Interval Tonsillectomy Research Articles

Anatomical Factor for Formation of Peritonsillar Abscess in a Tertiary Care Centre.

Peritonsillar abscess is a polymicrobial infection with acute life threatening complications if not treated promptly. Primary objective is to find the anatomical factor for unilateral abscess formation and appropriate management protocols. Secondary objectives include the bacteriological study,antibiotic preference and comparison of crypt length of both tonsils post tonsillectomy to look for any significant association. A prospective study was carried out for one year in patients with peritonsillitis or peritonsillar abscess attending the Department of ENT in our hospital. Acute cases were treated by incision and drainage followed by IV antibiotics after taking pus or throat swab for culture and sensitivity. Patients further planned for interval tonsillectomy after 6weeks followed by histopathological examination to compare the infected side and normal side. Crypt length measurements done to see any disparity which would have lead to the development of peritonsillar abscess unilaterally. In patients with peritonsillitis or peritonsillar abscess, histopathological examination of tonsils after interval tonsillectomy showed that risk of peritonsillitis or peritonsillar abscess were more on the tonsil with larger crypt length with more preponderance on left side and in males. This study concludes that deeper the crypt length,male sex, history of recurrent tonsillitis are main risk factors for development of peritonsillar abscess. Bacteriology showed Staphylococcus aureus against the most common Streptococcus Sp. Hence prompt use of antibiotics help in early recovery and reducing complications.

Outcomes of abscess tonsillectomy in patients awaiting tonsillectomy: A comparison with interval tonsillectomy

PurposePeritonsillar 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 methodsA 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. Results110 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). ConclusionImmediate 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.

Comparison of post-op heamorrhage and hospital stay in early and delayed interval tonsillectomy for quinsy.

Objective: To compare post-op hemorrhage and hospital stay in patients with quinsy undergoing early and delayed interval tonsillectomy. Study Design: Randomized Control study. Setting: Department of ENT, Gajju Khan Medical College (GKMC) Swabi. Period: June 2018 to June 2019. Material &amp; Methods: A total of 50 patients of Quinsy were randomly divided in to two groups equally. Group A including 25 patients underwent early interval tonsillectomy while in 25 patients of Group B, delayed interval tonsillectomy was done. Results: A total of 50 patients were included with age ranging from 15 to 41 years with mean age of 26.70±5.63 (mean±SD) years. There were 29 males and 21 females with male to female ratio of 1.4:1 respectively. Post-operative hemorrhage and side of bleeding between the two groups, was not significant (P Value= 0.555). The duration of hospital stay was less in group A as compared to group B with p value of 0.0003. Conclusion: In quinsy there is no difference in post-op hemorrhage between early and delayed interval tonsillectomy while hospital stay is shorter in early as compared to delayed interval tonsillectomy.

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis.

Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = -0.78; CI-1.39 to-0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI-0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI-0.49, 0.57; p = 0.88; respectively). This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.

A COMPARATIVE ANALYSIS OF PER AND POST-OPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING EARLY AND DELAYED INTERVAL TONSILLECTOMIES

Abstract:&#x0D; Background: Peritonsillar abscess is most prevalent deep neck space infection and treatment is mainly medical and surgical. There are three major surgical procedures namely incision &amp; drainage, interval tonsillectomy and needle aspiration.&#x0D; Aim: To compare per and post-operative complications in patients of PTA undergoing early and delayed interval tonsillectomies in respect of pain, hemorrhage and hospital stay.&#x0D; Material and Methods: It was a randomized control trial study of sixty patients of peritonsillar abscess. Among thirty patients early interval tonsillectomy was performed while other thirty patients underwent delayed interval tonsillectomy. The study was conducted in ENT Department of Lahore General Hospital, Lahore.&#x0D; Results: The age range in both groups was 13-46 years. The male to female ratio was 2.3:1 and 1.3:1 in group I and II respectively. Per-operative hemorrhage in group I, mild in 53.3% patients, moderate in 36.7% and severe in 10.0% patients while in group II, mild in 43.3%, moderate in 40.0% and severe in 16.7% patients. A Single case in group II had secondary hemorrhage. Post-operative pain in group I was mild in 66.7%, moderate in 26.7% and severe in 6.7% patients while in group II, it was mild in 26.7%, moderate in 56.7% and severe in 16.7% patients. The duration of hospital stay less than one week was 76.7% in group I and 13.3% in group II.&#x0D; Conclusion: Early interval tonsillectomy has a lower incidence of postoperative hemorrhage and pain with less hospital stay as compared to delayed interval tonsillectomy.&#x0D; &#x0D;

Tonsilectomia la cald în flegmonul periamigdalian la copil

The treatment of peritonsillar abcess in children is controversial: it consists either of immediate drainage followed by interval tonsillectomy, either of immediate tonsillectomy (abcess tonsillectomy or quinsy tonsillectomy). The authors report 3 cases of quinsy tonsillectomy performed in children with peritonsillar abcesses.

Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess

Objective: To compare early versus interval tonsillectomy in cases of peritonsillar abscess.Study Design: Comparative study.Place and Duration of Study: The study was carried out at ENT Department of Combined Military Hospital, Mardan from January 2017 to January 2018.Materials and Methods: A total 50 patients were selected from ENT outpatient department. All the cases were randomly divided into two groups of 25 each. Group A underwent early tonsillectomy after initial incision and drainage, Group B underwent interval tonsillectomy after 6 weeks. Both the groups were compared in terms of perioperative blood loss, operation time, ease of dissection and postoperative complications including pain and hemorrhage. Tonsillectomy was done with bipolar cautery in all the cases.Results: The mean age was 30.22 + 8.25. Out of 50 patients, 42 (84%) were males and 8 (16%) were females. The mean operative time of surgery in group A (early tonsillectomy) was 45.04+5.78 minutes compared to 32.72+4.37 minutes for group B (interval tonsillectomy (p=0.00). Mean post-operative pain in group A was 3.68+2.12 compared to group B where mean score was 3.36+1.93 (p=0.579). There were 3 cases of mild perioperative blood loss, 19 cases of moderate and 3 of severe perioperative blood loss in group A. There were 18 cases of mild perioperative blood loss, 7 cases of moderate and no case of severe perioperative blood loss in group B (p=0.00). Dissection was found to be significantly easier in group B (interval tonsillectomy). There were 7 cases of post-op secondary hemorrhage in group A compared to 3 in group B (p=0.289). All these cases of secondary hemorrhage were managed conservatively.Conclusion: Interval tonsillectomy is a safer procedure as compared to early tonsillectomy in terms of perioperative blood loss, operative time, dissection with almost similar post-op pain and similar risk of post tonsillectomy hemorrhage.&#x0D; How to cite this: Khan MA, Ahmed A, Khan M. Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess. Life and Science. 2020; 1(1): 24-28. doi: https://doi.org/10.37185/L&amp;S.1.1.13

Quinsy in Adult: Clinical Profile and Management Challenges in Two Tertiary Hospitals Northwest Nigeria

Purpose of the Study: Quinsy also known as Peritonsillar abscess (PTA) is a life threatened complication of acute exudative tonsillitis requiring immediate surgical intervention. We profile the clinical presentation and highlight challenges in management.&#x0D; Materials and Methods: A retrospective analysis of all patients diagnosed with Quinsy at the departments of otorhinolaryngology of two-government referral hospital in northwest Nigeria from May 2014 to April 2017. These patients’ clinical records were retrieved from the health record department and data extracted were analyzed using Microsoft excel program.&#x0D; Results: A total of 147 adult patients had tonsillitis within the study period. Only eighteen patients with quinsy 13(72.2%) females and 5(27.8%) males with an M: F=1:2.6 were analyzed. Age range is between 18 years – 58 years with a mean age of 35.4 years. The highest incidence was 66.7% in patients within the age group 21-40 years. Odynophagia and trismus were the commonest presenting features in all the patients. Side of Quinsy involvement was on the left tonsils 12(66.7%). There was spontaneous rupture in 5(27.8%) while 13(72.2%) of patients had incision and drainage. All patients had broad-spectrum antibiotics. Interval tonsillectomy was carried out on 12(66.7%) of patients while 6(33.3%) of patients did not consent for tonsillectomy and were subsequently lost to follow up. No recurrence of symptoms or mortality recorded.&#x0D; Conclusion: Quinsy is a life threatening otorhinolaryngological emergency common amongst young female adults. Optimal management is still antibiotics therapy and drainage of abscess in our center.

