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Cureus Mar 2022Background Peritonsillar abscesses (PTA) are the most common deep space infection of the head and neck. They appear to have an association with a patient's smoking...
Background Peritonsillar abscesses (PTA) are the most common deep space infection of the head and neck. They appear to have an association with a patient's smoking history but data showing this relationship is sparse and controversial. Currently, no data on this association exists for those who seek care at a rural community emergency department (ED). Based upon the lack of data in this setting, the authors sought to determine the incidence, treatments, and outcomes between smokers and non-smokers with a PTA at a rural community ED. Methods A retrospective chart review of all patients undergoing a soft tissue neck computed tomography (CT) scan with or without intravenous contrast was completed from September 25th, 2019 through October 4th, 2021. Patients with a previously diagnosed PTA and those diagnosed via another means (clinical, needle aspiration, etc.), or outside of the ED were excluded from the dataset. Abstracted data included demographics, treatments, and outcomes of each patient. The data were analyzed using the Mann-Whitney test for continuous data and the chi-square test for categorical data. Results During the study period, a total of 50 patients were diagnosed with a PTA via soft tissue neck CT. Of those diagnosed, the median age was 40.5 (25.5 - 53.3) years, 15 were female, 38 self-identified as white, and 27 noted a current smoking history. Smokers presented to ED earlier than non-smokers (2.0 vs 4.0 days; p=0.03), but no difference was noted in the size of PTA identified via CT (2.0 vs 1.5 cm; p=0.13). No difference among smokers and non-smokers was noted in corticosteroid therapy either administered in the ED (p = 0.53) or prescribed as an outpatient (p = 0.75), incision and drainage (p = 0.19), outpatient follow-up (p = 0.53), or resolution of the symptoms (p = 0.86). However, more patients in the non-smoking group had an unplanned return to the ED as compared to those who smoked (p=0.02). In those patients who were not discharged from the ED after initial presentation, four were admitted to the hospital and 11 were transferred to a higher level of care. Conclusion Although drawn from a limited sample from a single rural community ED, a positive smoking history was more common among patients with a PTA. While there was no statistically significant difference in the overall treatment, a difference was noted for unscheduled return visits to the ED in those without a history of smoking.
PubMed: 35464569
DOI: 10.7759/cureus.23300 -
Ear, Nose, & Throat Journal Mar 2022Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and...
BACKGROUND
Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia.
METHOD
This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors.
RESULTS
A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate ( = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; = .006).
CONCLUSION
This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.
Topics: Child; Factor Analysis, Statistical; Humans; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Saudi Arabia; Tonsillectomy; Tonsillitis
PubMed: 32830579
DOI: 10.1177/0145561320944662 -
Infection and Drug Resistance 2022Although is a commensal microorganism of the oral cavity, it may sometimes cause severe systemic infections. We report a case of Lemierre syndrome (LS), which developed...
Although is a commensal microorganism of the oral cavity, it may sometimes cause severe systemic infections. We report a case of Lemierre syndrome (LS), which developed after infection, in a 73-year-old Japanese woman who was admitted to the hospital for throat pain, neck swelling, and fever for 3 days. She had a 3-month history of neglected dental caries, gingivitis, and periodontitis. Physical examination revealed right tonsillar erythema and swelling, and computed tomography (CT) showed peritonsillar and retropharyngeal abscesses. Ampicillin/sulbactam was promptly administered after collecting two sets of blood cultures. Surgical drainage for peritonsillar and retropharyngeal abscesses was also conducted on the second hospital day. Although only commensal oral microflora grew in the culture from the drained pus, Gram-negative bacilli were confirmed in the anaerobic blood cultures. Metronidazole was administered intravenously; however, the fever and neck swelling persisted. Repeat CT performed on the fifth hospital day revealed right internal jugular vein thrombosis, a known complication of tonsillitis and pharyngitis once the infection extends beyond the oropharynx. We diagnosed she had coexisting LS, and anticoagulant therapy was added to her treatment regimen. Her condition improved, and she was discharged after completing 3 weeks of antibiotics. Conventional methods failed to identify the isolated bacterium, and 16S rRNA sequencing ultimately identified it as . In a literature review of bacteremia due to , poor oral hygiene was considered a probable risk factor for invasive infection. We consider this to be the case in our patient who presented with dental caries, gingivitis, and periodontitis. In addition, all cases revealed that the 16S rRNA gene sequencing is useful for identifying this species. Although the diagnosis of LS by physical examination is difficult, physicians should always consider it as a potential complication of infections in the pharyngeal area.
PubMed: 35668853
DOI: 10.2147/IDR.S359074 -
The Journal of Laryngology and Otology Jul 2021The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the...
BACKGROUND
The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre.
METHODS
A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures.
RESULTS
Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates.
