Management Of Peritonsillar Abscess Research Articles

Conscious sedation for the management of peritonsillar abscess in pediatric patients: A prospective case series and literature review

ObjectivePeritonsillar abscess (PTA) is a common pediatric infection requiring drainage. Conscious Sedation (CS) can facilitate drainage in uncooperative children. However, it carries risks, especially if the airway is compromised. Moreover, evidence on its safety and efficacy is limited. This study examined the safety, pain reduction, and anxiety management of hospitalized pediatric patients treated for PTA under CS. Materials and methodsWe performed a prospective observational case series of 118 children aged 2–15 years with 155 PTA episodes, managed from 2016 to 2023. Conscious sedation was used in 42 episodes. Outcomes were compared among CS and non-CS (local anesthesia only). Complications assessed safety. Efficacy was evaluated by the amount of pus, hospitalization parameters, pain scores, and recurrence. ResultsNo significant differences were found regarding the demographic and presentation parameters except for younger age among the CS group (9 vs 11 years p = 0.001). One minor oxygen desaturation (2 %) event occurred with CS. Abscess drainage amount was greater with CS than non-CS, 4.9±4 mL vs. 3.2±2 mL, respectively (p = 0.03). Hospitalization stays were similar among groups. Maximum pain scores were lower with CS than non-CS, 1.4 ± 2 vs 4.2 ± 3 (p < 0.001); similarly, IV pain medication was used less frequently, 0.9 ± 1 vs. 1.6 ± 3 (p = 0.045), and the need for re-aspiration was less common 14 % vs. 28 % (p = 0.04), with CS than non-CS, respectively. The three-month recurrence rate was numerically lower with CS (5 % vs. 14 % non-CS). ConclusionsConscious sedation facilitates PTA drainage with excellent safety and improved efficacy compared to local anesthesia in children. Pain scores are reduced both during drainage and hospitalization. Our prospective data add to the limited evidence supporting CS as a viable option for abscess drainage in uncooperative pediatric patients. Further study is warranted to confirm potential long-term reductions in recurrence.

Therapeutic management of peritonsillar abscess during COVID-19.

The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27-0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99-1.01], p = 0.52). The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates.

Airway management in a morbidly obese patient with impending airway obstruction

Peritonsillar abscess is not an uncommon referral to the otorhinolaryngology team. Treatment entails incision and drainage, followed by antibiotics. Emergent treatment is required to avoid complications such as extension into deep neck spaces, like retropharyngeal and danger space, which may result in spread into the mediastinum and airway obstruction. Herein, we describe peritonsillar abscess management in a morbidly obese woman who presented with peritonsillar abscess with impending airway obstruction. We highlight the importance of multidisciplinary team involvement in managing the difficult airway as well as the preparedness of the difficult airway team.

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

IntroductionThis 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.MethodsWe 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.ResultsA 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.ConclusionDue 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).

A systematic review of the role of penicillin versus penicillin plus metronidazole in the management of peritonsillar abscess.

Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess. A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole. Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects. Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.

Is there a consensus on peritonsillar abscess management?—an audit of a tertiary hospital in Australia

Background: Peritonsillar abscess is the most common deep space infection of the head and neck. It can have life threatening complications if inadequately treated. The study aimed to analyse the workup and management trends of peritonsillar abscess presentations in a tertiary Australian hospital.

Management of Peritonsillar Abscess in a Tertiary Hospital in Southwest Nigeria

Background: Peritonsillar abscess (PTA) occurs when pus accumulates in the peritonsillar space. There are controversies about the most adequate form of treatment. The objectives of this study were to describe the clinical profile of patients, PTA and bacteriological profile of aspirates, and management of PTA.&#x0D; Methods: This retrospective study included patients with PTA managed in a tertiary hospital. The clinico-demographic characteristics, oropharyngeal examination findings, including that of the tonsils, test aspiration of swelling, and culture results were documented. The treatment modalities, hospitalization period, and outcome were recorded.&#x0D; Results: Seventeen records of adults were available (mean age, 33.3±9.7 years; female, 58.8%). All patients presented with fever, odynophagia, and trismus within 3 days. Five (29.4%) had previous sore throat, 94.1% had previous medications, and 52.9% had the abscesses on the left side. Test aspirate yielded pus in 76.5% of patients, whereas 8 aspirates cultured micro-organisms; 70.6% of the patients had incision and drainage (I&amp;D) of the abscess, and the average hospitalization period was 3 days. Most (94.1%) of the patients had favorable outcomes.&#x0D; Conclusion: PTA is common in adults, and they present early with classical symptoms. Purulent aspiration is usually positive, and patients are treated with I&amp;D with antibiotic coverage, which leads to a generally good outcome.

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer.

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer.

