Management Of Peritonsillar Abscess Research Articles

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.

Role of Needle Aspiration in the Management of Peritonsillar Abscess

Role of Needle Aspiration in the Management of Peritonsillar Abscess

National prospective cohort study of peritonsillar abscess management and outcomes: the Multicentre Audit of Quinsies study.

To investigate variations in the management and outcomes of peritonsillar abscesses, and to develop a trainee collaborative network in the UK. Data were collected prospectively on suspected peritonsillar abscess cases presenting over a 2-month period at 42 participating secondary care centres, covering a population of 16 million. The primary outcome was an adverse event at 30 days, defined as re-presentation or re-drainage. Eighteen per cent of the 325 cases experienced an adverse event. Follow-up data were valid for 90 per cent of cases. Regression analyses showed a significant reduction in adverse events in the 12 per cent of patients who were discharged within 12 hours, and there was no significant increase in adverse events for the 70 per cent receiving corticosteroids. Out-patient management of peritonsillar abscess is not commonly practised in the UK. Corticosteroid usage is common and appears safe. This study demonstrates that trainees working in collaboration can effectively deliver prospective multicentre cohort studies in the UK.

The role of bacteriological studies in the management of peritonsillar abscess.

Since most patients with peritonsillar abscess (PTA) can be successfully treated with surgical drainage and empirical antibiotic therapy, routine bacteriologic studies for all patients with PTA may be unnecessary. This study tried to evaluate which patients with PTA should certainly undergo bacteriologic studies. Hundred consecutive patients with PTA were treated and underwent culture tests of purulent contents obtained by surgical drainage between April 2008 and December 2013. In 62 of the 100 patients, 71 pathogenic bacteria were identified; 61 (86%) were Gram-positive cocci (GPC), 8 (11%) were Gram-negative rods (GNR), and 6 (8%) were anaerobes. Normal flora were isolated in 27 patients, and culture results were negative in 11 patients. Although not significant, primary (without prior antibiotic therapy) case (odds ratio (OR)=2.19; 95% CI, 0.95-5.05) and laryngeal edema (OR=2.04; 95% CI, 0.82-5.03) showed a tendency of associations with detection of pathogenic bacteria. After taking into account interactions between smoking habit and laryngeal edema, the covariate-adjusted OR for non-smokers with laryngeal edema was significant and showed a strong relationship (OR=7.43; 95% confidence interval, 1.05-52.73) compared to non-smokers without laryngeal edema. Although empirical antibiotic therapy was effective for most of the PTA patients, bacteriologic studies might be indispensable for the patients with laryngeal edema considering the failure of the first treatments. Particularly, the culture tests may be useful for non-smokers with laryngeal edema.

Treatment and Management of Peritonsillar Abscess-A Review

Aim: To review the treatment and management of Peritonsillar abscess. Objective: To find out the various treatment procedures, precautions taken during the management peritonsillar abscess. Background: Peritonsillar abscess also known as quinsy is a complication of tonsillitis. It consists of pus formation is the supratonsillar space. It is very common in children as their intake of chocolate and sticky substances is high, hence more prone to infection .Also it can be caused due an infection caused in the loose connective tissue present in this area. Its early symptoms include sore throat and severe pain during swallowing and as the case progresses the pain increase and a distortion of vowels called as the “hot potato voice “may appear. Reason: I have interest in this area of research as every member in my family has had tonsillitis except me and it makes me curious about its occurrence and its management.

COMPARISON OF EFFICACY OF NEEDLE ASPIRATION VERSUS INCISION AND DRAINAGE IN MANAGEMENT OF PERITONSILLAR ABSCESS

Objective: To compare the efficacy of needle aspiration versus incision and drainage (I & D) in management of peritonsillar abscess (PTA) in terms of recovery period and recurrence rate. Study Design: Randomized controlled trial. Place and Duration of Study: Otolaryngology departments, Combined Military Hospitals, Rawalpindi and Multan, from January 2011 to January 2013. Material and Methods: Using World Health Organization sample size calculator, a calculated sample of 60 subjects was divided into two equal groups. One group underwent needle aspiration and the other groupunderwent I & D for PTA. The groups were compared for recovery period and recurrence using independent samples t-test and Fisher’s Exact test respectively calculated through SPSS version 20. A p-value <0.05 was considered significant.Results: The mean recovery period was 3.5 ± 1 days for the I & D group and 3.6 ± 1 days for the needle aspiration group (p=0.64). Recurrence rate with I & D was 6.7% and with needle aspiration was 13.7% (p=0.67).Conclusion: Both needle aspiration and I & D are satisfactory surgical options for the treatment of PTA with no significant difference in clinical outcome. However, needle aspiration has an advantage over I & D in terms of minimal morbidity and its ease of performance

A Novel Peritonsillar Abscess Simulator.