CONCLUSION
Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; COVID-19; Drainage; Female; Hospitalization; Humans; Length of Stay; London; Male; Middle Aged; Otolaryngology; Peritonsillar Abscess; Practice Patterns, Physicians'; Quality Improvement; Referral and Consultation; Retrospective Studies; Tonsillitis; Young Adult
PubMed: 33913412
DOI: 10.1017/S0022215121001213 -
BMJ Case Reports Sep 2020Transoral drainage of peritonsillar abscess during the COVID-19 pandemic is a high-risk procedure due to potential aerosolisation of SARS-CoV-2. This case describes...
Transoral drainage of peritonsillar abscess during the COVID-19 pandemic is a high-risk procedure due to potential aerosolisation of SARS-CoV-2. This case describes conservative management of peritonsillar abscess in a 21-year-old male with COVID-19.
Topics: COVID-19; Coronavirus Infections; Humans; Male; Pandemics; Peritonsillar Abscess; Pneumonia, Viral; Young Adult
PubMed: 32900754
DOI: 10.1136/bcr-2020-238104 -
Indian Journal of Pediatrics Nov 2021To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
OBJECTIVE
To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
METHODS
Retrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management.
RESULTS
Out of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population.
CONCLUSION
Pediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.
Topics: Airway Obstruction; Child; Humans; Infant; Respiratory Sounds; Retrospective Studies; Tracheal Diseases; Tracheostomy
PubMed: 33728566
DOI: 10.1007/s12098-021-03722-8 -
HNO Aug 2022The incidence of acute ear, nose, and throat (ENT) diagnoses is influenced by multiple parameters, for example meteorological and seasonal influences. By better...
BACKGROUND
The incidence of acute ear, nose, and throat (ENT) diagnoses is influenced by multiple parameters, for example meteorological and seasonal influences. By better understanding the triggering factors, prophylactic approaches can be developed.
MATERIALS AND METHODS
A retrospective analysis was performed over 6 years of all patients who presented to the university hospital because of typical and minor ENT emergencies. The diagnoses impacted cerumen, acute otitis media, acute otitis externa, nasal bone fracture, epistaxis, acute tonsillitis, acute rhinosinusitis, and peritonsillar abscess were analyzed.
RESULTS
A total of 32,968 cases were analyzed. Epistaxis was the most common of the investigated emergency diagnoses, accounting for 24.5% (8082 cases). Epistaxis, acute otitis media, and acute rhinosinusitis occurred significantly more frequently in the colder half of the year. There was no significant correlation of the incidence of nasal bone fracture with public holidays. Acute otitis externa correlated significantly with the local summer vacations. In calendar week 38, the fewest total emergency presentations occurred, whereas in calendar week 52, the most emergency presentations occurred.
CONCLUSION
Seasonal and meteorological factors play a significant role in the pathogenesis of many emergency ENT diagnoses.
Topics: Acute Disease; Emergencies; Epistaxis; Fractures, Bone; Humans; Nose Diseases; Otitis Externa; Otolaryngology; Peritonsillar Abscess; Retrospective Studies; Seasons
PubMed: 35657418
DOI: 10.1007/s00106-022-01185-7 -
Danish Medical Journal Apr 2023No Danish validated patient-reported outcome measure (PROM) exises for assessing throat-related quality of life in patients with recurrent acute tonsillitis (RT) and...
INTRODUCTION
No Danish validated patient-reported outcome measure (PROM) exises for assessing throat-related quality of life in patients with recurrent acute tonsillitis (RT) and chronic tonsillitis (CT). We aimed to translate and linguistically validate the Tonsillectomy Outcome Inventory 14 (TOI-14) into Danish and describe scores in RT and CT patients before and after tonsillectomy as well as in healthy controls.
METHODS
We followed the guideline for PROM translation and cultural adaption set out by the Quality of Life Special Interest Group - Translation and Cultural Adaptation group formed by ISPOR. We included RT and CT patients undergoing elective tonsillectomy, who answered the questionnaire pre- and post-operatively (six-month follow-up) as well as healthy controls who answered the questionnaire once.
RESULTS
A Danish version of the TOI-14 was developed according to the guideline. A total of 49 RT patients, 34 CT patients and 67 controls were included in the final analysis. Preoperatively, RT and CT patients had markedly higher TOI-14 scores than controls (mean total scores: RT: 45.6; CT: 21.7; controls: 8.9, both p less-than 0.001). Post-operatively, scores fell to levels similar to those of controls (RT: 10.2, p = 0.51; CT: 4.7, p = 0.05).
CONCLUSION
We translated, culturally adapted and linguistically validated the Danish version of the TOI-14, finding scores in RT patients, CT patients and controls similar to those recorded by previous studies in German, English and Finnish.
FUNDING
The Lundbeck Foundation, grant #R185-2014-2482.