Peritonsillar Abscess Treatment under Local Anaesthesia: Incision and Drainage versus Needle Aspiration

Background: Peritonsillar abscess is usually complication of acute tonsillitis which itself is prevalent in society. As a general surgical principle, abscess any were, has to be drained so same applies for quinsy but methodology for this drainage is not being agreed. Aim: To find best modality for drainage of this abscess and see its incidence in which age group and sex. Study design: Prospective study Place and duration of the study: Department of ENT, Rai Medical College, Sargodha from 1st Feb. 2017 to 31st Jan. 2019. Methodology: One hundred and thirty five patients above 15 years of age and those in need of hospital admission due to severity of symptoms were included. Paediatric, immunocompromised, requiring general anesthesia and acute tonsillitis patients were excluded. Results: There were 65.2% males and 34.8% females. Commonly affected age group was 21-40 years. Needle aspiration was found more effective for management of peritonsillar abscess. Conclusion: No consensus for single modality and both needle aspiration and incision/drainage is advocated and needle aspiration proved fruitful in management. Keywords: Quinsy, Peritonsillar abscess, needle aspiration

Management of Peritonsillar Abscess Within a Local Emergency Department: A Quality Analysis Study

Objective: Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting thousands of people annually with high treatment costs. The purpose of this project was to determine how in-network emergency departments (EDs) adhere to generally accepted guidelines regarding diagnosis and management of potential PTAs.Methods: The authors performed a retrospective chart review to identify patients with PTA in five EDs in one year. Information pertaining to diagnostic tests, treatment, and airway status was also collected. Descriptive analysis was used to assess if EDs were consistent with generally accepted guidelines.Results: Six hundred twenty-one patient records were identified and 140 were included in final analysis. Out of 140 patients, 71 were admitted for inpatient management and 23 were admitted for observation. Of the 46 patients diagnosed and discharged from the ED, 61% received a computerized tomography (CT) scan and only 39% had PTA drainage performed. Four (3%) patients received a point of care ultrasound and a CT scan and no patient received only an ultrasound. Out of all patients, 116/140 received a CT scan and 22 received drainage in the ED. The remainder of these patients either had drainage performed by an otolaryngologist or had no drainage performed. Of the 94 patients admitted for inpatient or observation, 84 received a CT scan and six received drainage by an ED physician. Only 62% of patients were given a penicillin derivative and 29% were given clindamycin, which has no Gram-negative coverage.Conclusion: One-third of PTA patients were managed within the ED, far less than similar studies. Of these, over 50% received a CT scan and less than 50% had PTA drainage. PTA drainage can improve patients’ symptoms and antibiotic effectiveness. The majority of patients were prescribed a penicillin derivative with or without another antibiotic.

Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States.

ObjectiveThe management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA.Study DesignCross-sectional survey.SettingThe 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).MethodsAn iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models.ResultsThe survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO.ConclusionThere is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.

Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship

Residency preparation courses (RPCs) have become a widely adopted practice to ease the transition of medical students into residency, but these courses often lack training in skills expected of subspecialty interns. To fill this gap, a simulation-based curriculum in otolaryngology (ORL) was implemented at the University of Michigan Medical School. The curriculum aimed to improve confidence and perceived ability to perform common ORL skills for graduating students prior to internship. Cross-sectional study. Six basic simulations (tracheostomy, flexible laryngoscopy, otomicroscopy, myringotomy and tube insertion, epistaxis and peritonsillar abscess management) were included in the first course in 2019. The course was expanded in 2020 with the addition of three advanced simulations (ear foreign body extraction, tracheostomy complications, and "cannot intubate, cannot ventilate" situations). Pre- and postsession surveys were collected to assess individual simulations and the course overall. A total of 32 students participated in the ORL simulation curriculum in Spring 2019 and 2020. Paired t-tests showed significant improvement in self-perception of ability on every simulation. Qualitative feedback revealed that students particularly valued the opportunity for hands-on learning. Non-ORL students rated their baseline abilities significantly lower than ORL students on five stations, but they achieved statistically equivalent postsession ratings on all but the otomicroscopy station. An ORL-specific curriculum is a valuable addition to procedural RPCs. The curriculum resulted in increased confidence and perceived ability in skill performance for both students pursuing ORL residencies, as well as those pursuing other procedural specialties. 4. Laryngoscope, 2021.

Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians.

Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.

Advantages of otorhinolaryngologist performed transcervical ultrasonography in the management of peritonsillar abscess.

