A phase 2 trial of abbreviated fixed-duration (Default 4 Cycles) linvoseltamab immuno-consolidation to deepen responses post newly diagnosed multiple myeloma combination therapy for minimal residual disease positivity (the IMMUNOPLANT Study)

IntroductionTonsillectomy is often used to treat recurrent tonsillitis (RT), but it is less commonly performed to treat peritonsillar abscess (PTA). While most PTAs are treated with needle aspiration or incision and drainage, quinsy tonsillectomy is used in select cases.ObjectiveTo compare clinical characteristics and postoperative outcomes of patients undergoing quinsy tonsillectomy for PTA versus those undergoing tonsillectomy for RT.MethodsThe American College of Surgeons NSQIP database was used to identify adults who underwent tonsillectomy (CPT code 42826) with a diagnosis of either PTA or RT. Data was collected from 2018–2021. Demographics, comorbidities, risk factors, postoperative complications, and outcomes including operative time, length of stay (LOS), readmission, and reoperation were compared. Logistic regression identified predictors of readmission and reoperation.Results10241 patients had RT and 366 had PTA. PTA patients had significantly higher rates of smoking (27.0% versus 12.3%), diabetes (6.6% versus 2.5%), hypertension (11.5% versus 5.8%), and preoperative sepsis (14.5% versus 0.3%;p < .001 for all). Operative time and LOS were longer in the PTA group (33.5 minutes versus 25.8 minutes; 2.5 days versus 0.2 days, respectively;p < .001 for both). Despite higher rates of rare complications like ventilator use (0.8% versus 0.0%) and sepsis (2.2% versus 0.0%;p < .001 for both), no significant differences were observed in postoperative hemorrhage, readmission, or reoperation.ConclusionAdults undergoing quinsy tonsillectomy for PTA have more comorbidities and rare complications compared with RT patients, likely due to active infection. However, the procedure is not linked to increased hemorrhage risk and remains safe treatment.

Background/Objectives: Peritonsillar abscess (PTA) and cellulitis (PTC) often present with similar clinical features, making differentiation challenging despite imaging. This study evaluates the diagnostic performance of serum HMGB1 and kallistatin levels as potential independent biomarkers to distinguish PTA from PTC. Methods: In this single-center prospective cohort study, 97 patients aged 18 to 65 years who met the inclusion criteria and presented with peritonsillar infection (39 PTA; 58 PTC) between February and July 2025 were enrolled. Serum levels of HMGB1, kallistatin, and routine inflammatory markers were measured and compared. Univariate and multivariate logistic regression analyses identified independent predictors for distinguishing PTA from PTC. Receiver operating characteristic (ROC) curve analysis assessed the diagnostic accuracy of biomarkers. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of individual biomarkers and their combinations across a range of threshold probabilities. Results: Compared to controls, patients with peritonsillar infection had significantly higher WBC, neutrophil, CRP, procalcitonin, and HMGB1 levels and significantly lower kallistatin levels (all p < 0.05). Within the infection group, PTA patients showed significantly higher CRP (p = 0.036) and HMGB1 (p = 0.003) levels and lower kallistatin (p < 0.001) levels compared to PTC patients. In univariate analysis, CRP, HMGB1, and kallistatin were significantly associated with PTA; however, in multivariate analysis, only elevated HMGB1 (OR: 1.21; 95% CI: 1.09–1.35; p < 0.001) and reduced kallistatin (OR: 0.395; 95% CI: 0.24–0.648; p < 0.001) remained independent predictors. ROC analysis showed that both HMGB1 and kallistatin demonstrated good discriminative ability in distinguishing PTA from PTC. DCA revealed that the three-biomarker combination (kallistatin + HMGB1 + CRP) achieved the highest mean net benefit (0.183) across all threshold probabilities, outperforming individual biomarkers (kallistatin: 0.131, HMGB1: 0.111, CRP: 0.099) and the two-biomarker model (0.176). The combined model maintained superior net benefit across threshold probabilities of 25–75%, indicating optimal clinical utility within this decision range. Conclusions: Serum HMGB1 and kallistatin may be effective adjunctive biomarkers for differentiating PTA from PTC.