INTERVAL TONSILLECTOMIES

Introduction: Peritonsillar abscess is a common clinical problem faced byotorhinolaryngologist all over the world. There are different schools of thoughts regardingtonsillectomy after peritonsillar abscess due to its expected complications. This comparativestudy was conducted to know about frequency of complications in each of the techniques.Objective: To compare per and post operative complications in patients undergoing early anddelayed interval tonsillectomy after peritonsillar abscess. Design: This was randomized controltrial. Setting: Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. Period:From Jan 2012 to Dec 2013. Material and Methods: After taking detailed history, thoroughexamination, relevant investigations and informed written consent peritonsillar abscess wasdrained and then interval tonsillectomy was performed. The complications were noted onpredesigned proforma. Chi square test was used to compare the complications in both thegroups while keeping P &lt; 0.05 as significant. Results: Out of 60 patients males were 38 andfemales were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SDwith a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SDwith a range of 13-46 years. Findings of per-operative and post operative hemorrhage showedthat there was insignificant difference in both the groups (P=0.601). However pain and hospitalstay in both the groups was significantly different with P value of 0.004 and 0.000 respectively.Conclusions: Early interval tonsillectomy is an easy and safe procedure for peritonsillarabscess.

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.

Pediatric peritonsillar abscess: Quinsy ie versus interval tonsillectomy

Peritonsillar abscessQuinsy versus interval tonsillectomy. Objectives(1)Compare operative time and intraoperative blood loss in patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess.(2)Compare post-operative bleeding and readmission rates between patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess. Study designCase series with chart review. MethodsWe reviewed the records of children treated for peritonsillar abscess between 2007 and 2011 at an academic tertiary pediatric hospital. We identified patients by searching the hospital database for all children treated for the ICD-9 code 475 (peritonsillar abscess). Data points extracted included length of stay, intraoperative blood loss, operative time, and incidence of complications. Statistical analysis was performed to identify significant differences between treatment categories. Children who never received a tonsillectomy (CPT codes 42820/42821/42825/42826) were excluded. Results34 children received tonsillectomy for peritonsillar abscess from 2007 to 2011. Of these: 23 received a Quinsy tonsillectomy, and 11 received antibiotics with or without incision and drainage, followed by tonsillectomy a minimum of 2 weeks later. Total hospital days in treatment course was 2.2 days for Quinsy tonsillectomy group and 2.3 days for the interval tonsillectomy group. Estimated blood loss was less than 20ml for both groups. Operative time was 38min for Quinsy tonsillectomy and 39min for interval tonsillectomy. There were no post-tonsillectomy hemorrhages. One patient in the interval tonsillectomy group required readmission for dehydration. ConclusionThere were no significant differences in total hospital days, blood loss, operative time, or post-operative complications between Quinsy tonsillectomy and interval tonsillectomy in the treatment of pediatric peritonsillar abscess.

An evidence‐based review of peritonsillar abscess

We present the current literature surrounding peritonsillar abscess management highlighting areas of controversy. TYPE OF REVIEW AND SEARCH STRATEGY: Literature review using Medline and Embase databases (search terms 'peritonsillar abscess', 'peritonsillar infection' and 'quinsy') limited to articles published from 1991 to 2011 (English language). (i) Intraoral ultrasound has a sensitivity and specificity of between 89-95% and 79-100%, respectively, for correctly diagnosing peritonsillar abscess and is underutilised currently. (ii) Medical management: Steroids can effectively aid recovery, reducing hospitalisation time and improving symptom relief; however, further study is needed, especially related to risk and cost benefit. Penicillin and metronidazole are an effective combination in 98-99% of cases of peritonsillar abscess. (iii) Surgical management: Overall, there is no convincing evidence in favour of either aspiration or incision & drainage. Quinsy tonsillectomy is subject to great geographical variation, however, is a safe procedure and reduces overall recovery time when compared with interval tonsillectomy. (iv) Admission: peritonsillar abscess can be effectively managed as an outpatient in many cases. (v) Further management: Overall, the recurrence rate of peritonsillar abscess is poorly defined but estimated as 9-22% based on current evidence. Interval tonsillectomy may be indicated in selected groups of patients at high risk of recurrence. Peritonsillar abscess is a common condition with increasing incidence. We demonstrate the potential for evidence-based modifications in clinical management. However, lack of national consensus may mean that this evidence base is not being adequately exploited in current practice. A national audit of peritonsillar abscess management, in particular looking at recurrence rates and patient experience with different management strategies, appears indicated.

Management strategies of peritonsillar abscess in the tropics: a survey of surgeons' preference.