Peritonsillar abscess (PTA) is a very common infection, in particular in pediatric and adolescent population. A distinction between peritonsillar cellulitis and abscess should be made to determine the appropriate treatment. Nonetheless, the difference cannot always be made on physical examination alone and often requires imaging by computed tomography (CT). Radiation exposure as well as the cost and waiting time question the use of CT in this pathology. We present our experience in the use of Transcutaneous Cervical Ultrasonography for the diagnosis and management of peritonsillar abscess in the adult population. Clinical-prospective. Adult patients were evaluated for suspicion of PTA. Clinical findings were documented and all patients underwent a Transcutaneous Cervical Ultrasonography performed by a second otorhinolaryngology specialist well versed in Ultrasonography without knowing the clinical history, details of the physical examination, or the suspected side. Ultrasonography findings were later compared with the clinical examination and outcome of the medical or surgical management. Eight adult patients (range 18-53year-old) were enrolled in the study. Six of them, had, ultrasonography findings compatible with a peritonsillar liquid collection underwent surgical drainage that confirmed and drained an abscess. On two patients, the ultrasonography images described an aspect of peritonsillar cellulitis that was managed conservatively and showed a favorable remission. No complications during stay or side effects or intolerance to the ultrasound were recorded. Transcutaneous Cervical ultrasonography is a fast, useful tool, better tolerated than the intra-oral ultrasonography in diagnosing PTA. It avoids all irradiation exposure is much cheaper and the waiting time is shorter. Worth noting, is the richness of information pertaining the anatomy, vessels and abscess location and extension, for the surgeon performing the exam just prior to surgery. The efficiency and training of otorhinolaryngology specialists with this technique shows numerous promising benefits and deserves to be further developed.

Clinical Profile and Management of Peritonsillar Abscess in a Sub Saharan Africa

Background: Peritonsillar abscess is a common pathology that presents to an otolaryngologist with poor documentation especially in developing countries.&#x0D; The aim of this study was to describe the clinical profile and management of peritonsillar abscess in our practice.&#x0D; Material and Method: This was a retrospective study of patients presenting to our Ear, Nose and Throat facility with diagnosis of peritonsillar abscess. Information obtained includes detailed demographic characteristics, clinical findings and management of the patients. All obtained data were collated, entered into computer system and analyzed using SPSS version 18.0.&#x0D; Results: Prevalence of peritonsillar abscess was 0.2%. There were 38.9% males and male to female ratio was 1:1.6. Duration of illness at presentation with more than 1 week was 75.9% and single episode occurred in 85.2%. Right peritonsillar abscess accounted for 66.7% and aspirated pus of more than 5 ml was recorded in 48.1%. Majority (87.0%) of the patients was referred and 42.6% of such referral is by family physician. Patients seen in ear, nose and throat outpatient clinic were 83.3%.&#x0D; Common symptoms at presentation were fever, sore throat, odynophagia and otalgia in 100%, 94.4%, 90.7% and 59.3% respectively. All the patients (100%) had enlarged tonsils and with deviated uvula on clinical examination followed by 98.1% exudate on the tonsils and 31.5% trismus. Test aspirate confirmed peritonsillar abscess in 68.5% and all revealed growth of bacteria. Common isolated bacteria were 35.2% Streptococcus species and 11.1% Staphyloccocus aureus.&#x0D; Isolated Streptococcus species and Staphylococcus aureus had 100% sensitivity to cefuroxime, gentamicin, azithromycin, ceftazidine, Amoxicillin and Streptomycin.&#x0D; Prior prehospital treatment was received by 81.5% patients. Hospital treatments were surgical intervention and medical treatment in 90.7% and 100% respectively. Recurrences occurred in 3.7% during followed up.&#x0D; Conclusion: Peritonsillar abscess are common disorder with female preponderance in this study. The prevalence recorded in this study was 0.2%. It usually mimic other causes of fever hence eye index of suspicion is essential. Surgical treatment remains the effective mode of management in our study.

Trends in the management of peritonsillar abscess in children: A nationwide population-based study in Taiwan

ObjectivePopulation-based studies analyzing peritonsillar abscess in children are lacking. In this study, a population-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted. MethodsThis cross-sectional study was conducted using the Taiwan National Health Insurance Research Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender, hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during the study period were analyzed. ResultsA total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion of treatments involving incision and drainage or needle aspiration increased significantly (1.3%–4.1% and 49.4%–65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%–29.0%). The use of computed tomography (CT) increased (1.4%–12%, ptrend < 0.001). The use of nonsteroidal anti-inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays increased from 3.78 to 4.67 days. ConclusionsThe incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan. Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle aspiration procedures, and the length of hospital stay in this study cohort.

Is corticosteroid a treatment choice for the management of peritonsillar abscess?

ObjectiveTo investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA). MethodsThis retrospective case-control trial included 32 patients with the diagnosis of PTA between December 2013 and January 2016 in our clinic. Patients were divided into two groups based on the approaches of two authors for the treatment after PTA drainage. The study group included the patients treated with single dose systemic corticosteroid after PTA drainage. Other patients who had no corticosteroid treatment were in the control group. Two groups were compared based on time to oral intake, grade of trismus, pain severity and duration of hospitalization. ResultsStatistically significant differences between two groups were observed in terms of time to oral intake, grade of trismus, pain severity and length of hospitalization. The degree of trismus and pain severity significantly decreased in study group comparing to control group at the end of the first day. This difference disappeared at Day 7. Time to oral intake and the duration of hospitalization were shorter in the study group than in control group. ConclusionCorticosteroid treatment following drainage procedure in patients with peritonsillar abscess improves pain severity and trismus thus it decreases time to oral intake and duration of hospitalization.