ABSTRACTObjectivesThis study aimed to evaluate the long‐term efficacy and safety of microdebrider‐assisted endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA) using caregiver‐reported retrospective assessments of pre‐ and post‐operative symptom states.MethodsThis single‐center retrospective observational study included 65 children aged < 15 years who underwent PITA and at least 1 year of postoperative follow‐up. Caregivers completed a structured postoperative questionnaire, retrospectively assessing preoperative and postoperative symptom severity using the validated Japanese version of the Obstructive Sleep Apnea Questionnaire‐18 (OSA‐18). The questionnaire evaluated sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns. Postoperative complications, including tonsillitis, peritonsillar abscess, and perceived symptom recurrence, were also assessed. All surgeries were performed using an endoscopic PITA technique designed to preserve the tonsillar capsules.ResultsAmong the 65 pediatric patients (median follow‐up, 48.0 months; interquartile range, 25.0–65.0), significant improvements were observed across all five OSA‐18 domains. The mean preoperative scores were 5.2, 4.5, 2.3, 3.4, and 4.7 for sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns, respectively. Postoperative scores improved to 1.7, 2.3, 1.7, 2.1, and 1.8, respectively (all, p < 0.001). Subgroup analyses showed no significant differences in outcomes based on follow‐up duration (< 5 vs. ≥ 5 years) or age at surgery (≤ 4 vs. > 4 years), suggesting durable and consistent long‐term benefits of PITA regardless of age or time since surgery. No peritonsillar abscesses were reported; only three patients (4.6%) experienced postoperative tonsillitis. Thirteen percent of the caregivers reported a subjective recurrence of symptoms; however, none required revision surgery.ConclusionPITA is a potentially safe and effective long‐term surgical option for pediatric OSA. Retrospective caregiver evaluation revealed sustained symptom improvement, minimal postoperative complications, and high satisfaction levels.Level of EvidenceLevel IV.

A randomized clinical trial of peritonsillar abscess treatment comparing drainage and tonsillectomy.

Acute tonsillitis is a bacterial infection characterized by painful swallowing, swelling, and redness of the tonsils. The purpose of this literature review is to improve understanding of acute tonsillitis, which is essential for patient care and a favorable prognosis. The method used is a systematic literature review. The results of this literature review indicate that tonsillitis is a common inflammatory condition affecting the palatine tonsils, accounting for approximately 1.3% of outpatient visits. The condition is typically caused by viral or bacterial infections and manifests with symptoms such as sore throat, fever, odynophagia, and tonsillar erythema or exudate. Viral tonsillitis is often self-limiting; however, bacterial causes most notably Streptococcus group A can lead to significant complications, including peritonsillar abscess, acute rheumatic fever, and poststreptococcal glomerulonephritis. Prompt and accurate diagnosis is essential to distinguish viral from bacterial etiologies. Clinical scoring systems, such as the Centor or McIsaac criteria, and microbiological testing, help guide appropriate management and reduce unnecessary antibiotic use. Early identification and intervention are critical to preventing complications and promoting effective recovery. In conclusion, the prognosis for acute tonsillitis is generally good, with most cases healing on their own without complications.

