Recurrence Of Peritonsillar Abscess Research Articles

High rate of early recurrence of peritonsillar abscess among adolescents and young adults

Background Peritonsillar abscess (PTA) can be treated with aspiration or incision for drainage, but a subsequent PTA can occur if tonsillectomy is not performed. Better understanding is needed of when tonsillectomy should be performed to avoid PTA recurrence. Objective This study investigated the recurrence rate of PTA following aspiration or incision for drainage and evaluated the risk factors for recurrence. Methods The medical records of 292 patients treated for PTA were reviewed. Recurrence of PTA and elective or quinsy tonsillectomy were the primary endpoints. A Cox proportional hazards regression model for PTA recurrence was constructed with sex, age, and PTA history as predictors. Results Young age was the only significant predictor of PTA recurrence. Patients aged 15 to 24 years had a 30-day recurrence rate of 15.5% and a total recurrence rate of 26.6%. The total recurrence rate among patients over 30 years of age was significantly less at 4.0% (Fisher’s exact test, p < .05). Conclusion and Significance Based on our results, tonsillectomy should be considered for PTA in patients between 15 and– 25 years of age and, to effectively avoid future recurrence of PTA, should be performed urgently.

Risk Factors for Recurrence of Peritonsillar Abscess.

This study aimed to investigate the risk factors associated with peritonsillar abscess (PTA) recurrence in adult patients. This retrospective cohort study used a nationwide insurance claims database in Japan. Adult patients (aged ≥ 20 years) who received intravenous antibiotics or surgical therapy within 5 days of their first PTA diagnosis were included. Multivariable Cox proportional modeling was used to investigate the risk factors for PTA recurrence using the variables: age, sex, comorbidities, tobacco use, history of recurrent tonsillitis, duration of intravenous antibiotics, and surgical therapy for PTA. This study included 12,012 patients (8784 men, 73.1%). Of them, 1358 (11.3%) experienced PTA recurrence. An age ≥40 years and treatment with intravenous antibiotics for 3 days or more were associated with a lower risk of PTA recurrence (aged ≥ 40 years: adjusted hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.62-0.78, treated with intravenous antibiotics for 3 days or more: adjusted HR: 0.85; 95% CI: 0.76-0.96). Patients with a history of recurrent tonsillitis were associated with a higher risk of recurrence (adjusted HR: 1.79; 95% CI: 1.47-2.19). A median age of 20-39 years, a history of recurrent tonsillitis, and less than 3 days of intravenous antibiotic therapy may be risk factors for PTA recurrence among adult patients. Further studies exploring more detailed clinical data are necessary to confirm the risk factors for PTA recurrence. 3 Laryngoscope, 133:1846-1852, 2023.

The Surgical Treatment of Peritonsillar Abscess: A Retrospective Analysis in 584 Patients.

There are three surgical treatment options for patients with peritonsillar abscess (PTA): needle aspiration, incision and drainage (ID), and abscess tonsillectomy (ATE). The updated German national guideline (2015) included changes in the treatment of PTA. The indication for tonsillectomy (TE) in patients became more stringent and preference was given to ID in certain cases. Retrospective analysis. We performed a retrospective systematic analysis of patient data using the in-house electronic patient records and considered a 4-year period from 2014 to 2017. About 584 patients were identified. Our aim was to analyze the influence of the updated guideline on clinical practice. 236 of 584 patients (40.4%) underwent ATE with contralateral TE. In 225 patients (38.5%), unilateral ATE was performed. Mean surgery time was significantly shortened when only unilateral ATE was performed. Concerning postoperative bleeding, we noted a tendency toward a lower incidence after ATE in comparison to ATE with contralateral TE. Less than 1% of patients who underwent ATE had to be revised surgically due to postoperative hemorrhage. After the revision of the guideline, unilateral ATE and ID were conducted more frequently. These results support that ATE in an inpatient setting is a considerably safe and effective primary therapeutic option. ID represents a favorable treatment option for patients with PTA and comorbidities, nevertheless, patient compliance is required and insufficient drainage or recurrence of PTA may occur. The revision of the guideline had a significant impact on the choice of interventions (P< .001), which is reflected by the increased number of unilateral ATE. 4 Laryngoscope, 131:2706-2712, 2021.

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

The Veneto region's database of hospital discharge records was queried for ICD-9 codes corresponding to: peritonsillar abscess (PTA), PTA incision and drainage, tonsillectomy, pharyngeal-retropharyngeal abscess, cervical phlegmon, cervical abscess, and mediastinitis recorded from 1997 to 2006. All these codes were considered to identify cases of PTA recurrence and severe infectious complications occurring in conservatively treated patients. Among 4,199 patients whose PTA was incised and drained on admission to hospital, 1,532 were treated with tonsillectomy, while 2,667 were treated conservatively (without tonsillectomy). Abscess tonsillectomy was carried out almost exclusively in children (0-14 years of age), and only in 40 young and adult patients (0.95 %). The relapse rate after a single episode of PTA was 11.7 %, while potentially fatal complication occurred in 0.41 % of cases. Incidence of PTA hospital admission has remained stable in the considered period despite a 45 % reduction in the tonsillectomy rate. In conclusion, our data seem to show that conservative treatment for PTA is not associated with a significant risk of recurrence (and becomes minimal after 6-12 months), provided that patients have not suffered from previous PTA episodes.