TRIAL REGISTRATION
Central Denmark Region #1-16-02-723-20.
Topics: Humans; Tonsillectomy; Quality of Life; Tonsillitis; Peritonsillar Abscess; Translations; Surveys and Questionnaires; Chronic Disease; Reproducibility of Results
PubMed: 37125826
DOI: No ID Found -
Scientific Reports Aug 2021Polyols are effective against caries-causing streptococci but the effect on oropharynx-derived pyogenic streptococci is not well characterised. We aimed to study the...
Polyols are effective against caries-causing streptococci but the effect on oropharynx-derived pyogenic streptococci is not well characterised. We aimed to study the effect of erythritol (ERY) and xylitol (XYL) against Streptococcus pyogenes isolated from peritonsillar abscesses (PTA). We used 31 clinical isolates and 5 throat culture collection strains. Inhibition of bacterial growth by polyols at 2.5%, 5% and 10% concentrations was studied and the results were scored. Amylase levels in PTA pus were compared to polyol effectivity scores (PES). Growth curves of four S. pyogenes isolates were analysed. Our study showed that XYL was more effective than ERY inhibiting 71-97% and 48-84% of isolates, respectively, depending of concentrations. 48% of clinical and all throat strains were inhibited by polyols in all concentrations (PES 3). PES was negative or zero in 26% of the isolates in the presence of ERY and in 19% of XYL. ERY enhanced the growth of S. pyogenes isolated from pus with high amylase levels. Polyols in all concentrations inhibited the growth in exponential phase. In conclusion, ERY and XYL are potent growth inhibitors of S. pyogenes isolated from PTA. Therefore, ERY and XYL may have potential in preventing PTA in the patients with frequent tonsillitis episodes.
Topics: Erythritol; Humans; Peritonsillar Abscess; Streptococcal Infections; Streptococcus pyogenes; Sweetening Agents; Vasodilator Agents; Xylitol
PubMed: 34349211
DOI: 10.1038/s41598-021-95367-y -
European Radiology Experimental Oct 2023We investigated whether a short, 5-min magnetic resonance imaging (MRI) protocol consisting of only axial T2-weighted and diffusion-weighted imaging (DWI) sequences can...
BACKGROUND
We investigated whether a short, 5-min magnetic resonance imaging (MRI) protocol consisting of only axial T2-weighted and diffusion-weighted imaging (DWI) sequences can discriminate between tonsillar infections, peritonsillar abscesses and deeply extending abscesses in a retrospective, blinded, multireader setting.
METHODS
We included patients sent by emergency physicians with suspected pharyngotonsillar infections who underwent emergency neck 3-T MRI from April 1 2013 to December 31 2018. Three radiologists (with 10-16 years of experience) reviewed the images for abscesses and their extension into deep neck spaces. Data were reviewed first using only axial T2-weighted Dixon images and DWI (short protocol) and second including other sequences and contrast-enhanced T1-weighted Dixon images (full protocol). Diagnostic accuracy, interobserver agreement, and reader confidence were measured. Surgical findings and clinical course served as standard of reference.
RESULTS
The final sample consisted of 52 patients: 13 acute tonsillitis with no abscesses, 19 peritonsillar abscesses, and 20 deeply extending abscesses. Using the short protocol, diagnostic accuracy for abscesses across all readers was good-to-excellent: sensitivity 0.93 (95% confidence interval 0.87-0.97), specificity 0.85 (0.70-0.93), accuracy 0.91 (0.85-0.95). Using the full protocol, respective values were 0.98 (0.93-1.00), 0.85 (0.70-0.93), and 0.95 (0.90-0.97), not significantly different compared with the short protocol. Similar trends were seen with detecting deep extension. Interobserver agreement was similar between protocols. However, readers had higher confidence in diagnosing abscesses using the full protocol.
CONCLUSIONS
Short MRI protocol showed good-to-excellent accuracy for tonsillar abscesses. Contrast-enhanced images improved reader confidence but did not affect diagnostic accuracy or interobserver agreement.
RELEVANCE STATEMENT
Short protocol consisting only of T2-weighted Dixon and DWI sequences can accurately image tonsillar abscesses, which may improve feasibility of emergency neck MRI.
KEY POINTS
• The short 3-T MRI protocol (T2-weighted images and DWI) was faster (5 min) than the full protocol including T1-weighted contrast-enhanced images (24 min). • The short 3-T MRI protocol showed good diagnostic accuracy for pharyngotonsillar abscesses. • Contrast-enhanced sequences improved reader confidence but did not impact diagnostic accuracy or interobserver agreement.
Topics: Humans; Peritonsillar Abscess; Retrospective Studies; Contrast Media; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging
PubMed: 37872406
DOI: 10.1186/s41747-023-00379-0