In recent years, the incidence of severe Streptococcus pyogenes (group A Streptococcus, GAS) infections has been increasing worldwide, similar to trends observed prior to the COVID-19 pandemic, alongside a rise in antibiotic resistance. In the present study, we identified the circulating 12 emm types and 8 clusters of 70 GAS isolates among inpatients, investigated their association with antibiotic susceptibility, and compared these findings with earlier research conducted in our country. The predominant emm types and clusters were emm1, emm3, and emm4, and A-C3, E4, and, A-C5, respectively. emm1 was the most common among patients with skin and soft tissue infections or pneumonia, while emm3 was detected in patients with peritonsillar abscesses. All isolates demonstrated susceptibility to penicillin and linezolid, whereas the prevalence of resistance to macrolides, lincosamides, and tetracyclines was found to be 14.3%, 14.3%, and 18.6%, respectively. A notable change in the distribution of emm-types/clusters has been observed, with emm1/A-C3 now identified as the most prevalent, differing from our previous study conducted in the pre-COVID-19 period. Additionally, we noted a decrease in resistance to macrolides attributed to a lower prevalence of emm28 clone. The current research is important for monitoring isolates responsible for severe infections, which is crucial for GAS surveillance.

Medical Therapy Algorithm With Telehealth Reduces Procedures and Transfers for Peritonsillar Abscess.

&lt;b&gt;Introduction:&lt;/b&gt; The COVID-19 pandemic significantly altered healthcare-seeking trends, leading to reduced emergency department (ED) visits and changes in referral patterns. By temporally distancing from the pandemic, healthcare utilization trends might be re-explored.&lt;b&gt;Aim:&lt;/b&gt; This study aims to analyze the epidemiologic trends of ear, nose, and throat (ENT) cases at the ED of a tertiary hospital in Crete, Greece, after the COVID-19 pandemic. It investigates changes in patient visit patterns, referral trends, and hospitalization rates.&lt;b&gt;Materials and methods:&lt;/b&gt; A prospective design data collection was conducted on all patients examined by an ENT specialist in the ED of the tertiary hospital of Crete during 2024. Data collected included patients' demographics, diagnosis (ICD-10 coded), referrals, and patient outcomes. Specific Hospitalization Index (SHI) was calculated as a rate of the total cases admitted for a specific ICD-10 by all visits recorded for that ICD-10.&lt;b&gt;Results:&lt;/b&gt; A total of 6,000 patients were examined. The most common diagnoses were acute otitis media (8.1%) and external otitis (7.0%). A total of 373 hospital admissions (6.2%) were recorded, with peritonsillar abscess (91 cases, SHI: 0.892) being the leading cause of in-hospital treatment, followed by vestibular neuronitis (29 cases, SHI: 0.617) and Bell's palsy (26 cases, SHI: 0.268). A total of 196 referrals (3.3%) were recorded, with 49.6% originating from public primary care. A decline was observed in referrals, from public primary care settings, to the same hospital, when compared with 2023 data (p = 0.013).&lt;b&gt;Conclusions:&lt;/b&gt; This study underscores the significant role of ENT emergencies for ED workload, indicating a return to pre-pandemic levels of ED overcrowding. The most common diagnoses recorded provided a low SHI, suggesting that they could be managed on an outpatient basis. Future research should focus on enhancing primary care in managing ENT cases to reduce unnecessary ED visits.

Prompt diagnosis of a peritonsillar abscess (PTA) is critical to prevent complications such as airway compromise. Bedside drainage and medical therapy are the mainstays of treatment, but there is a lack of research into clinical and radiographic markers that are predictive of successful PTA drainage. In this study, we sought to identify those factors. We retrospectively analyzed all patients who presented to our Emergency Department from January 2013 to December 2023 with PTA for whom a CT neck was obtained. Patient demographics, medical history, radiographic imaging, procedures performed, and clinical course were collected. A multivariable analysis was run to determine which factors were predictive of successful PTA drainage. One hundred thirty-two patients met inclusion criteria. There were 72 males. The mean age was 41 years. Patients who had successful PTA drainage had larger abscesses (largest cross-sectional dimension 26.38 vs. 20.02 mm, p < 0.001). They were also more likely to have soft palate effacement (53.7% vs. 34.0%, p = 0.028) and continuous ring enhancement on CT (75.0% vs. 50.9%, p = 0.003), whereas patients who had unsuccessful drainage were more likely to have higher temperature (99.40°F vs. 98.67°F, p = 0.003). Clinical and CT parameters were useful in predicting successful PTA drainage. Soft palate effacement, continuous ring enhancement, and size of abscess were statistically significant predictors and can be used to guide management.