In response to the growing demand for a peritonsillar abscess simulator, we developed a novel model to teach needle aspiration as well as incision and drainage of this common oropharyngeal disorder. The objectives of this study were to describe the construction of the simulator and to assess its realism and usefulness in the acquisition of drainage skills. The training model was created with reusable and readily available materials. During an otolaryngology emergencies boot camp, expert otolaryngologists performed abscess drainage and subsequently instructed novice learners on the techniques of the procedure. Each participant completed a questionnaire using a 5-point Likert-type scale to assess simulator realism and training usefulness. A peritonsillar abscess drainage model was created using readily available materials. A total of 18 experienced attending otolaryngologists and senior otolaryngology residents (postgraduate year 4 and postgraduate year 5) participated in this study. All participants rated the trainer realistic, and 94% agreed that the model correlates with the essential skills needed for peritonsillar abscess management. All participants felt that this model would be useful in residency training to help develop dexterity, accuracy, and precision with peritonsillar abscess drainage instruments. An easily reproducible peritonsillar abscess simulator was highly rated as a means of teaching peritonsillar abscess anatomy and provided opportunity for hands-on learning of drainage skills.

252 Comparison of Clinical Characteristics and Outcomes of Medical versus Surgical Management of Peritonsillar Abscess

252 Comparison of Clinical Characteristics and Outcomes of Medical versus Surgical Management of Peritonsillar Abscess

Novel Peritonsillar Abscess Task Simulator

The management of peritonsillar abscesses is a skill developed early in residency training. Although drainage is not technically complicated, the procedure is intimidating to the neophyte. Task simulators have become increasingly common to provide training opportunities in a controlled environment. The authors designed a peritonsillar abscess simulator using a latex moulage of the oral cavity and other common materials. Twelve medical professionals of various levels of experience were instructed to expose, anesthetize, aspirate, and drain the simulated abscess. After completion, a questionnaire was completed by each volunteer. Initial impressions were positive that the model adequately replicated the tasks requisite for abscess drainage and was suitable as an instructional device. The initial construct cost was approximately 10 dollars, with disposables costing roughly 25 cents. Further research is under way to formally assess the simulator for face, content, and construct validity.

Management of Peritonsillar Abscess: comparative prospective study of Needle aspiration and Incision & Drainage in central Indian Population

Background: Peritonsillar abscess also called as Quinsy is commonest infection in head and neck region. It is collection of pus within the peritonsillar space as a result of acute tonsillitis and subsequent Peritonsillar cellulites. The treatment is controversial- medical or surgical. Surgical modalities available are- incision & drainage, needle aspiration, quinsy tonsillectomy etc. Materials and Methods: 2 year prospective study was carried out in ENT department of our medical college hospital covering 140 patients. All patients were divided in two groups according to surgical procedures carried out. Group 1: patients who have undergone Incision and Drainage Group 2: patients on whom Needle aspiration was carried out Results: Out of 78 patients in group 1, PTA recurred once in 4 patients and twice in two patients. Conversely 7 (11.29%) patients showed recurrence in group 2. Mean hospital stay 3.6 and 2.9 days respectively in both cases. History of recurrent tonsillitis was present in 62.82% patients in group 1 and 66.12% in group 2. Conclusion: Incision and drainage is better treatment modality as compared to needle aspiration. But Needle aspiration can be utilized as first step of management of peritonsillar abscess as it is simple, cheap, effective and less traumatic to the patients.

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.

クリンダマイシン，穿刺排膿による扁桃周囲膿瘍治療―広域抗菌剤や多剤併用は必要なのか？―

Peritonsillar abscess, although common in Japan, as yet has no treatment guidelines. Current treatment consists of abscess drainage and antibiotic administration. Despite guidelines in other countries recommending clindamycin or augmented penicillins, Japanese practice still often uses beta lactum drugs with or without clindamycin. We evaluated inpatient peritonsillar abscess management by intravenous clindamycin injection following needle aspiration. Of 54 such subjects treated between 2006 and 2009, 46 underwent intravenous aintibiotic administration following needle aspiration. Antibiotics used were clindamycin, sulbactam/cefoperazon, cefepime, and carbapenems. We compared clinical drug efficacy to hospitalization length, posttherapeutic pain duration and days until normal meal resumption. Clinical outcome showed no statistically significant difference among the four drug groups. We concluded that post needle aspitaion clindamycin treatment is as effective as and cheaper than alternatives. Narrow-spectrum antibiotics, such as clindamycin, also help prevent pathogen resistance.

Bacteriology and Antibiotic Susceptibility Pattern of Peitonsillar Abscess

Peritonsillar abscess is a common complication of acute tonsillitis. Its management consists of aspiration or surgical drainage followed by appropriate antibiotics. Appropriate antibiotic treatment depends on the common organisms associated with infection and their antibiotic sensitivity pattern in local scenario. Pus samples aspirated from diagnosed cases of peritonsillar abscess and submitted for culture and sensitivity in last two years were included in this study. Identification of different microorganisms was made on the basis of the microscopic findings, observation of their colony morphology and standard biochemical reactions. Susceptibility pattern to commonly used antibiotics were determined by Clinical Laboratory Standards Institute (CLSI) guidelines. Altogether 24 pus samples were included in the study. Positive culture was obtained from 18 samples. Among them one organism was isolated from 13 samples whereas from five samples multiple organisms were isolated. From six samples no organisms could be cultured. Altogether Streptococcus pyogenes was isolated from 12 samples and Staphylococcus aureus from five samples. Other isolated organisms included Haemophlilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Enterococcus species. Penicillin was effective for Streptococcus pyogenes whereas Staphylococcus aureus was resistant to it. Cloxacillin was found to be effective for Staphylococcus aureus. Ciprofloxacin and Ceftazidime were found to be effective for both organisms. Streptococcus pyogenes and Staphylococcus aureus were more commonly associated with peritonsillar abscess. Streptococcus pyogenes were sensitive to penicillin but all Staphylococcus aureus were resistant to it. This fact should be considered in clinical practice for management of peritonsillar abscess.