Peritonsillar abscess (PTA) or Quinsy is one of the common abscesses of the head and neck that requires urgent attention. Its treatment may often require hospital admission. Needle aspiration, incision & drainage and tonsillectomy have been the various treatment policies available depending on surgeon's preference. We present a survey of current practices in the management of PTA of practicing ENT surgeons in Nigeria. Questionnaires were mailed to members of the Otorhinolaryngological Society of Nigeria (ORLSON). Of the 60 surgeons surveyed, 56.7 % advise tonsillectomy in patients with history of recurrence, 20 % when there is previous history of tonsillitis and 23.3 % in patients with single attack of PTA. Overall 96.7 % of surgeons advises interval tonsillectomy and only 3.3 % advice abscess/quinsy tonsillectomy. There is paucity of literature on PTA in the tropical region, the survey therefore serves as a baseline information for further research especially outcome based in order to establish a standard criteria for choice of a treatment policy in our region. We suggest maintaining the policy of interval tonsillectomy in the appropriate patients for the time being.

Who ends up having tonsillectomy after peritonsillar infection?

We wanted to explore how many patients will undergo tonsillectomy during the first 5 years after peritonsillar abscess or peritonsillar cellulitis, and why. In addition we sought predictive factors as to who would benefit from tonsillectomy. Medical records of 809 patients with peritonsillar infection (ICD-10 J36) aged over six were analyzed, and data on the history of tonsil infections and differences in treatment were collected. Data on patients who underwent tonsillectomy during the next 5 years were compared with data on patients needing no tonsillectomy. An abscess or planned interval tonsillectomy was performed on 159 patients. Of the conservatively treated 7- to 16.9-year-old patients, 42.5% required surgery later, of those aged 17-29.9 years, 31.3%, and those over 30, 13.2% (p < 0.001). Previous tonsillar infections led to increased (p = 0.067) probability of delayed tonsillectomy. Re-opening of the abscess cavity at the polyclinics, use of broad-spectrum antibiotics in the acute phase of infection, or being an outpatient or inpatient had no influence on the probability of later surgery. Overall one-fourth of the patients with peritonsillar infection underwent tonsillectomy during the next 5 years, even without being originally planned. Young age and previous tonsillar infections caused increased probability of delayed tonsillectomy.

Immediate versus Interval Tonsillectomy for Peritonsillar Abscess

Objective: 1) Compare operative time and intraoperative blood loss in patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess. 2) Compare postoperative bleeding and readmission rates for patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess. Method: Study design: Retrospective review. Setting: Academic tertiary pediatric hospital. Patients: Children treated between 2007 and 2011 for peritonsillar abscess. Patients were identified by searching the hospital database for all children treated for the ICD-9 code 475 (peritonsillar abscess). Children who never received a tonsillectomy (CPT codes 42820/42821/42825/42826) were excluded. Results: A total of 49 children received tonsillectomy for peritonsillar abscess from 2007 to 2011. Of these, 37 received a Quinsy tonsillectomy, and 12 received antibiotics with or without incision and drainage, followed by tonsillectomy a minimum of 2 weeks later. Total hospital days in treatment course was 2.2 days for the Quinsy tonsillectomy group and 2.3 days for the interval tonsillectomy group. Estimated blood loss was less than 20 milliliters for both groups. Operative time was 38 minutes for Quinsy tonsillectomy and 39 minutes for interval tonsillectomy. There were no posttonsillectomy hemorrhages. One patient in the interval tonsillectomy group required readmission for dehydration. Conclusion: There were no significant differences in total hospital days, blood loss, operative time, or postoperative complications between Quinsy tonsillectomy and interval tonsillectomy in the treatment of pediatric peritonsillar abscess.

Is a single quinsy an indication for tonsillectomy?

There has recently been some discussion on whether a single quinsy is an indication for tonsillectomy. This paper presents a retrospective study of 36 patients who presented with a quinsy over the past 37 years but did not have interval tonsillectomy. Prolonged follow-up shows that the rate of recurrence of a quinsy can double compared to the recurrence rate under 5 years. Despite this it remains relatively low and an uncomplicated quinsy does not warrant tonsillectomy.

