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JAAPA : Official Journal of the... Jan 2024
Topics: Humans; Peritonsillar Abscess
PubMed: 38128143
DOI: 10.1097/01.JAA.0000995688.96837.65 -
Radiology Case Reports Feb 2024Peritonsillar abscess (PTA) is the most common deep neck infection in the United States. Timely treatment of PTA with antibiotics and aspiration or drainage is...
Peritonsillar abscess (PTA) is the most common deep neck infection in the United States. Timely treatment of PTA with antibiotics and aspiration or drainage is paramount, as delay in management may lead to further complications. The oral approach is the preferred route of drainage however may not always be accessible, warranting consideration of other routes of drainage. To the best of our knowledge, CT guidance for aspiration or drainage of a PTA has not been previously described. We present a 50-year-old patient with a PTA who initially presented with throat pain and dysphagia, rapidly developed upper airway obstruction, and required intubation. After the failure of clinical improvement and unsuccessful PTA aspiration via the conventional oral route, successful CT-guided percutaneous needle aspiration was performed by neuroradiology. Shortly thereafter, the patient clinically improved and was discharged with an oral course of antibiotics and follow-up on an as-needed basis. Total hospital length of stay was seven days. The complex patient may not allow for simple incision and drainage or needle aspiration of a suspected PTA. Assistance with ultrasound guidance is often utilized, however, challenges may persist depending on the anatomical location of the PTA and patient comorbidities. In cases where external drainage is considered and conventional ultrasound imaging is particularly challenging, CT-guided percutaneous aspiration may provide a useful alternative. PTAs are common with the possibility of complication. Although the usual route of drainage is oral, there are instances in which this cannot be performed. This case exhibits an uncommon approach to PTA aspiration via an external CT-guided percutaneous approach with rapid subsequent clinical improvement, exhibiting the utility of CT guidance.
PubMed: 38111556
DOI: 10.1016/j.radcr.2023.11.007 -
Research Square Dec 2023There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. By conducting this study, we will understand the...
IMPORTANCE
There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. By conducting this study, we will understand the current landscape of low-cost otolaryngology-head and neck surgery simulation for early medical trainees and students.
OBJECTIVES
Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature.
EVIDENCE REVIEW
This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents.
FINDINGS
Of the 1706 studies screened, 17 met the inclusion criteria. Most studies were conducted in HICs. Most models were low fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation.
CONCLUSION AND RELEVANCE
Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.
PubMed: 38106212
DOI: 10.21203/rs.3.rs-3673832/v1 -
American Journal of Otolaryngology 2024Peritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet...
PURPOSE
Peritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet the indications for elective tonsillectomy even prior to the current PTA event. Abscess ("Quinsy") tonsillectomy (QT) could serve as definitive treatment in this specific subgroup, though it is not performed often. The purpose of this study was to compare the perioperative outcomes between immediate QT and tonsillectomy performed several days (delayed QT) or weeks (Interval tonsillectomy, IT) after incision and drainage (I&D) of the PTA in this specific subgroup.
MATERIALS AND METHODS
A retrospective perioperative outcomes analysis of patients undergoing tonsillectomy (2002-2022) compared QT to delayed QT and IT in patients with PTA meeting AAO-HNS elective tonsillectomy criteria.
RESULTS
110 patients were included: 55 underwent IT, 36 underwent delayed QT, and 19 underwent immediate QT. Postoperative hemorrhage rates were 14.5 %, 11.1 %, and 5.3 % for IT, delayed QT, and immediate QT, respectively (P = 0.08). Mean hospitalization durations were 7.98, 6.92, and 5.37 days for IT, delayed QT, and immediate QT, respectively (P < 0.01). IT had a higher readmission rate due to pain compared to QT (14.5 % vs. 1.9 %, p = 0.032).
CONCLUSION
Immediate QT in PTA patients eligible for elective tonsillectomy is associated with lower postoperative hemorrhage, shorter admission time, and potentially reduced postoperative pain compared to I&D and delayed or interval tonsillectomy. These findings suggest that immediate QT should be considered as a primary treatment in this subgroup of eligible patients.
Topics: Humans; Tonsillectomy; Retrospective Studies; Peritonsillar Abscess; Tonsillitis; Postoperative Hemorrhage
PubMed: 38104468
DOI: 10.1016/j.amjoto.2023.104198 -
Clinical Otolaryngology : Official... Mar 2024Peritonsillar abscess (PTA) is the most common soft-tissue infection of the head and neck. This potential complication of tonsillitis has demonstrated unique microbial...
OBJECTIVES
Peritonsillar abscess (PTA) is the most common soft-tissue infection of the head and neck. This potential complication of tonsillitis has demonstrated unique microbial trends during the COVID-19 pandemic. This era has resulted in a major shift in the hygiene and social habits of the general population, which has resulted in changes in the presentation, management and microbiology of several infectious diseases. To date, the impact of COVID 19 on PTA microbiology and clinical presentation in the paediatric population has yet to be investigated.
