Recurrent Peritonsillar Abscess Research Articles

Peritonsillar Abscess Outcomes with and Without Computed Tomography: A Retrospective Cohort Study.

Peritonsillar abscess (PTA) is a common deep space head and neck infection, which can be diagnosed with or without computed tomography (CT). CT poses a risk for false positives, leading to unnecessary abscess drainage attempts without benefit, whereas needle or open aspiration without imaging could potentially lead to missed abscess in need of treatment. This study considered the utility and impact of obtaining CT scans in patients with suspected PTA by comparing outcomes between CT and non-CT usage. Retrospective cohort analysis using TriNetX datasets compared the outcomes of two cohorts: PTA without CT and PTA with CT. Measured outcomes included incision and drainage; quinsy adenotonsillectomy; recurrent PTA; airway emergency/obstruction; repeat emergency department (ED) visits; and need for antibiotics, opiates, or steroids. Odds ratios (OR) were calculated using a cohort analysis. The CT usage group had increased odds of receiving antibiotics (OR 3.043, [2.043-4.531]), opiates (OR 1.614, [1.138-1.289]), and steroids (OR 1.373, [1.108-1.702]), as well as a higher likelihood of returning to the ED (OR 5.900, [3.534-9.849]) and developing a recurrent PTA (OR 1.943, [1.410-2.677]). No significant differences were observed in the incidence of incision and drainage, quinsy adenotonsillectomy, or airway emergency/obstruction. Our study indicated that CT scans for PTA diagnosis were associated with increased prescription of antibiotics, opioids, steroids, return ED visits, and recurrent PTA. Future prospective trials are needed to determine if the use of CT scans indicates higher patient acuity that explains the potential negative outcomes. Level II Laryngoscope, 2024.

Recurrent Peritonsillar Abscess Caused by Vaginal Flora: A Common Problem From a Unique Source.

Peritonsillar abscesses (PTAs) are typically caused by group A Streptococcus or mixed oral flora. Gardnerella vaginalis is a part of the normal vaginal microbiome, and overgrowth can cause bacterial vaginosis. We present a case of recurrent PTA with G. vaginalis superinfection, which occurred after the patient performed oral sex on a female after incision and drainage of her initial PTA. The patient continued to have recurrent PTAs until G. vaginalis was identified, and antibiotic coverage was broadened to cover both group A Streptococcus and G. vaginalis. This case highlights the importance of culturing PTA aspirate for directed antibiosis in persistent or recurrent infections. The rare superinfection also raises the question of advising abstinence from oral-genital contact after oral procedures to minimize risk of superinfection.

Adalimumab (Humira®) Induced Recurrent Peritonsillar Abscess in A Patient Received Three Different Anti-TNF Therapies: A Case Report

Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response. Therefore, physicians should be careful about recurrent infections in patients under anti-tumor necrosis factor agents.

Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis.

Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia. This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors. A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate (P = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; P = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; P = .006). This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.

Tonsillar colonisation of Fusobacterium necrophorum in patients subjected to tonsillectomy.

BackgroundFusobacterium necrophorum is a well-known cause of Lemirre’s disease and accumulating evidence support its pathogenic role in peritonsillar abscess while its role in recurrent and chronic tonsillitis is uncertain. The objective of this study was to assess the prevalence of oropharyngeal colonisation with F. necrophorum and Beta-haemolytic streptococci in a cohort of patients scheduled for tonsillectomy due to recurrent or persistent throat pain, and to evaluate the dynamics of colonisation with repeated sampling during a follow-up time of 6 to 8 months.MethodsFifty-seven (57) patients aged 15–52 years scheduled for tonsillectomy due to chronic/recurrent tonsillitis or recurrent peritonsillar abscess were included. Throat swabs for the detection of F. necrophorum and Beta-haemolytic streptococci and clinical data was collected at inclusion, at the time of surgery and 6 to 8 months after surgery. Statistical analysis was performed using the Chi-square, Fisher’s exact and Mc Nemar tests.ResultsFusobacterium necrophorum was found in 28, 30 and 16 % of the patients at inclusion, surgery and follow up respectively. The corresponding results for beta-haemolytic streptococci were 5, 9 and 5 %. Patients colonised with F. necrophorum at follow-up, after tonsillectomy, were equally relieved from their previous throat pain as non-colonised patients. Looking at individual patients, the culture results for F. necrophorum varied over time, indicating a transient colonisation.ConclusionFusobacterium necrophorum was frequently found in throat cultures in this cohort of patients with recurrent or chronic throat pain leading to tonsillectomy. Colonisation was equally frequent in the asymptomatic cohort post-tonsillectomy, indicating that F. necrophorum is not alone causative of the symptoms. In an individual perspective, colonisation with F. necrophorum was transient over time.