A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses.

1. Risa E. Bochner, MD* 2. Mona Gangar, MD*,† 3. Peter F. Belamarich, MD* 1. *Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY 2. †Department of Otorhinolaryngology/Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, NY * Abbreviations: ALPS: : Autoimmune lymphoproliferative syndrome ARF: : Acute rheumatic fever CMV: : Cytomegalovirus CT: : Computed tomography EBV: : Epstein-Barr virus GAS: : Group A Streptococcus HIV: : Human immunodeficiency virus NSAIDs: : Nonsteroidal anti-inflammatory drugs OSA: : Obstructive sleep apnea PFAPA: : Periodic fever, apthous stomatitis, pharyngitis, and adenitis PSGN: : Poststreptococcal glomerulonephritis PTA: : Peritonsillar abscess RADT: : Rapid antigen detection test SDB: : Sleep-disordered breathing T&A: : Tonsillectomy and adenoidectomy Despite established guidelines for group A Streptococcus pharyngitis diagnosis and treatment, pediatricians are overtreating and mistreating sore throat in children. (1) This results in unnecessary antibiotic use and contributes to antimicrobial resistance, increased health care costs, and risk for adverse drug reactions. In addition, controversy exists among pediatricians regarding the indications for tonsillectomy and adenoidectomy in children. After completing this article, readers should be able to: 1. Describe the clinical presentation, differential diagnosis, diagnostic evaluation, and management of tonsillitis/pharyngitis in pediatric patients. 2. Describe the clinical presentation, diagnostic evaluation, and management of peritonsillar abscess in pediatric patients. 3. Describe the clinical presentation, diagnostic evaluation, and management of retropharyngeal abscess in pediatric patients. 4. Describe the indications for tonsillectomy and adenoidectomy in pediatric patients and associated complications. ### Epidemiology Sore throat is a common complaint in children and adolescents. Most cases of pharyngitis are viral and self-limited. Group A Streptococcus (GAS) pharyngitis is the only commonly occurring infectious pharyngitis in which antimicrobial treatment is indicated. Treatment of GAS decreases the risk of acute rheumatic fever (ARF), suppurative complications and transmission of disease, and provides symptomatic relief. GAS pharyngitis accounts for 20%-30% of office visits for sore throats in children. (2) Infection typically occurs in school-age children and adolescents, and is uncommon in children younger than 3 years. GAS pharyngitis occurs most commonly in the winter and early spring months …

扁桃周囲膿瘍における細菌学的検査の役割

扁桃周囲膿瘍における細菌学的検査の役割

Impact of anti-inflammatory drug consumption in peritonsillar abscesses: a retrospective cohort study.

BackgroundThe experience of clinicians in charge of the in-hospital management of peritonsillar abscesses supports the association between severe forms and anti-inflammatory drug (AID) consumption. However, this observation is based on a limited number of clinical studies. Our objective was to assess the prevalence and impact of AID consumption in patients with peritonsillar abscesses.MethodsAll patients referred to the ear, nose and throat surgery department for a peritonsillar abscess were included in a retrospective cohort study (2012–2014).ResultsAmong the 216 included patients (male, 55 %; median age, 32 years [IQR, 26–40]), 127 had received AID (59 %), including corticosteroids (n = 67, 31 %) and/or non-steroidal AIDs (NSAIDs, n = 76, 35 %). 199 patients (92 %) benefit from a puncture and 5 (2 %) from a surgery under general anesthesia, associated with ceftriaxone/metronidazole (51 %) or amoxicillin/clavulanic acid (46 %). An iterative surgical procedure was required in 93 cases (43 %), including 19 % under general anesthesia. Bacteriological analysis (79 %) mainly disclosed streptococci (66 %) of A (18 %) and/or milleri (33 %) groups. The prevalence of anaerobes was higher in patients using AIDs (46 % versus 29 %, p = 0.034), regardless of prior antibiotic therapy. 65 patients benefited from a CT-scan; AID consumption was associated with larger abscesses (6.8 [IQR, 3.7–12.7] versus 2.9 [IQR, 0.9–7.8] cm3; p = 0.005). AID consumption was not a risk factor of iterative surgical procedure.ConclusionsIn comparison to the prescribing habits in uncomplicated upper respiratory tract infection, the high prevalence of AID consumption in patients with peritonsillar suppuration suggests a role of AIDs in promoting these complications.