Palatine tonsils are part of the Waldeyer's ring and consist of lymphoid tissue. As a first-line immune system mechanism, they act against entering pathogens. They recognize and initiate an immune response to exogenous antigens. Tonsillar disease in children, particularly inflammatory conditions, is well known in the medical community. Inflammatory diseases include conditions such as tonsillitis and peritonsillar cellulitis and other more complicated diseases such as intratonsillar abscess, peritonsillar abscess, and parapharyngeal abscess. Their treatment varies, with more severe cases often requiring intervention when antibiotic therapy is insufficient. Prompt differential diagnosis should be performed to prevent the misdiagnosis of life-threatening conditions, including neoplastic disease, which may present with clinical and imaging findings mimicking an inflammatory process. An intraoral or transcutaneous ultrasonographic approach in such patients can help differentiate cases that eventually require intervention, without the risk of ionizing radiation. This article aims to analyze the ultrasound findings of normal tonsillar tissue and to categorize abnormal findings indicative of tonsillar disease.

Pharyngitis is an upper respiratory tract condition common in both general and specialist clinics. Though the majority of cases are viral, bacterial pharyngitis led by Streptococcus pyogenes (group A streptococcus) still forms a major percentage of infections with a risk for severe complications like rheumatic fever and peritonsillar abscesses. Knowledge of the pathogens, epidemiological trends, and treatment strategies would ensure optimal care and prevent antibiotic misuse. The purpose of this review is to describe what is currently known about the bacterial etiologies of pharyngitis while narrowing the more likely causative organisms—Streptococcus pyogenes, Mycoplasma pneumoniae, and Fusobacterium necrophorum. It then discusses global and regional epidemiological trends plus how age, seasonal timing, and socioeconomic status factor into disease prevalence. This paper reviews treatment strategies. It discusses the use of empiric antibiotics based on evidence, antimicrobial resistance, clinical scoring systems, and rapid diagnostics in guiding treatment. Antimicrobial resistance is a global problem increasingly pressing that has not left bacterial pharyngitis untouched as timely and adequate management depend on accurate diagnosis. Thus, recent evidence consolidated here offers clinicians as well as investigators an updated comprehensive insight into bacterial pharyngitis toward improved disease targeting through enhanced precision in diagnosis and appropriate therapeutic decision-making besides public health measures in transmission control and antimicrobial resistance.

Background The impact of COVID-19-related nonpharmaceutical interventions (NPI) on the bacterial composition of upper airway infections remains largely unexplored. Objectives We aimed to investigate the incidence and microbiology of peritonsillar abscess (PTA) following the cessation of NPI and to compare these findings with the periods before and during NPI implementation. Methods We performed a cross-sectional analysis of all PTA cases and their microbiological findings from 12 March, 2018 to 11 March, 2024, among patients admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Patients were categorised into three two-year periods in relation to NPI. Age-stratified population data for the catchment area were sourced from Statistics Denmark. Results A total of 1,030 patients were included. The annual incidence rate of PTA was significantly higher post-NPI (26.9 cases/100,000) compared to both the NPI period (14.9 cases/100,000, p < 0.001) and the pre-NPI period (21.8 cases/100,000, p = 0.003). Increased post-NPI rates were observed across all age groups. The number of cases positive for Streptococcuspyogenes and Fusobacterium necrophorum increased post-NPI (n = 102 and n = 89, respectively) compared to during the NPI period (n = 28 and n = 64, p < 0.001 and p = 0.052, respectively) and pre-NPI (n = 67 and n = 60, p = 0.009 and p = 0.021, respectively). Statistically non-significant increasing trends were found for less prevalent bacteria. Conclusion Following NPI cessation, PTA incidence rates surpassed both the NPI and pre-NPI levels. The rising PTA incidence rates post-NPI were primarily driven by an increasing number of cases positive for S. pyogenes and F. necrophorum, suggesting an immunity debt to these prevalent pathogens.