Treatment and Long‐term Follow‐up of Peritonsillar Abscess

Objectives: Study the therapeutic management, recurrence, and need of tonsillectomy in Peritonsillar abscess. Study design: Retrospective study and long term telephone survey. Setting: Otolaryngology Head and Neck Surgery Department at Shaare Zedek Medical Center, Jerusalem, Israel. Methods: Review of 117 files of patients diagnosed with peritonsillar abscess who underwent needle aspiration obtaining pus were hospitalized at our department between the years of 2004 to 2007, and were followed at least four years after their discharge date. Results: One hundred four patients (89%) improved without any other intervention. Thirteen patients (11%) underwent an additional procedure such as aspiration and/or incision and drainage. After the needle aspiration, the patients were treated with intravenous antibiotic treatment: penicillin or broad spectrum antibiotics, amoxicillin-clavulanate, or a combination of metronidazole and cefuroxime. There was no clinical distinction between the various groups. A hundred and five patients (90%) were followed up by telephone call, obtaining the following information: 88 patients (84%) had no recurrence. The remaining 17 suffered recurrence; most of them, 9 patients, had only one. 18 patients underwent tonsillectomy; 13 due to recurrent peritonsillar abscess and 5 due to recurrent tonsillitis. Conclusions: 1) Needle aspiration is an effective treatment for peritonsillar abscess. 2) The supplementary antibiotic treatment with penicillin was satisfactory, and no advantage was found to the broad-spectrum antibiotic treatment. 3) A sweeping recommendation for tonsillectomy is not required after a single episode. Surgery should be recommended only after two or more episodes of peritonsillar abscess.

Involvement of Minor Salivary Glands in the Pathogenesis of Peritonsillar Abscess

To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. Prospective population-based study. Tertiary care university hospital. Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group (P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L (P = .01). High amylase in the pus lends further support for involvement of minor salivary glands. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection. It is possible that both minor salivary glands as well as tonsillar infection play a role in the pathogenesis of peritonsillar infections.

Infected Branchial Cleft Cyst Presenting as a Recurrent Peritonsillar Abscess

Objective: Peritonsillar abscess (PTA) is the most common deep infection of the head and neck in young adults. The incidence of recurrent unilateral PTA is extremely low, and a patient with recurrent unilateral PTA development deserves a more vigorous workup for other pathologic entities, including branchial cleft cysts (BCC). Method: We describe a unique clinical case illustrating the workup and diagnosis of a patient presenting with “recurrent unilateral PTA” that actually turned out to be a second BCC. We discuss the necessity to keep a broad differential when evaluating patients presenting with “classic” symptomatology. Results: A 40-year-old male presented to the emergency department with a history of 5 previous right-sided PTAs. The patient was again treated for “recurrent PTA” due to computed tomography (CT) scan and physical examination findings. An outpatient CT scan later showed a residual fluid collection in the peritonsillar and parapharyngeal space. The patient was subsequently taken to the operating room for a definitive exploration where a second BCC was discovered and removed. Conclusion: BCCs may be asymptomatic but commonly present as recurrent infected neck abscesses. In any patient who presents with recurrent unilateral PTAs, a broader differential diagnosis should be formulated (including BCC), and necessary imaging studies should be ordered to properly classify and treat these individuals.

