Recurrent Peritonsillar Abscess Research Articles

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.

Changing face of treatment of peritonsillar abscess.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.

Peritonsillar Abscess: Recurrence Rate and Treatment

• In 161 patients treated for a peritonsillar abscess by stab incision as the only surgical procedure, a follow-up study was conducted after 3½ to eight years. Of all the patients examined, 51% had experienced no throat symptoms, 22% had had recurrent peritonsillar abscesses, 20% had had recurrent episodes of tonsillitis with fever, and 7% had had symptoms resembling episodic pharyngitis in varying degrees. The age of the patient and the patient's history of previous throat infections were found to have prognostic value. Older patients (older than 40 years) had a lower incidence of new throat infections (peritonsillar abscess, tonsillitis, or both) than younger patients. Patients without previous throat symptoms had a lower incidence of new throat infections than patients with a history of throat infection before the peritonsillar abscess, which in itself might indicate the need for tonsillectomy. ( Arch Otolaryngol 1981;107:540-542)

Peritonsillar abscesses in children.

A follow-up retrospective study was performed on 41 children who presented with peritonsillar abscesses from 1970-1980. The ages ranged from 3 to 16 years, with the mean age of 10 years. There were 26 females and 15 males. The abscesses were predominantly left-sided (28 vs. 13 right-sided) and the mean duration of symptoms was 3 days. Of the patients, 39% had been treated with antibiotics prior to the abscess development. Only 15% of the patients had a documented past history of exudative tonsillitis. Of the 41, 1 patient was lost to follow-up, and 11 underwent tonsillectomy for the abscess. Thus, 29 patients were reviewed who received no surgical therapy for their peritonsillar abscess other than incision and drainage. These patients were contacted for an interval history with a period of follow-up ranging from 6 months to 10 years. Only 2 of the 29 patients (7%) had recurrent abscesses. Two other patients (7%) had further recurrent bouts of exudative tonsillitis but not abscesses. These 4 children were in an initial group of 6 who had a prior history of documented tonsillitis. The incidence of recurrent peritonsillar abscesses reported in the literature has ranged from 7.6 to 16% in series which were comprised mainly of adults. The low incidence of recurrent abscesses (7%) in this series would indicate a need to reevaluate the indication for tonsillectomy for peritonsillar abscess in the pediatric age group. The authors recommend that tonsillectomy be performed in those children who present with a previous history of documented tonsillitis or suffer a complication at the time of the first abscess (neck abscess or airway compromise).

Tonsillectomy—Trials and Tribulations

IF three quarters of a million young Americans were being subjected each year to a surgical procedure of doubtful benefit at a cost approaching $1 billion and untold cost in pain, suffering, and psychological trauma, the medical profession might expect a torrent of justifiable criticism. To many, this is an accurate description of the basis for controversy over tonsillectomy and adenotonsillectomy. There are zealots on both sides of the issue. Those who consider themselves purists would permit tonsillectomy or adenotonsillectomy only in cases of carcinoma of the tonsil, recurrent peritonsillar abscess, cor pulmonale due to upper-airway obstruction, and dysphagia and weight loss due to digestive tract obstruction. If these criteria were accepted and enforced, the number of procedures performed annually would be less than 1% of the current rate. At the other end of the spectrum are those physicians who are convinced that tonsillectomy and adenotonsillectomy are effective therapeutic and

Tonsillectomy--trials and tribulations. Report on the National Institutes of Health consensus conference on indications for tonsillectomy and adenoidectomy

IF three quarters of a million young Americans were being subjected each year to a surgical procedure of doubtful benefit at a cost approaching $1 billion and untold cost in pain, suffering, and psychological trauma, the medical profession might expect a torrent of justifiable criticism. To many, this is an accurate description of the basis for controversy over tonsillectomy and adenotonsillectomy. There are zealots on both sides of the issue. Those who consider themselves purists would permit tonsillectomy or adenotonsillectomy only in cases of carcinoma of the tonsil, recurrent peritonsillar abscess, cor pulmonale due to upper-airway obstruction, and dysphagia and weight loss due to digestive tract obstruction. If these criteria were accepted and enforced, the number of procedures performed annually would be less than 1% of the current rate. At the other end of the spectrum are those physicians who are convinced that tonsillectomy and adenotonsillectomy are effective therapeutic and