Bilateral Peritonsillar Abscess Research Articles

Bilateral Peritonsillar Abscess in Pediatric Age: A Case Report

Background: Bilateral peritonsillar abscesses are a rare occurrence in children. Peritonsillar abscess is characterized by the pushing of the tonsils forward and toward the uvula. Untreated acute tonsillitis can lead to the development of peritonsillar abscesses as an early complication. Case presentation: The study presents a rare case report of a 5-year-old male with no prior medical conditions presented with a history of fever (38.5°) and a runny nose for the past 2 days. No abnormalities were observed in chest, cardiovascular, abdominal, or central nervous system examination. Nevertheless, the tonsils appeared to be pushed by a mass and the uvula deviated. Computed tomography (CT) revealed enlarged bilateral palatine tonsils with a few small peritonsillar abscesses measuring 0.7 cm. Thus, bilateral palatine tonsillitis with few peritonsillar small abscesses associated with multilevel cervical lymphadenopathy was diagnosed. Conclusion: The emphasis of the report is the importance of considering peritonsillar abscess as a differential diagnosis when encountering a child with previously reported clinical presentations and characteristics, as in the aforementioned case.

Case Report: Bilateral peritonsillar abscess with complications of upper airway obstruction

Background: Peritonsillar abscess is a collection of pus between the tonsillar fibrous capsule and the pharyngeal constrictor muscle. Unilateral peritonsillar abscess is a common complication of acute tonsillitis, whereas bilateral peritonsillar abscess is rare. The incidence of bilateral peritonsillar abscess remains unknown but is estimated to be 4.9% of all peritonsillar abscess cases. Case report: A 20-year-old man came to the emergency room with bilateral peritonsillar abscess and complained of shortness of breath for two weeks. Physical examination showed muffled voice, 82% oxygen saturation, and inspiratory stridor. The isthmus faucium was narrow, with approximately 30% remaining. Peritonsillar puncture revealed pus mixed with blood. The treatment for this patient included bilateral peritonsillar incision and drainage and intravenous antibiotics of levofloxacin and metronidazole. The patient came to the Ear, Nose, Throat, Head, and Neck (ENTHN) Outpatient Unit eight days after the procedure for a control checkup and was in good condition. Conclusion: We have reported a bilateral peritonsillar abscess with complications of upper airway obstruction, in which we performed incision and drainage. Prompt and appropriate management is needed to avoid unwanted morbidity and mortality.

Case Report: Bilateral peritonsillar abscess with complications of upper airway obstruction

Background: Peritonsillar abscess is a collection of pus between the tonsillar fibrous capsule and the pharyngeal constrictor muscle. Unilateral peritonsillar abscess is a common complication of acute tonsillitis, whereas bilateral peritonsillar abscess is rare. The incidence of bilateral peritonsillar abscess remains unknown but is estimated to be 4.9% of all peritonsillar abscess cases. Case report: A 20-year-old man came to the emergency room with bilateral peritonsillar abscess and complained of shortness of breath for two weeks. Physical examination showed muffled voice, 82% oxygen saturation, and inspiratory stridor. The isthmus faucium was narrow, with approximately 30% remaining. Peritonsillar puncture revealed pus mixed with blood. The treatment for this patient included bilateral peritonsillar incision and drainage and intravenous antibiotics of levofloxacin and metronidazole. The patient came to the Ear, Nose, Throat, Head, and Neck (ENTHN) Outpatient Unit eight days after the procedure for a control checkup and was in good condition. Conclusion: We have reported a bilateral peritonsillar abscess with complications of upper airway obstruction, in which we performed incision and drainage. Prompt and appropriate management is needed to avoid unwanted morbidity and mortality.

Case Report: Bilateral peritonsillar abscess with complications of upper airway obstruction

Background: Peritonsillar abscess is a collection of pus between the tonsillar fibrous capsule and the pharyngeal constrictor muscle. Unilateral peritonsillar abscess is a common complication of acute tonsillitis, whereas bilateral peritonsillar abscess is rare. The incidence of bilateral peritonsillar abscess remains unknown but is estimated to be 4.9% of all peritonsillar abscess cases. Case report: A 20-year-old man came to the emergency room with bilateral peritonsillar abscess and complaining of shortness of breath for two weeks. Physical examination showed muffled voice, 82% oxygen saturation, and inspiratory stridor. The isthmus faucium was narrow, with approximately 30% remaining. Peritonsillar puncture revealed pus mixed with blood. The treatment for this patient included bilateral peritonsillar incision and drainage and intravenous antibiotics of levofloxacin and metronidazole. The patient came to the Ear, Nose, Throat, Head, and Neck (ENTHN) Outpatient Unit eight days after the procedure for a control checkup and was in good condition. Conclusion: We have reported a bilateral peritonsillar abscess with complications of upper airway obstruction, in which we performed incision and drainage. Prompt and appropriate management is needed to avoid unwanted morbidity and mortality.

