Treatment and Long‐term Follow‐up of Peritonsillar Abscess

Abstract

Objectives: Study the therapeutic management, recurrence, and need of tonsillectomy in Peritonsillar abscess. Study design: Retrospective study and long term telephone survey. Setting: Otolaryngology Head and Neck Surgery Department at Shaare Zedek Medical Center, Jerusalem, Israel. Methods: Review of 117 files of patients diagnosed with peritonsillar abscess who underwent needle aspiration obtaining pus were hospitalized at our department between the years of 2004 to 2007, and were followed at least four years after their discharge date. Results: One hundred four patients (89%) improved without any other intervention. Thirteen patients (11%) underwent an additional procedure such as aspiration and/or incision and drainage. After the needle aspiration, the patients were treated with intravenous antibiotic treatment: penicillin or broad spectrum antibiotics, amoxicillin-clavulanate, or a combination of metronidazole and cefuroxime. There was no clinical distinction between the various groups. A hundred and five patients (90%) were followed up by telephone call, obtaining the following information: 88 patients (84%) had no recurrence. The remaining 17 suffered recurrence; most of them, 9 patients, had only one. 18 patients underwent tonsillectomy; 13 due to recurrent peritonsillar abscess and 5 due to recurrent tonsillitis. Conclusions: 1) Needle aspiration is an effective treatment for peritonsillar abscess. 2) The supplementary antibiotic treatment with penicillin was satisfactory, and no advantage was found to the broad-spectrum antibiotic treatment. 3) A sweeping recommendation for tonsillectomy is not required after a single episode. Surgery should be recommended only after two or more episodes of peritonsillar abscess.