMed, Scopus, Web of Science, Ovid, and Cochrane.
REVIEW METHODS
A search of the abovementioned databases was performed in August 2022 using the terms "peritonsillar abscess/quinsy," "incision/drainage/aspiration," and "simulation." No time restrictions were applied. We included studies that clearly described how their PTA models were built and underwent validation from experts and/or evaluation from trainees. Articles describing a model only without any evaluation and reports in languages other than English were excluded.
RESULTS
Our search initially yielded 80 articles after duplicate removal, 10 of which met our criteria and were included. Two studies trained participants on both needle aspiration and incision and drainage (I&D), four studies on I&D only, and four on needle aspiration only. 87.5% to 100% of junior residents reported minimal exposure to PTA prior to simulation. Five studies provided some form of validation to their models. The value of the simulators to train participants on skills received better appreciation than their anatomical fidelity. The perceived confidence level of trainees in managing PTA, which was assessed in 7 studies, substantially improved after training.
CONCLUSION
PTA simulation improves the confidence of trainees to perform PTA drainage. There is, however, a lack of standardization and evidence regarding transfer validity among PTA simulators. The development of a standardized PTA simulator could allow for more widespread use and increase resident comfort with this procedure in a pre-clinical setting.
LEVEL OF EVIDENCE
NA Laryngoscope, 134:2495-2501, 2024.
Topics: Peritonsillar Abscess; Humans; Drainage; Clinical Competence; Simulation Training; Internship and Residency; Models, Anatomic
PubMed: 37991176
DOI: 10.1002/lary.31196 -
The Annals of Otology, Rhinology, and... Feb 2022To evaluate the success of sole medical therapy (MT) versus surgical therapy (ST) in patients with both clinically and radiographically confirmed peritonsillar abscess...
OBJECTIVE
To evaluate the success of sole medical therapy (MT) versus surgical therapy (ST) in patients with both clinically and radiographically confirmed peritonsillar abscess (PTA). To also determine treatment safety based on abscess size, and identify predictors of treatment failure.
METHODS
This was a retrospective cohort of 3 hospitals in a single academic health system. A total of 214 immunocompetent patients diagnosed with uncomplicated PTA underwent a contrasted CT scan of the neck. About 87 patients were treated with sole MT (intravenous antibiotics and steroids), and 127 patients were treated with ST (MT plus drainage).
RESULTS
Treatment failure occurred in 8.0% of the MT group and 7.9% of the ST group ( = 1.00). In PTAs <2 cm, treatment failure occurred in 5.3% of the MT group and 5.0% of the ST group ( = 1.00). In PTAs ≥2 cm, treatment failure occurred in 13.3% of the MT group and 9.0% treated with ST ( = .53). Size ≥2 cm (OR - 3.46, = .08) and IV clindamycin as sole IV antibiotic (OR - 2.46, = .15) trended toward predicting treatment failure. In addition to those considered failures, 7.0% of the ST group returned to the ED with pain versus 0% of the MT group ( = .01).
CONCLUSION
Frequency of treatment failure was not significantly different among patients receiving MT and ST. Abscesses ≥2 cm in size were more likely to fail in both groups and ST was not statistically superior. Sole MT for uncomplicated PTA may help reduce unnecessary procedures and healthcare costs.
PubMed: 33980073
DOI: 10.1177/00034894211015590 -
Ear, Nose, & Throat Journal Jan 2022Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle....
Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of parapharyngeal BCC misdiagnosed as peritonsillar abscess.
PubMed: 35088618
DOI: 10.1177/01455613211067846 -
The Laryngoscope Dec 2020The purpose of this study was to evaluate the relationship among smoking, alcohol consumption, and peritonsillar abscess in a Korean population.
OBJECTIVES/HYPOTHESIS
The purpose of this study was to evaluate the relationship among smoking, alcohol consumption, and peritonsillar abscess in a Korean population.
STUDY DESIGN
Individuals ≥40 years old from the Korean National Health Insurance Service-Health Screening Cohort were assessed from 2002 to 2013.
METHODS
In total, 1,285 peritonsillar abscess participants were matched with 5,140 controls at a ratio of 1:4 with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the participants' previous histories of smoking (current smokers vs. nonsmokers or past smokers) and alcohol consumption (drinkers vs. nondrinkers) in the peritonsillar abscess and control groups. Peritonsillar abscess was defined using the International Classification of Disease-10 code J36 combined with claim codes for incision and drainage or aspiration. Crude and adjusted odds ratios (ORs) were analyzed using unconditional logistic regression analyses, and 95% confidence intervals (CI) were calculated.
RESULTS
The rates of smoking and consuming alcohol were higher in the peritonsillar abscess group than in the control group. The adjusted OR of smoking for peritonsillar abscess was 1.23 (95% CI = 1.06-1.44, P = .009), and that of alcohol consumption was 1.18 (95% CI = 1.02-1.36, P = .024).
CONCLUSION
The odds of smoking and alcohol consumption were increased in peritonsillar abscess patients compared to those in the control group.
LEVEL OF EVIDENCE
NA Laryngoscope, 2020.
Topics: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Case-Control Studies; Female; Humans; Male; Middle Aged; Peritonsillar Abscess; Republic of Korea; Risk Factors; Smoking
PubMed: 32040204
DOI: 10.1002/lary.28510 -
Turkish Archives of Otorhinolaryngology Dec 2018Peritonsillar abscess (PTA) is defined as pus accumulation between the tonsillar capsule and constrictor pharyngeal muscle. It can be seen as a complication of acute...
OBJECTIVE
Peritonsillar abscess (PTA) is defined as pus accumulation between the tonsillar capsule and constrictor pharyngeal muscle. It can be seen as a complication of acute tonsillitis, but other mechanisms have also been proposed. In this study we aimed to reveal the seasonal variations and epidemiologic features of PTA.
METHODS
This is a retrospective, observational study. We reviewed 221 patients, and together with 24 recurrent cases, 245 admissions were reviewed in total. Age, gender, the duration of admission, seasonal and monthly distribution of cases, diabetes and smoking status, white blood cell count, and C-reactive protein (CRP) levels were recorded. Monthly and seasonal incidences of PTA were reviewed to see if there is any association of climate variations and PTA incidence rate. Features associated with the length of hospitalization and recurrence were also analyzed.
RESULTS
A total of 245 PTA cases were admitted to our clinic between June 2014 and June 2017. The highest amount of cases was observed in spring and winter. The C-reactive protein and white blood cell count (WBC) levels were found to be positively correlated with the length of hospitalization. There was no statistically significant correlation with recurrence and smoking, the WBC levels, CRP levels, and length of prior hospitalization. Diabetes status was not found to be associated with length of hospitalization and CRP levels.
CONCLUSION
The present study reflects the epidemiologic and clinical features of PTA in İstanbul. Our findings showed that seasonal variation was not significant, consistent with previous studies. The highest incidence rate was observed in spring and winter. Length of hospitalization was found to be positively correlated with C-reactive protein and white blood cell count (WBC) levels. Recurrence was not statistically correlated with and smoking, the WBC levels, CRP levels, and length of hospitalization. More studies are recommended to reveal the different epidemiologic factors affecting the incidence of PTA.
PubMed: 30701118
DOI: 10.5152/tao.2018.3362