Bilateral peritonsillar abscess-developed ruptured Meckel's diverticulum: A case report

Peritonsillar abscess (PTA) is an accumulation of pus between the fibrous capsule of the palatine tonsils and the superior pharyngeal constrictor muscle. Bilateral PTA (BPTA) is a rare disease. Meckel's diverticulum (MD) is a congenital abnormality of the distal ileum associated with failed vitelline duct closure. Spontaneous MD rupture during the management of PTA never happened before. In this article, the authors present a case of BPTA-developed MD rupture. We present a case involving an 18-year-old male who presented to the emergency department (ED) for a 2-day history of worsening sore throat, trismus, fever, and odynophagia; a diagnosis of bilateral severe PTA was made. During the management of the BPTA, the patient developed severe acute abdominal pain which was diagnosed later as a case of MD rupture. In ED, the patient underwent computerized tomography (CT) scan of the neck that showed bilateral hypodense masses, consistent with BPTA. Conservative management was started on IV antibiotics, IV fluids, and IV analgesia at the time of diagnosis in the ED. The patient then underwent two attempts of needle aspiration using 18-gauge needles that showed evidence of aspirated pus. Later on, the patient developed severe abdominal pain, which is evaluated by the general surgery department (GS), and underwent ultrasonography (US) and CT scan; then, the diagnosis of rupture MD was made. The patient underwent diagnostic laparoscopy performed by the GS team and improved thereafter. In this article, the authors present a case of BPTA-developed MD rupture.

Recurrent and Bilateral Peritonsillar Abscess: A Rare Cause of Upper Airway Obstruction

Recurrent and Bilateral Peritonsillar Abscess: A Rare Cause of Upper Airway Obstruction

Simultaneous bilateral peritonsillar abscess in an adolescent

Aim of the study: The aim of this case report is to emphasise the importance of meticulous history-taking and examination, and to raise the awareness of various possibilities of diagnosis and management. Unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis. However, bilateral peritonsillar abscess is considered rare, and only a meagre number of cases has been reported to date in the English medical literature. The challenging part involved in the diagnosis of bilateral peritonsillar abscess is the absence of common physical findings of unilateral peritonsillar abscess. Case report: We present a case of a teenage girl who presented with a history of worsening sore throat, odynophagia and muffled voice, which turned out to be bilateral peritonsillar abscess. Oropharyngeal examination revealed bilateral peritonsillar fullness, and pus was aspirated bilaterally. The patient underwent bilateral peritonsillar incision and drainage, and was discharged well after a few days, with no recurrence. Bilateral peritonsillar abscess can present with usual symptoms, but physical findings may vary. Conclusion: Proper history-taking and meticulous physical examination may direct the physician towards correct diagnosis, and an imaging evaluation is warranted if in doubt, so as to avoid unwanted perilous complications.

Prospective observational study evaluating the C-MAC Video Stylet for awake tracheal intubation: a single-center study.

The gold standard for management of known or predicted difficult airways is awake tracheal intubation. The newly developed C-MAC Video Stylet promises to combine the advantages of rigid stylets and flexible optical scopes. We therefore evaluated the feasibility of awake orotracheal intubations with this device. In this prospective observational study, three anesthesiologists experienced in advanced airway management performed each 12 awake oral intubations with this device on adult patients with known or predicted intubation difficulties. The primary outcome was overall intubation success. Secondary outcomes were total attempts, successful time, first postoperative day sequelae, and subjective intubation difficulty rated on a visual analogue scale (1, very easy; 10, extremely difficult). Thirty-six patients (10 females), aged 64±13 years, with BMI 26±5 kg/m2, were enrolled in the study. ASA status II, III, IV were eight (22%), 23 (64%), and five (14%), respectively. Indications for awake oral intubation were: oropharyngeal tumor 20 (56%), cervical-spine fracture eight (22%), previously known difficult airway four (11%), spinal canal stenosis three (8%), and bilateral peritonsillar abscess one (3%). Overall, 97% were successfully intubated in 45 s (31-88). First-attempt success rate was 80% in 37 s (29-54); 92% of patients would choose the same procedure again. On the first postoperative day, 11 (31%) patients complained of sore throat; five (14%) had minor injuries. Ease of intubation was rated as median VAS 3 (IQR: 1-7). The new C-MAC Video Stylet has the potential to serve as a suitable device for visualized oral awake intubation in difficult airway situations.