Immediate tonsillectomy: indications for use as first-line surgical management of peritonsillar abscess (quinsy) and parapharyngeal abscess

This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess. This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded. The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post-operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days). Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department.

Prospective Audit on the Outpatient Management of Peritonsillar Abscess

Prospective Audit on the Outpatient Management of Peritonsillar Abscess

Role of microbiological studies in management of peritonsillar abscess

Peritonsillar abscess (quinsy) is one of the most common ENT emergencies. A 2002 UK audit of quinsy management revealed that an average ENT department treated 29 cases annually; the most common treatment was needle aspiration with intravenous antibiotics, and culture of the aspirate was often performed routinely. The aims of our study were to evaluate the value of routine culture of quinsy aspirates, and to establish whether the information thus gained was clinically useful. We examined the notes of patients admitted with quinsy to two hospitals in south-west England, from January 1998 to January 2004 in one hospital and from January 1995 to January 2005 in the other. A total of 577 cases was found. Aspirated pus had been sent for culture in 119 (21 per cent). These cases were examined in more detail. Of the 119 patients, 78.2 per cent (93/119) were treated with either a cephalosporin or penicillin, plus metronidazole. Streptococcal species were cultured in 43.7 per cent (52/119) and anaerobes in 23.5 per cent (28/119; of these cultures, 5.9 per cent (7/119) were pure anaerobes only). All the anaerobes were sensitive to metronidazole. One of the 119 cultures, growing aerobic bacteria, was resistant to penicillin; however, this patient improved clinically on a combination of penicillin and metronidazole. No patients had their treatment changed because of culture results. There appears to be no need to routinely culture quinsy aspirates, based upon our findings (of 16 hospital years) and previous studies (which found no recorded episodes of treatment change as a result of culture sensitivities). The combination of penicillin or a cephalosporin, plus metronidazole appeared to be theoretically effective in 99.2 per cent (118/119) of our specimens; this finding is supported by other studies. However, the rare but potentially life-threatening complications of quinsy must be recognised.

Use of bacteriologic studies in the management of peritonsillar abscess

Use of bacteriologic studies in the management of peritonsillar abscess

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess - and elective tonsillectomy

Objective: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy a chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy a chaud and tonsillectomy a froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsil. Material and methods: All patients had been operated on at the Department of Otorhinolaryngology, St. Marina University Hospital, Prof. P. Stoyanov- Varna University of Medicine 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years). Results: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative hemorrhages which required treatment under general anesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of ‘selected’ elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of hemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative hemorrhages. Conclusion: There is no increased risk of postoperative hemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. Scripta Scientifica Medica 2008; 40(2): 149-152

Phlegmons péritonsillaires

Objectives To study the circumstances of diagnosis, the supporting factors, the bacteriology, and the therapeutic management of peritonsillar abscesses (quinsy). Material and methods This was a retrospective study over a period of 10 years in 98 patients hospitalized in an ENT and Head and Neck Surgery department for peritonsillar abscess. Results Ninety percent of cases of peritonsillar abscesses complicated angina. Forty-nine percent of patients had no previous antibiotic therapy, 9% had a previous history of peritonsillar abscess, 62% were treated in the emergency department, and fever was present in 64% of cases. The diagnosis was clinical in 98% of cases. The average hospitalization stay lasted 2 days. Sixty-five percent of patients had one needle aspiration of the abscess, 35% had surgical drainage with local anaesthesia. The needle aspiration was negative in 14% of cases. In 29% of cases one bacterium was identified. The patients were completely cured in 10 days. Forty-five percent of patients underwent tonsillectomy at a later date. Conclusion The progression of peritonsillar abscess is favorable in 2–3 days since a local therapeutic act (needle aspiration or drainage) is done associated with an antibiotic and corticoid treatment that is initially intravenous. An emergency tonsillectomy can be proposed in cases of recurrent tonsillitis or peritonsillar abscess.

Hemorrhage Risk After Quinsy Tonsillectomy

The goal of the study was to evaluate the incidence and possible predictive factors of post-tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy. A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon's experience, procedure duration, intra- and postoperative anti-inflammatory medications, and side of bleeding were analyzed. Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant (P = 0.02). Male gender (P = 0.042), smoking (P = 0.009), and aspirin intake (P = 0.008) were statistically significant factors associated with an increased PTH risk. The risk of bleeding following abscess tonsillectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo-tonsillar infections, aspirin intake, and clinical improvement after initial drainage and antibiotherapy. C.