Microbiology of Peritonsillar Abscess as an Indication for Tonsillectomy

No conclusive data are available regarding the influence of the microbial content of a peritonsillar abscess (PTA) on the development of recurrence. We conducted the current study to evaluate the effect of microbiologic growth on the recurrence rate of PTA and the need for tonsillectomy. Of 469 patients with PTA, 295 patients who underwent bacteriologic studies were subdivided into 2 groups, nonrecurrent group (273 patients) and recurrent group (22 patients), and their results were compared. A higher rate of anaerobic growth (10 anaerobic pathogens, 57.1% of total pathogens found) was identified in the recurrent PTA group compared with the nonrecurrent group (39 anaerobic pathogens, 45.8%), with a higher rate of anaerobic growth in the recurrent group in the first episode (60% vs. 45.8% in the nonrecurrent group) (odds ratio, 1.76; sensitivity, 80%; specificity, 45%). Anaerobic bacterial growth correlates with a higher rate of recurrence, and may serve as an additional relative indicator for tonsillectomy.

Coblation®: Improving outcomes for children following adenotonsillectomy

Tonsillectomy and adenoidectomy, 2 of the most common childhood surgeries, are performed for a number of indications, the most common being airway obstruction caused by adenotonsillar hypertrophy. Other indications for tonsillectomy include recurrent pharyngotonsillitis, streptococcal carriage, recurrent peritonsillar abscess, halitosis, and presumed neoplasia. Although adenotonsillar surgery is a safe and effective technique for treating disease and obstruction, parents remain concerned about postoperative morbidity, for which the potential is much greater after tonsillectomy than adenoidectomy. Postoperative pain and hemorrhage are 2 unpleasant side effects that can prolong postoperative recovery. Surgeons use a variety of surgical techniques to remove the tonsils and adenoids. When compared with older techniques, such as cold steel dissection and monopolar electrocautery, a new technique named Coblation that uses lower temperatures than electrocautery to remove tonsil tissue and achieve hemostasis, has been shown to reduce pain and decrease postoperative narcotic use, leading to shorter recovery times and a quicker return to normal in children.

扁桃周囲膿瘍１０３例の臨床的分析

One hundred three patients with peritonsillar abscess treated between January 2001 and June 2005 were clinically analysed. Seventy-four patients were male and 29 were female. The male to female ratio was 2.5:1. Patient ages ranged from 10 to 76 years old. The average age was 32.4 years old. Fourty nine patients were affected in the right side, and 54 in the left side. Sixty-four of 103 patients were referred to us by other doctors. The local findings deteriorated during the course of treatment in 4 of 103 patients are these four patients developed recurrent peritonsillar abscess. Only 2 patients were diabetic.All patients were treated with a peritonsillar incision and retropharyngeal incision if retropharyngeal abscess was seen, and at the same time antibiotics were administered intravenously. The most common etiological bacteria was Genus Streptococcus viridans seen in 32 patients, i. e. 33% of 97 patients examined. The second most common was Streptococcus pyogenes seen in 18 patient.Deep neck infection due to peritonsillar abscess was seen in 8 patients, that is, 8% of this series. Of these 8 patients, all but one were over 40 years old. Four patients had cellulitis and the other 3 had an abscess in the retrophalyngeal space. The former were incised independently from the peritonsillar incision, and the latter were incised from the peritonsillar to retropharyngeal region. Another patient had cellulitis in the parapharyngeal space and was cured with a peritonsillar incision and intravenous antibiotics alone without an external skin incision. This finding was considered an indication that peritonsillar abscess should be correctly treated before deterioration of deep neck infection, especially in patients over 40 years old.

Inside-Out Complete Tonsillectomy: Extended Intracapsular Tonsillectomy for Severe Sore Throat