DESIGN
Retrospective chart review comparing all cases of paediatric (age 0-18) PTA in an academic tertiary centre during the COVID-19 pandemic (03/2020-02/2022) and compared them to two control groups: pre-COVID (03/2018-02/2020) and post-COVID (03/2022-03/2023). All patients were treated with either needle aspiration, incision and drainage or both means in addition to intravenous antibiotics.
SETTING
A large Ear Nose and Throat department in a tertiary referral center.
PARTICIPANTS
Consecutive children aged 18 years or under, admitted with a diagnosis of Peritonsillar abscess.
MAIN OUTCOME MEASURES
We analyzed the clinical and microbiologcal features of all cases of pediatric peritonsillar abscess during the COVID-19 era (03/2020-02/2022) and compared them to a pre and post control cases.
RESULTS
A total of 96 PTA cases were included (35 pre-COVID, 35 COVID and 26 post-COVID). The means of procedural treatment shifted in favour of incision and drainage versus needle aspiration during the COVID era. The length of hospitalisation increased during the COVID era (3.6 days vs. 2.1 and 3.1 pre and post-COVID respectively, p < .001). No other notable differences in the clinical and demographic features were found between the three eras. The COVID-19 era saw an increase in Fusobacterium (37.1% vs. 8.6% and 24% pre and post-COVID, respectively; p = .008) and Streptococcus Anginosus (31.4% vs. 5.7% and 7.7% pre and post-COVID, respectively; p = .007) species isolation.
CONCLUSIONS
The COVID-19 pandemic did not seem to impact the clinical presentation of paediatric PTA yet resulted in a change in microbiological pathogens. The choice of I&D as a means to shorten hospital stay during the pandemic may have led to an actual increase in hospital stay, suggesting that NA may be the preferred management approach.
Topics: Humans; Child; Peritonsillar Abscess; Case-Control Studies; Retrospective Studies; Pandemics; COVID-19; Drainage
PubMed: 38100150
DOI: 10.1111/coa.14133 -
POCUS Journal 2023The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing 1. Proven advantages include improved diagnostic...
The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing 1. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay 1. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.
PubMed: 38099156
DOI: 10.24908/pocus.v8i2.16568 -
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 -
Peritonsillar abscess caused by Mycoplasma hominis and Fusobacterium necrophorum following oral sex.Auris, Nasus, Larynx Apr 2024Mycoplasma hominis is a bacterium that colonizes the genital tract of some females and males, as well as their respiratory tracts. Although only two cases of deep neck...
Mycoplasma hominis is a bacterium that colonizes the genital tract of some females and males, as well as their respiratory tracts. Although only two cases of deep neck infection have been reported, the associations between the onset and sexual intercourse have not been reported. A healthy 19-year-old female was diagnosed with a left peritonsillar abscess. The patient had sexual intercourse with a new partner, including oral sex, two days prior to symptom onset. It was not known whether the male partner had urethritis symptoms. M. hominis and Fusobacterium necrophorum were isolated from the abscess culture. The patient's condition improved after drainage, and sulbactam ampicillin was switched to oral clindamycin.
Topics: Female; Humans; Male; Young Adult; Adult; Peritonsillar Abscess; Fusobacterium necrophorum; Mycoplasma hominis; Fusobacterium Infections; Sexual Behavior; Anti-Bacterial Agents
PubMed: 38042699
DOI: 10.1016/j.anl.2023.10.004 -
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 -
European Review For Medical and... Nov 2023In clinical practice, identifying abscesses in tonsillar infections is crucial for early therapeutic management. Diagnosis of a peritonsillar abscess is usually based on...
OBJECTIVE
In clinical practice, identifying abscesses in tonsillar infections is crucial for early therapeutic management. Diagnosis of a peritonsillar abscess is usually based on clinical symptoms. Complementary examination procedures, such as laboratory parameters and imaging, are available for confirmation.
PATIENTS AND METHODS
A retrospective analysis was carried out of data for 752 patients who presented with acute tonsillar infection and were hospitalized between January 2012 and February 2021. The data analyses involved evaluating the patient's clinical symptoms, inflammatory parameters, and previous medical history in relation to the predictive power of these factors for the presence of an abscess.
RESULTS
Predictor analysis for the presence of an abscess showed significant values for trismus (OR 2.392; 95% CI, 1.305 to 4.383; p=0.005) and palatal arch protrusion (OR 29.679; 95% CI, 17.460 to 50.447; p=0.000). The inflammatory parameter C-reactive protein and the leukocyte count were not statistically significant as predictors.
CONCLUSIONS
The presence of a tonsillar abscess can be diagnosed from the clinical presentation alone if the findings are clear. Further diagnostic procedures are indicated in case of inconclusive findings, and ultrasound should be the primary noninvasive method. Computed tomography is only required in selected cases. Inflammatory parameters can be assessed in order to monitor therapy, but do not predict the presence of an abscess. However, if defined action sequences are being considered, tonsillar abscesses can be differentiated at an early point.
Topics: Humans; Retrospective Studies; Tonsillitis; Peritonsillar Abscess; Leukocyte Count; C-Reactive Protein
PubMed: 37975394
DOI: 10.26355/eurrev_202311_34349