The impact of prior tonsillitis and treatment modality on the recurrence of peritonsillar abscess: a nationwide cohort study.

Ying-Piao Wang,Pesus Chou,Mao-Che Wang,Hung-Ching Lin,Salomon Amar

doi:10.1371/journal.pone.0109887

Abstract

BackgroundStudies suggest an increased risk of peritonsillar abscess (PTA) recurrence in patients with prior tonsillitis. However, this association is inconsistent and could be confounded by different treatment modalities. This study aimed to assess the risk of recurrence among PTA patients with different degrees of prior tonsillitis and treatment modalities, and the role of tonsillectomy in current practice.MethodsAll in-patients with peritonsillar abscess between January 2001 and December 2009 were identified in a nationwide, retrospective cohort study. Recurrence was defined as the first occurrence of PTA ≧30 days from the initial PTA. Factors independently associated with recurrence were analyzed using Cox proportional hazard model after adjusting for demographic and clinical data.ResultsThere were 28,837 patients, with a 5.15% recurrence rate and 4.74 years of follow-up. The recurrence rates were significantly higher among subjects with more than five prior tonsillitis or 1–4 prior tonsillitis compared to those without prior tonsillitis (adjusted hazard ratio, 2.82 [95% confidence interval, 2.39–3.33] and 1.59 [95% CI: 1.38–1.82]). The adjusted HR in patients treated with needle aspiration was 1.08 compared to those treated with incision & drainage (95% CI: 0.85–1.38). After age stratification, the adjusted HRs of more than five prior tonsillitis increased to 2.92 and 3.50 in patients aged ≦18 and 19–29 years respectively. The adjusted HR ofneedle aspiration only increased in patients ≦18 years old (aHR: 1.98 [95% CI: 0.99–3.97]). The overall tonsillectomy rate was 1.48% during our study period.ConclusionsThe risk of PTA recurrence increases with higher degrees of prior tonsillitis in all age groups and management by needle aspiration only in the pediatric population. Patients younger than 30 years old with PTA and more than five prior tonsillitis have the greatest risk of recurrence.

Highlights

Deep neck infection is one of the most lethal infectious diseases in the complex framework formed by the three layers of the deep cervical fascia, with potential morbidity and mortality ranging from 1.6% to 40% [1,2,3,4]
This study provided tonsillectomy data on peritonsillar abscess (PTA) patients that had not been addressed in a nationwide setting
The risk of recurrent PTA among patients with 1–4 prior tonsillitis was significantly different from those without prior tonsillitis (Table 2)

Summary

Introduction

Deep neck infection is one of the most lethal infectious diseases in the complex framework formed by the three layers of the deep cervical fascia, with potential morbidity and mortality ranging from 1.6% to 40% [1,2,3,4]. The recurrence rate of PTA is poorly defined in the literature, ranging from 5% to 22%, with variability in age, sex, duration of follow-up, and different managements [8,13,14,15,16,17,18,19]. Studies suggest an increased risk of peritonsillar abscess (PTA) recurrence in patients with prior tonsillitis. This association is inconsistent and could be confounded by different treatment modalities. This study aimed to assess the risk of recurrence among PTA patients with different degrees of prior tonsillitis and treatment modalities, and the role of tonsillectomy in current practice

Objectives

Methods

Results

Conclusion