Tonsillectomy à chaud for quinsy: revisited

In a prospective study involving 16 patients over a 12 month period, we determined whether tonsillectomy à chaud is an acceptable alternative to interval tonsillectomy for patients with quinsy. Guidelines for the acute surgical management of quinsy (or peritonsillar abscess) were established following a departmental audit. Sixteen patients were admitted with a quinsy plus an indication for tonsillectomy; 12 were evaluated prospectively. Each was treated either by incision and drainage or needle aspiration, rehydration, analgesia and intravenous antibiotic therapy, followed by a tonsillectomy à chaud (immediate tonsillectomy) within 30 h of the acute admission. Despite initial drainage, a high incidence of pus was detected intra-operatively. A much larger group of patients had peritonsillitis rather than peritonsillar abscess. Of the 16 patients admitted with a quinsy and indication for tonsillectomy over a 12 month period, 12 consented to tonsillectomy à chaud. Aspiration was used to confirm the presence of a quinsy in seven patients (58%), and incision and drainage in the remaining five. There were no complications, and further hospitalisations were avoided thus reducing patient morbidity and costs. We propose that tonsillectomy à chaud remains a justifiable alternative to interval tonsillectomy for such patients when personnel and theatre facilities permit.

Bilateral peritonsillar abscesses

In the discussion about the management of the peritonsillar abscess (PTA) in regard to the pros and cons of tonsillectomy à chaud versus à froid, the risk of obscure contralateral abscesses is often neglected. To the authors' knowledge, there are only a few series of PTA being analyzed for the abscess rate of bilateral PTA. A group of 541 abscess tonsillectomies was retrospectively analyzed for the presence of a bilateral manifestation of peritonsillar abscess. Twenty-one patients (3.88%) had bilateral abscesses. None of these had been detected prior to the operation. Of the 541 patients, 2.22% had postoperative hemorrhages that had to be arrested under general anesthesia. Within the discussion about abscess tonsillectomy versus stab incision followed by interval tonsillectomy (à froid), the rate of almost 4% bilateral abscesses should be taken into consideration as dangerous complications such as mediastinitis could develop from the remaining abscess formation of the contralateral side.

An economic analysis of practice guidelines for peritonsillar abscess

Problem: Practice variation exists in regard to both the initial management of peritonsillar abscess (PTA) and the method for preventing recurrences. Practice guidelines may reduce variation and costs. The purpose of this study was to consider these issues from an economic analysis perspective. The hypothesis is that the application of practice guidelines will be cost-effective as compared to performing abscess tonsillectomy for all patients with PTA. Methods: A cost-effectiveness analysis (CEA) from the payer perspective was undertaken to compare practice guidelines to abscess tonsillectomy for the treatment of PTA and prevention of recurrences. A do-nothing option was included. The practice guidelines studied included initial treatment with outpatient needle aspiration or incision and drainage, abscess tonsillectomy for persistent treatment failures, and interval tonsillectomy for patients under age 30 with recurrent tonsillitis or a prior PTA. A decision diagram tree was developed and modeled using Microsoft Excel 97. Costs were compared to life expectancy. The assumptions for the models were derived from the literature. Long-term costs and life years were discounted. Multiple one-way sensitivity analyses were performed. Results: The practice guidelines strategy dominated the other 2 alternatives; therefore no incremental cost effectiveness ratio is relevant. The results were not sensitive to changes in the model assumptions. If the effectiveness measure is changed to “number of recurrent abscess prevented,” abscess tonsillectomy was cost-effective compared to the practice guidelines at a cost of $32,723 per recurrence prevented. Conclusion: A CEA approach represents an improvement over previously reported estimations of the annual costs of management strategies for PTA by providing a consistent framework for analysis. Based on this analysis, the practice guidelines are cost-effective compared to other options for the management of PTA Significance: The study demonstrates that the application of practice guidelines for the management of PTA can result in excellent outcomes and remain cost-effective. Support: None reported.

Management of peritonsillar abscess

To attempt to determine the appropriate management for peritonsillar abscess (PTA) and recurrences, we retrospectively analyzed 337 PTA and recurrent PTA, referred to our department between 1995 and 2002. Of the 205 patients treated surgically; needle aspiration was performed in 52 (15%), incision and drainage in 108 (32%), immediate abscess tonsillectomy in 42 (12%), and neck incision in 3 (1%), and 69 patients (20%) were treated medically with antibiotics alone. Interval tonsillectomy was performed in 39 patients (12%). Among 106 patients who did not undergo tonsillectomy, PTA recurred an average of 2.0 months after recovery from previous PTA. Patients not treated by tonsillectomy should be carefully followed for at least 3 months. Abscess or early interval tonsillectomy should be considered in PTA patients under 40 years old, because they have a high rate of recurrence of PTA.