This consecutive case series is presented to describe inside-out complete tonsillectomy and to assess its effects on postoperative pain and bleeding and its initial effectiveness in controlling recurrent sore throat and peritonsillar abscess formation. Bipolar electrosurgical scissors are used for bloodless resection of 90% of the tonsillar mass. During controlled resection, tonsil tissue is intentionally left at the superior and inferior poles and at the deepest part of the tonsillar fossa to provide coverage for nutrient arteries and the tonsillar plexus of veins. This tissue is then electrodesiccated and removed under direct vision and indirect mirror guidance to achieve complete tonsillectomy. One hundred eighty-three consecutive tonsillectomies were performed by a single surgeon in a 16-month period, 47 of which were for the indication of recurrent sore throat (44) or recurrent peritonsillar abscess (3). Among these 47 children, there were 2 readmissions for dehydration. There were no immediate or delayed bleeding episodes. The average child required 4 days of narcotic pain medication. The mean annualized number of severe sore throats decreased from 5.24 before operation to 0.36 after operation (p < .0001, Student's paired t-test). There were no recurrent peritonsillar abscesses. Inside-out complete tonsillectomy achieves the surgical goal of complete tonsillectomy with the smallest possible wound and minimal injury to the surrounding tissue. The perioperative morbidity is markedly decreased compared to that of historical controls. The initial results suggest effectiveness similar to that of extracapsular tonsillectomy.

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.

Use of bacteriologic studies in the outpatient management of peritonsillar abscess.

To examine whether obtaining bacterial Gram stain and aerobic/anaerobic cultures alters management of patients with peritonsillar abscess. Retrospective study. A total of 221 cases of suspected peritonsillar abscess from July 1990 to February 1999 were analyzed with regard to outcomes and management patterns of those who had bacteriologic studies performed and those who did not. Pus was aspirated in 153 (69%). Eighty-two had bacterial studies performed whereas 71 did not. Of patients that followed up, all patients had complete resolution in the first group based on initial management. Three patients of the latter group had a complicated course secondary to dehydration and antibiotic noncompliance (P =.24). Of the 82 cultures sent, sensitivities were conducted on only 17 (21%). Nine of 17 grew organisms that were penicillin-resistant. No patient in the study had any treatment decisions based on microbiologic studies. In the routine management of peritonsillar abscess, bacteriologic studies are unnecessary on initial presentation. They should be reserved for patients with a high likelihood of infection by resistant organisms, i.e., diabetics, immunocompromised patients, and patients with recurrent peritonsillar abscess.

Immunoglobulin- and complement-coated bacteria in pus from peritonsillar abscesses.

Fifty-five samples of pus were collected from 51 acute, non-perforated, two spontaneously ruptured and two recurrent peritonsillar abscesses (35 males and 18 females; median age 18 years) and analysed regarding (i) aerobic and anaerobic bacteria (standard culturing), (ii) morphology of bacteria and inflammatory cells (direct microscopy of acridine orange-stained material), and (iii) the percentage of bacteria coated with immunoglobulins IgG, secretory IgA (SIgA) and IgM and complement cleavage product C3b (immunofluorescence assay). Seventy-one per cent of the abscesses harboured a mixed bacterial flora of various aerobes and anaerobes. In none of the cases with a single bacterial species (27 per cent) could immunoglobulin- or complement-coated bacteria be found. In abscesses with a mixed flora, 18 per cent harboured IgG-coated, 15 per cent SIgA-coated, five per cent IgM-coated and five per cent C3b-coated bacteria, respectively. All pus samples contained inflammatory cells in abundance but they were mostly deformed and only occasionally could intracellular bacteria be recognized. Insufficient immunoglobulin-coating of bacteria might be an important aetiopathogenic factor in the development of a peritonsillar abscess. Bactericide in the abscesses is accomplished chiefly by protective mechanisms not dependent on antigen recognition by antibodies.

The indication for tonsillectomy in children following peritonsillar abscess

The clinical course of 19 consecutive children treated for peritonsillar abscess (PTA), in the Chaim Sheba Medical Center, between 1988–1992 was retrospectively reviewed. The abscess was drained through an incision (12 children) and by needle aspiration (7 children), under local (11 children) or general (8 children) anesthesia. One child suffered from recurrent bouts of tonsillitis after the abscess resolved and eventually underwent tonsillectomy. Two others, with a pre-PTA history of recurrent tonsillitis (T+) underwent interval tonsillectomy. Recurrent PTA did not develop in any of the 16 non-operated children. The involvement of mainly older children can explain both the low rate of the pre-PTA history of T+ and the number of children whose abscess could be drained under local anesthesia. Tonsillectomy should be indicated in cases of recurrent PTA or in children with a pre-PTA history of T+. The need for general anesthesia for draining the abscess in young children does not seem, in itself, to warrant a routine hot tonsillectomy.