This pilot randomised controlled trial evaluated virtual reality as a supplementary teaching tool for peritonsillar abscess drainage among third year medical students. Twenty students were randomised to virtual reality-based or traditional teaching, each receiving a 90-minute session followed by an objective structured clinical examination and pre-/post-session knowledge tests. The virtual reality group used HTC Vive Focus 3 headsets with Virti, 3D Organon and EXR platforms. The virtual reality group scored higher in objective structured clinical examinations (26.9 vs. 21.5; p = 0.005) and reported greater procedural confidence (p = 0.008) and engagement (p = 0.003). Both groups improved knowledge (p < 0.001) without significant difference post-session (p = 0.701). Virtual reality was rated highly for effectiveness (9.6/10) and immersion (8.5/10) and had minimal cybersickness (1.8/10). Virtual reality significantly enhances procedural confidence and performance. Its immersive format supports integration into surgical education, warranting further validation in larger studies.

Peritonsillar and cervical infections, such as peritonsillar phlegmon and laterocervical abscesses, are serious complications of oropharyngeal infections. Although poor dental status and inadequate oral hygiene are recognized risk factors, their association with infection severity remains insufficiently explored. This study aimed to assess the relationship between dental status and the clinical severity and management of peritonsillar and cervical infections. In this retrospective cohort study, hospitalized patients diagnosed with peritonsillar phlegmon, laterocervical/submandibular abscess, or peritonsillar abscess were included. Clinical and biological data, including dental work, dental implants, dentition quality, treatment, and hospitalization duration, were analyzed. Statistical tests and regression analyses were performed to explore associations between dental status and infection-related outcomes. Patients with prior dental work or compromised dentition more frequently underwent complex treatments, including corticosteroids. Absence of dental implants was associated with increased antibiotic use and prolonged hospitalization. Although patients with poor dentition required corticosteroids less frequently, they presented more severe infection patterns. Dental status may be associated with differences in infection severity and treatment patterns among patients with peritonsillar and cervical infections. These findings underscore the potential value of maintaining good oral health as part of a multidisciplinary approach involving ENT specialists and dental professionals.

Objective: In this study, tonsillectomy indications and post-tonsillectomy complications were discussed in the light of the literature. Material and Method: A retrospective file review of 775 patients who underwent tonsillectomy was performed between January 2014 and January 2024. Demographic data, preoperative indications, perioperative and postoperative complications of the patients were accessed from hospital records. Results: Of the 775 patients who underwent tonsillectomy, 459 (59.2%) were male and 316 (40.8%) were female. Of the 630 pediatric patients, 404 (64.1%) were operated on for obstruction, 209 (33.1%) for recurrent tonsillitis, 11 (1.7%) for suspected malignancy, and 6 (0.9%) for Periodic Fever-Aphthous-Stomatitis-Pharyngitis-Adenitis (PFAPA) Syndrome. Of the 145 adult patients, 67 (46.2%) were operated on for recurrent tonsillitis, 39 (26.9%) for obstruction, 32 (22.1%) for suspected malignancy, 4 (2.7%) for peritonsillar abscess, and 3 (2.1%) for chronic caseous tonsillitis. In the postoperative period, bleeding was detected in 18 (2.8%) of 630 pediatric patients and oral intake disorder was detected in 4 (0.6%). Postoperative bleeding complications were observed in 15 (10.3%) of 145 adult patients. Conclusion: In our study, obstruction was seen as the primary indication for surgical intervention in the pediatric patient group, while infectious causes were seen in the adult patient group. The most common complication was bleeding. Tonsillectomy is an operation in which good planning of surgical indications and good postoperative follow-up are important.

