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Ugeskrift For Laeger Jun 2023
Topics: Humans; Peritonsillar Abscess; Emergency Service, Hospital; Ultrasonography
PubMed: 37325984
DOI: No ID Found -
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 -
American Family Physician May 2011Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms... (Review)
Review
Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms usually start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress. In most children, the symptoms subside quickly with resolution of the cough within two days. Croup is often caused by viruses, with parainfluenza virus (types 1 to 3) as the most common. However, physicians should consider other diagnoses, including bacterial tracheitis, epiglottitis, foreign body aspiration, peritonsillar abscess, retropharyngeal abscess, and angioedema. Humidification therapy has not been proven beneficial. A single dose of dexamethasone (0.15 to 0.60 mg per kg usually given orally) is recommended in all patients with croup, including those with mild disease. Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup. Most episodes of croup are mild, with only 1 to 8 percent of patients with croup requiring hospital admission and less than 3 percent of admitted patients requiring intubation.
Topics: Adrenal Cortex Hormones; Child; Croup; Diagnosis, Differential; Epinephrine; Humans
PubMed: 21534520
DOI: No ID Found -
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 -
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 -
AJNR. American Journal of Neuroradiology Feb 2022Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep...
BACKGROUND AND PURPOSE
Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.
MATERIALS AND METHODS
We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.
RESULTS
The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.
CONCLUSIONS
Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.
Topics: Humans; Infections; Magnetic Resonance Imaging; Neck; Peritonsillar Abscess; Retrospective Studies
PubMed: 34916205
DOI: 10.3174/ajnr.A7368 -
Praxis 2020
Topics: Angina Pectoris; Anti-Bacterial Agents; Humans; Peritonsillar Abscess
PubMed: 33292007
DOI: 10.1024/1661-8157/a003572 -
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 -
Brazilian Journal of Otorhinolaryngology 2018Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors.
INTRODUCTION
Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors.
OBJECTIVE
To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration.
METHODS
This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration.
RESULTS
A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p=0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age>65 years) with an odds ratio (OR) of 2.76 (p=0.03), and decreased in the hot season (mean temperature>26°C) (OR=0.49, p=0.04). No specific microorganism was associated with prolonged hospital stay.
CONCLUSION
The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Fusobacterium Infections; Fusobacterium necrophorum; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Middle Aged; Peritonsillar Abscess; Prevotella; Retrospective Studies; Risk Factors; Viridans Streptococci; Young Adult
PubMed: 28756939
DOI: 10.1016/j.bjorl.2017.06.007 -
Indian Journal of Otolaryngology and... Dec 2022Peritonsillar abscess is a known complication of tonsillitis. The patient usually presents with typical symptoms of odynophagia, fever and difficulty in mouth opening....
Peritonsillar abscess is a known complication of tonsillitis. The patient usually presents with typical symptoms of odynophagia, fever and difficulty in mouth opening. The diagnosis is established by clinical examination that commonly revealed unilateral peritonsillar swelling. Aspiration of pus will confirm the diagnosis. We report an atypical presentation of peritonsillar abscess case which presented only with loss of taste sensation without dysphagia, fever, odynophagia or trismus.
PubMed: 33718102
DOI: 10.1007/s12070-021-02506-y