へん桃周囲膿よう様経過を呈したへん桃結石例

Recently we treated a patient with a tonsillolith 8.5 grams in weight which is believed to be the heaviest reported in Japan so far. This 26-year-old male patient visited a hospital complaining of pharyngeal pain with no difficulty in swallowing or trismus. A diagnosis of peritonsillar abscess was made from the local findings. Prior to this episode a stony mass had been expelled from right tonsil spontaneously. Tonsillectomy was indicated for the history chronic angina and recurrent peritonsillar abscess. On the morning of admission the tonsillolith was expelled spontaneously, but tonsillectomy was performed because of chronic angina. The operative findings suggested that the stone had been in the right upper region between the capsule of the tonsil and the superior constrictor muscle. It was yellowish gray and measured 30×26×16mm. Chemical analysis revealed calcium phoshate. In the world literature there have been about 20 reports of large tonsilloliths. This is the largest reported so far in Japan. Our observations and previous reports suggest that recurrent inflammation of the tonsils and peritonsillar tissues promote the accumulation of inflammatory debris in tonsillar crypts, which then become the organic nidus for stone formation. Salts from the saliva may precipitate to form tonsilloliths that gradually increase in size.

へん桃周囲膿よう 近畿大学医学部耳鼻咽喉科１３年間の統計

We reviewed 64 cases of peritonsillar abscess treated at our clinic between May, 1975 and March, 1988. The patients consisted of 42 males and 22 females, aged 3 to 68 years. The abscess was on the right side in 35 cases, on the left in 28 cases and bilateral in 1 case. Bacteriological study of the abscess revealed a high percentage of α-streptococcus and β-streptococcus in aerobic culture, and Bacteroides sp., Peptostreptococcus sp., and Peptococcus., in anerobic culture. All patients were treated with antibiotics. Removal of abscess by puncture was performed in 23 patients, and incision for drainage was perfomed in 41. Interval tonsillectomy was perfomed in 3 patients and immediate tonsillectomy was perfomed in 1 patient. Recurrent peritonsillar abscess was observed in one patient who had not undergone tonsillectomy. Puncture of abscess, incision for drainage and administration of antibiotics are essential in the treatment of peritonsillar abscess.

Peritonsillar Abscesses: A Prospective Study

At the recent Triological Society Eastern Section meeting, Dr Debra Freehling and colleagues, Menlo Park, Calif, presented a prospective analysis of 50 patients who suffered peritonsillar abscesses. The patients were studied to see if their subsequent courses and prior histories justified tonsillectomy. Thirty-three patients were followed up for two years, and 17 patients were excluded due to lack of follow-up. Twenty-three patients were treated only with incision and drainage and antibiotics. Eight patients underwent immediate tonsillectomy for treatment of the abscess, and two patients underwent interval tonsillectomy after recovering from the abscess. During the follow-up period, 79% of the patients had one culture-positive sore throat. Sixty-one percent had one sore throat in the year prior to their abscess. Two patients developed a recurrent peritonsillar abscess during the follow-up period. The authors also looked at the average cost per patient of the illness and its treatment. They found an average cost

Peritonsillar abscess: Recurrence rate and the indication for tonsillectomy

Two hundred ninety patients treated for peritonsillar abscess (PTA) between 1970 and 1982 were reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%). The patients in the first group had four times more recurrences than those in the second group (40% versus 9.6%). Patients older than 40 years were found to have a lower incidence of throat infections than younger patients, and no PTA recurrences were observed. Neither subsequent tonsillitis nor recurrent PTA was observed among 72 patients (25%) who underwent tonsillectomy 6 to 12 weeks after PTA. The pre-PTA history was found to be a dominant factor in determining the need for tonsillectomy. In patients who suffered from recurrent tonsillitis prior to PTA, tonsillectomy is recommended. In those with a single episode of PTA and no history of tonsillitis, tonsillectomy is not indicated.