Bilateral peritonsillar abscess: a case series

<p class="abstract">Peritonsillar abscess (PTA) is one of the most common deep neck abscesses. Unlike unilateral peritonsillar abscess, bilateral peritonsillar abscess is rather rare. We report 3 cases of bilateral peritonsillar abscess which were proven by either computerized tomography imaging or needle aspiration. One of the patients was treated with intravenous antibiotics and corticosteroid. The other 2 patients underwent needle aspiration for confirmation of diagnosis and subsequent incision and drainage. All patients were treated successfully with complete resolution. Bilateral PTA should always be considered when there is presence of bilateral peritonsillar swelling with non-deviated uvula and trismus. Despite surgical drainage being the most common management, the option of medical therapy alone may be sufficient. To the best of our knowledge, this is the first case of bilateral PTA reported being treated successfully with medical therapy.</p>

Wide bore needle aspiration for peritonsillar abscess

<p class="abstract"><strong>Background:</strong> Peritonsillar abscess is the most common complication of acute tonsillitis.</p><p class="abstract"><strong>Methods:</strong> A retrospective review was conducted to identify the cause, microbiology, management and outcomes of the peritonsillar abscess. Over a period of 4 years from September 2014 to September 2018, patients presenting with peritonsillar abscess to the Department of ENT, SMVMCH, Puducherry, who underwent wide bore needle aspiration at least once were included in this study. 45 patients were included in the study. Exclusion criteria were retropharyngeal and parapharyngeal abscess. </p><p class="abstract"><strong>Results:</strong> Among 45 patients, 18 were males and 27 were females. Two patients presented with bilateral peritonsillar abscess. 40 patients responded well with initial wide bore needle aspiration and IV antibiotics, with no postoperative complications. 5 patients needed incision and drainage under local anaesthesia.</p><p class="abstract"><strong>Conclusions:</strong> Wide bore needle aspiration is easy and cheap, less invasive, effective method of management in emergency situations of peritonsillar abscess. Early wide bore needle aspiration and iv antibiotics will prevent complications and reduce the need for incision and drainage.</p><p class="abstract"> </p>

A clinical and epidemiological study on peritonsillar abscess in tertiary health center

Background: Peritonsillar abscesses (PTA) are the most common deep neck space infection and are a common complication of tonsillitis with variable sequelae. Objective: To evaluate 22 cases of PTA cases observed at the SS Medical College and GM Hospital, Rewa. Materials and Methods: The present study was done on 22 patients of PTA who presented to the SS Medical College and GM Hospital, Rewa from August 2012 to August 2013. Results: The most common age group was found to be 11-20 years with age ranging from 12 to 55 years. Males (14 cases) were found to be predominant. The right side involvement was seen in the majority of cases. One case of the bilateral peritonsillar abscess was found. The majority of patients presented with odynophagia and dysphagia. The appropriate antibiotic therapy must be initiated after aspiration of the abscess. Treatment included mainly incision/drainage in 11 cases, needle aspiration in 4 cases, quinsy tonsillectomy in 1 case, and conservative treatment was done in 6 cases. Conclusion: The need of hour is to diagnose the cases of peritonsillar abscess earlier and to intervene thereafter. The early diagnosis and recognition of the abscess help in appropriate treatment to begin before the involvement of surrounding anatomic structures.

Clinical practice guideline: tonsillitis II. Surgical management.