Peritonsillar abscess (PTA) is a prevalent infection for specialists in otorhinolaryngology and pediatric primary care providers, that has the potential to cause severe complications. The aim of this study is to investigate the surgical treatment of pediatric peritonsillar abscesses and to compare the risk profiles of bilateral surgery versus surgery on the affected side alone. In addition, the evaluation of the microbiological smears obtained intraoperatively should provide information on whether the calculated antibiotic therapy adequately covers the microbial spectrum. We conducted a retrospective analysis of pediatric patients (n = 150), who were treated for PTA between 2009 and 2024 by unilateral tonsillectomy (UTE) or bilateral tonsillectomy (BTE). Patient charts were analyzed regarding risk of bleeding, occurrence of other complications, recurrence rates in case of UTE as well as microbiological flora and antibiotic treatment. Postoperative bleeding did not differ significantly between both groups. In 4.4% of the patients treated by UTE a recurrent PTA was found. No other severe complications after surgical treatment were found. Antibiotic treatment mainly relied on Cefuroxime and Ampicillin-Sulbactam, which is in accordance with the detected microbiological flora. No relevant differences were found with regard to the complication rate between UTE und BTE in pediatric patients. Broad-spectrum antibiotics were used in accordance with the detected microbiological flora. Since 2019, calculated antibiotic therapy with Ampicillin-Sulbactam has been the treatment of choice for pediatric PTA.

Risk of internal carotid injury during Peritonsillar abscess drainage in the emergency department.

Expression of concern: "Peritonsillar abscess complicated by internal carotid artery aneurysm in a pediatric patient with congenital hypoplastic posterior communicating artery: A case report" [Int. J. Surg. Case Rep, volume 130C, 111251

Background: Peritonsillar abscess is the most prominent outcome of acute tonsillitis, affecting adults aged 15 to 35 years. This acute infection causes pus to build up in the peritonsillar tissue, which is typically caused by recurrent infections or untreated tonsillar cellulitis, particularly around the tonsil's upper pole. The primary clinical signs include discomfort in the throat, fever, trouble swallowing, and unilateral tonsillar enlargement, which may be accompanied with trismus. Prompt care through early identification and treatment with incision, drainage, and antibiotics is critical to avoiding significant complications such as infection spread to surrounding tissues and breathing blockage. Objective: To provide an overview of a peritonsillar abscess in an adult patient, and also address the diagnosis, treatment, and outcome of the incision and drainage therapy. Case Report: A 28-year-old male came with a persistent painful throat for one week that had deteriorated during the previous three days, along with a high fever, inability to swallow solid food, difficulty opening his lips, and a muffled voice (hot potato voice). The examination revealed edema in the left peritonsillar region, with the uvula displaced to the right, as well as bilateral tonsillar hypertrophy. Laboratory tests revealed leukocytosis, but a chest X-ray revealed no abnormalities. The patient had an abscess incision and drainage surgery, and pus samples were collected for culture and sensitivity testing. Intravenous antibiotics and supportive care were given, followed by a scheduled tonsillectomy. The patient's symptoms improved following the surgery, and he felt better throughout the follow-up visit. Clinical question: What is the diagnosis enforcement and management of a patient with peritonsillar abscess? Methods: Evidence-based literature study of diagnosis enforcement and management of a patient with peritonsillar abscess. Result: In the last 10 years, five key studies provided insights into diagnosing and managing peritonsillar abscess. Diagnosis relies on clinical signs, physical exam, and procedures like needle aspiration or imaging (ultrasound and CT). Ultrasound enhances diagnostic safety and guides treatment, while CT is useful in complex cases but may delay care. Broad-spectrum antibiotics targeting group A streptococcus and anaerobes are essential, with macrolides avoided due to resistance. Conclusion: A 28-year-old adult was diagnosed with a left peritonsillar abscess, presenting with uvular deviation, enlarged tonsils (T2/T4), and left-sided peritonsillar fluctuation and edema. Aspiration yielded pus and blood, followed by successful incision and drainage. The patient recovered well with antibiotics and routine drainage and is scheduled for a tonsillectomy.