The impact of prior tonsillitis and treatment modality on the recurrence of peritonsillar abscess: a nationwide cohort study.

BackgroundStudies suggest an increased risk of peritonsillar abscess (PTA) recurrence in patients with prior tonsillitis. However, this association is inconsistent and could be confounded by different treatment modalities. This study aimed to assess the risk of recurrence among PTA patients with different degrees of prior tonsillitis and treatment modalities, and the role of tonsillectomy in current practice.MethodsAll in-patients with peritonsillar abscess between January 2001 and December 2009 were identified in a nationwide, retrospective cohort study. Recurrence was defined as the first occurrence of PTA ≧30 days from the initial PTA. Factors independently associated with recurrence were analyzed using Cox proportional hazard model after adjusting for demographic and clinical data.ResultsThere were 28,837 patients, with a 5.15% recurrence rate and 4.74 years of follow-up. The recurrence rates were significantly higher among subjects with more than five prior tonsillitis or 1–4 prior tonsillitis compared to those without prior tonsillitis (adjusted hazard ratio, 2.82 [95% confidence interval, 2.39–3.33] and 1.59 [95% CI: 1.38–1.82]). The adjusted HR in patients treated with needle aspiration was 1.08 compared to those treated with incision & drainage (95% CI: 0.85–1.38). After age stratification, the adjusted HRs of more than five prior tonsillitis increased to 2.92 and 3.50 in patients aged ≦18 and 19–29 years respectively. The adjusted HR ofneedle aspiration only increased in patients ≦18 years old (aHR: 1.98 [95% CI: 0.99–3.97]). The overall tonsillectomy rate was 1.48% during our study period.ConclusionsThe risk of PTA recurrence increases with higher degrees of prior tonsillitis in all age groups and management by needle aspiration only in the pediatric population. Patients younger than 30 years old with PTA and more than five prior tonsillitis have the greatest risk of recurrence.

入院加療を行った扁桃周囲膿瘍２１５例

In a retrospective clinical peritonsillar abscess study, we reviewed 215 cases—169 men and 46 women from 8 to 85 years old (median: 34.5)—hospitalized and treated between January 2001 and December 2009. Of these, 111 (51.6%) were affected on the right side, 99 (46.0%) on the left, and 5 (2.3%) bilaterally. Abscess formed in the superior poles of 192 (89.3%), the inferior of 19 (8.8%), and bilaterally in 4 (1.9%). The smoking ratio was 78.6% in men and 48.7% in women. Bacteriological examination in 127 showed etiological bacteria of 107 strains—70 aerobic—mostly S. milleri (41.4%) and S. pyogenes (31.4%)—and the remainder anaerobic—Bacteroides (29.7%), Porphyromonas (29.7%), and Peptostreptococcus (21.6%). The ratio of antibiotic bacteria resistance was 22.4% to PIPC, 5.6% to FMOX, 11.2% to CLDM, 6.5% to LVFX, and none to IPM/CS. Of our subjects, 141 (65.6%) were treated by incision, 34 (15.8%) by puncture, 38 (17.7%) by antibiotics, and 2 (1.0%) by abscess tonsillectomy. Antibiotics used most often were FMOX combined with CLDM. Among our 28 subjects (13.7%) undergoing tonsillectomy—2 abscess and 26 interval—69.2% felt that acute peritonsillar abscess throat pain was severer than postoperative tonsillectomy pain. Peritonsillar abscess recurred in 26 (12.7%), with younger subjects outnumbering older in tonsillectomy and recurrence of peritonsillar abscess. We recommend tonsillectomy after acute inflammatory healing in those with peritonsillar abscess recurrence and habitual angina.

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.

An evidence-based review of the treatment of peritonsillar abscess.

Peritonsillar abscess (PTA) is commonly seen but still controversial. We performed an evidence-based review to answer 3 questions: Are steroids beneficial? Which is the best technique for acute surgical management? When is tonsillectomy indicated? We performed a MEDLINE search of the published literature using appropriate search terms to identify pertinent articles, which were reviewed and graded according to the evidence quality. Forty-two articles were analyzed. There are no published studies on steroids in PTA. There were 5 level I clinical studies on surgical technique, which indicated that needle aspiration, incision and drainage, and quinsy tonsillectomy are all effective for initial management. The overall PTA recurrence rate is 10% to 15%. Overall, grade C evidence indicates that several methods of initial surgical drainage are equally effective, and the recurrence rate is low. The literature does not specifically address different treatments for children and adults.