In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative morbidity in terms of pain and bleeding. Although tonsillar tissue remains along the capsule, the outcome appears not to differ from TE, at least in the pediatric population and young adults. Age and a history of tonsillitis are not a contraindication, abscess formation in the tonsillar remnants is an extremely rare finding. The volume of the tonsils should be graded according to Brodsky and a grade >1 is considered to be eligible for TT. The number of episodes during 12 months prior to presentation is crucial to indicate either TE or TT. While surgery is not indicated in patients with less than three episodes, a wait-and-see policy for 6 months is justified to include the potential of a spontaneous healing before surgery is considered. Six or more episodes appear to justify tonsil surgery. (2) Needle aspiration, incision and drainage, and abscess tonsillectomy are effective methods to treat patients with peritonsillar abscess. Compliance and ability of the patient to cooperate must be taken into account when choosing the surgical method. Simultaneous antibiotic therapy is recommended but still subject of scientific research. Abscess tonsillectomy should be preferred, if complications have occurred or if alternative therapeutic procedures had failed. Simultaneous TE of the contralateral side should only be performed when criteria for elective TE are matched or in cases of bilateral peritonsillar abscess. Needle aspiration or incision and drainage should be preferred if co-morbidities exist or an increased surgical risk or coagulation disorders are present. Recurrences of peritonsillar abscesses after needle aspiration or incision and drainage are rare. Interval TE should not be performed, the approach is not supported by contemporary clinical studies. (3) In patients with infectious mononucleosis TE should not be performed as a routine procedure for symptom control. TE is indicated in cases with clinically significant upper airway obstruction resulting from inflammatory tonsillar hyperplasia. If signs of a concomitant bacterial infection are not present, antibiotics should not be applied. Steroids may be administered for symptom relief.

両側扁桃周囲膿瘍5例の検討

Peritonsillar abscesses are the most common deep neck infection in adults, however, bilateral cases are rare. We report herein on five patients who were diagnosed as having bilateral peritonsillar abscesses. In three of the five cases, we could not at first make a diagnosis of bilateral peritonsillar abscesses, but we suspected tonsillitis based on no laterality in the appearance of the pharynx before the CT scan.However, the CT scan in these patients showed bilateral peritonsillar abscesses. Along with intravenous administration of antibiotics, removal of the abscesses was performed by needle aspiration in one case, and incision for drainage in four cases. Interval tonsillectomy was carried out in three cases.Enhanced CT should be considered in patients presenting with high fever, severe throat pain, high values of C-reactive protein & white blood cells, and dyspnea.

Bilateral peritonsillar abscess: A case report

We describe a rare case of a previously healthy 27 year old man who presented to the otolaryngology clinic with bilateral peritonsillar abscess.The clinical presentation of sore throat, fever, odynophagia and trismus were consistent with peritonsillar abscess, but the presence of symmetric tonsillar swelling and midline uvula misguided the diagnosis.Diagnosis can be based on clinical criteria or imaging techniques. A clinical presentation of peritonsillar abscess with a physical examination of bilateral swollen tonsils and midline uvula is suggestive of bilateral peritonsillar abscess. The general principle of treatment is systemic antibiotics and drainage of the pus.

Bilateral peritonsillar abscess: case report and literature review

Although uncommon, bilateral peritonsillar abscess (PTA) may still present with symptoms found in unilateral cases but lack hallmark findings such as an asymmetric tonsillar bulge and uvular deviation. We present the case of an 18-year-old woman deemed to have a bilateral PTA based on physical examination and radiographic imaging. She underwent successful surgical drainage with needle aspiration, followed by incision and drainage. A computed tomography with intravenous contrast should be obtained when a patient displays signs suggestive of a bilateral PTA but the diagnosis is not certain. To our knowledge, this is the first report of 2 different bacterial species cultured from contralateral abscesses during the same encounter.

Bilateral Peritonsillar Abscesses: A Case Presentation and Review of the Current Literature with regard to the Controversies in Diagnosis and Treatment

Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.

Bilateral Peritonsillar Abscesses: Our Experience and Clinical Features

This study analyzed the incidence and characteristics of bilateral peritonsillar abscesses (PTAs) that were treated with immediate tonsillectomy. The study analyzed 409 patients with PTAs treated between 1984 and 2008. The patients included 304 male and 105 female patients between 2 and 85 years of age (median age, 30 years). Immediate tonsillectomy was performed in 371 of the PTA patients (90.7%). The incidence of bilateral PTAs and candidate predictive factors for bilateral PTAs were reviewed, including age, duration of PTA symptoms, history of recurrent tonsillitis, history of PTAs, deviation of the uvula, body temperature on admission, white blood cell count on admission, and C-reactive protein level on admission. Bilateral PTAs were found in 24 of 371 patients (6.5%). Younger age, absence of a deviated uvula, and a higher C-reactive protein value were the clinical features associated with bilateral PTAs in multivariate analysis. The occurrence of bilateral PTAs was not rare; this fact has to be taken into consideration in discussing therapeutic concepts. The clinical features of bilateral PTAs suggested that bilateral PTAs might be a part of the natural history of PTAs, and that they occur in cases in which there is a delay in diagnosis and treatment. Further study is necessary to confirm the causation of bilateral PTAs.

Suppurative complications and upper airway obstruction in infectious mononucleosis

A 17-year-old female patient presented to the emergency department reporting having fever, sore throat, and pain with swallowing for several days. The result of her rapid strep screen was negative. She had an elevated white blood cell count, mildly elevated AST and ALT levels, and a positive result from a heterophile antibody test (BBLTM MonoslideTM). She was diagnosed with infectious mononucleosis. Given her inability to tolerate oral fluids, she was admitted to the hospital for intravenous hydration. After 3 days of receiving methylprednisolone intravenously, she had worsening throat pain, progressive neck swelling, difficulty handling her secretions, and new respiratory symptoms. During the examination, she was sitting upright in bed in moderate respiratory distress. She had kissing, exudative tonsils with palatal and uvular edema. Examination of her neck showed significantly enlarged anterior and posterior cervical lymph nodes without fluctuance. Her lung exam revealed subcostal retractions with transmitted upper airway sounds but good aeration. The edge of her liver and spleen tip were palpable. Because of the rapid progression of symptoms while on medical therapy, computed tomography (CT) of the neck was performed. Sagittal reconstructions showed adenoidal hypertrophy compromising her nasopharynx, and massive tonsillar enlargement causing nearly complete obstruction of her oropharyngeal airway (Fig. 1), with airway narrowing to less than 2.5 mm in axial images. Bilateral low-density lesions within the paratonsillar regions were suggestive of abscesses and retropharyngeal soft-tissue swelling was consistent with phlegmon (Fig. 2). The patient was taken to the operating room for an emergent tonsillectomy. Bilateral peritonsillar abscesses were drained, pus was sent for culture, and her tonsils were excised. Cultures from the abscesses grew Streptococcus milleri. The patient was discharged home 2 days later to complete a 2-week course of oral clindamycin. Most patients with infectious mononucleosis (IM) have a benign, self-limited course. However, a wide range of severe complications have been described including airway obstruction, splenic rupture, meningoencephalitis, Guillain-Barre syndrome, peritonsillar abscess, and hemolytic anemia. Upper-airway obstruction results from lymphoid hyperplasia throughout Waldeyer’s ring, with associated soft-tissue edema. As many as 25% of patients hospitalized for IM will have some degree of airway obstruction. Peritonsillar abscesses (PTAs) occur in approximately 1% of hospitalized patients with IM and may further obstruct the airway. Most commonly, peritonsil-

Bilateral Peritonsillar Abscesses: A Challenging Diagnosis

Peritonsillar abscess is the most common complication of acute tonsillitis. Bilateral peritonsillar abscesses are much less common, and they may be more difficult to detect on physical examination because the oropharynx often appears to be symmetrical rather than asymmetrical, as is the case in unilateral abscess. Previous steroid treatment may also complicate the diagnosis by masking the signs and symptoms of abscess. We describe the case of a young woman who presented to the emergency department with relatively mild symptoms despite having large bilateral peritonsillar abscesses. We believe that her symptoms had been masked by previous steroid therapy. We also review the treatment and microbiology of peritonsillar abscess.

Bilateral peritonsillar abscesses: case report and literature review

Although unilateral peritonsillar abscesses (PTA) are a common complication of acute bacterial tonsillitis, bilateral PTA are quite rare. We present the case of a 14-year-old female teenager with a 1-week history of acute tonsillitis. Physical examination revealed significant trismus, symmetrically inflamed tonsils and soft palate, and a midline uvula. A contrast-enhanced CT scan of the neck demonstrated bilateral PTA. After bilateral needle aspiration and administration of antibiotics, complete disease resolution was rapidly achieved. Patients with bilateral PTA present a diagnostic dilemma because they do not demonstrate the classic asymmetric signs and symptoms seen in the more prevalent unilateral PTA. Contrast-enhanced CT imaging can help diagnose bilateral PTA and should be considered in the presence of marked trismus but with the absence of unilateral inflammatory findings.