An evidence‐based review of peritonsillar abscess

Powell, Jason; Wilson, Janet A.

doi:10.1111/j.1749-4486.2012.02452.x

Cited by 128 publications

(140 citation statements)

References 49 publications

(71 reference statements)

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“…Many authors recommend tonsillectomy even in the absence of the other classical indications for surgery (recurrent tonsillitis, dysphagia, snoring and sleep apnea), while others argue that the procedure may expose patients unnecessarily to the related risks of general anesthesia, surgery and post-operative hemorrhage, given the low recurrence rate of PTAs not treated surgically [12][13][14]. This means, as stated by Powell et al [15], that further good-quality evidence is needed on quinsy recurrence rates to enable betterinformed decision making regarding the need for tonsillectomy.…”

Section: Introductionmentioning

confidence: 84%

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

Bovo

Barillari

2015

Eur Arch Otorhinolaryngol

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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.

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Section: Introductionmentioning

confidence: 84%

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

Bovo

Barillari

2015

Eur Arch Otorhinolaryngol

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“…Investigations have shown that intraoral ultrasounds have a high specificity and sensitivity for correctly diagnosing a PTA. Unfortunately, this tool is currently underutilized [8]. The use of adjuvant steroids has been shown to reduce hospitalization time and reduce symptoms, yet much of this is anecdotal and further studies are needed [6].…”

Section: Discussionmentioning

confidence: 99%

“…The use of adjuvant steroids has been shown to reduce hospitalization time and reduce symptoms, yet much of this is anecdotal and further studies are needed [6]. The accepted surgical management continues to be needle aspiration or incision and drainage, however, no overwhelming evidence in favor of one or the other exists [8]. Quincy tonsillectomy, although infrequently performed, has been shown to be safe and to reduce recovery time when compared to interval tonsillectomy [2].…”

Section: Discussionmentioning

confidence: 99%

“…Quincy tonsillectomy, although infrequently performed, has been shown to be safe and to reduce recovery time when compared to interval tonsillectomy [2]. The recurrence rates vary between 10% and 22% [6,8].…”

Section: Discussionmentioning

confidence: 99%

“…Most PTAs resolve with simple medical and surgical management, but few can lead to life-threatening complications such as airway obstruction, abscess rupture, aspiration of pus, septic necrosis, or extension into deep neck tissues or posterior mediastinum [8]. Also of note, PTAs can develop into Lemierre's syndrome which is typically characterized by evidence of internal jugular vein thrombosis and isolation of anaerobic pathogens, mainly Fusobacterium necrophorum [7].…”

Section: Introductionmentioning

confidence: 99%

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Peritonsillar Abscess with Internal Carotid Artery Stenosis

Gal¹,

Hsu²,

Mallon³

et al. 2014

Journal of Case Reports in Medicine

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Peritonsillar abscesses are the most common deep infections of the head and neck in young adults, despite the widespread use of antibiotics for treating tonsillitis and pharyngitis. Peritonsillar abscesses can be treated effectively with swift medical and sometimes surgical intervention. There are many complications of peritonsillar abscesses, some of which may be fatal due to the proximity of major vasculature. Here we present a case of a patient with a peritonsillar abscess that resulted in stenosis of the internal carotid artery without neurological sequelae. To our knowledge, this is the first reported case in the otolaryngology literature.

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Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage

Mallen

Shah

Drake

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCETelemedicine is rapidly gaining traction as a way to reduce costs and connect patients with medical experts outside their local communities. Peritonsillar abscess (PTA) is a logical pathologic condition to evaluate for effectiveness of remote diagnosis given its prevalence and the paucity of on-site otolaryngologists at many institutions.OBJECTIVE To explore the potential of otolaryngology telemedical consultation in triaging and diagnosing patients with suspected PTA. DESIGN, SETTING, AND PARTICIPANTSA comparative effectiveness research study was conducted from January 1 to June 30, 2018, at 3 tertiary care hospitals among 31 consecutive patients aged 18 to 85 years for whom the otolaryngology department was consulted to assess for PTA. Statistical analysis was conducted from July 1 to September 30, 2018.INTERVENTIONS Telemedical evaluation of suspected PTA by 5 attending otolaryngologists blinded to patients' history aside from the chief report of odynophagia. Otolaryngologists rated each patient video on whether they believed the patient had a PTA and whether the case warranted prompt evaluation by an otolaryngologist. Predictions were compared with the criterion standard of drainage or negative needle aspiration. Otolaryngologists additionally assessed video quality. MAIN OUTCOMES AND MEASURESRates of accurate diagnosis and triage of PTA based on otolaryngologists' review of oropharyngeal examinations recorded using standard smartphone cameras, as well as percentage of videos of oropharyngeal examinations using standard smartphone cameras deemed of sufficiently high quality for clinical decisionmaking.RESULTS A total of 31 patients (16 women [51.6%]; mean age, 31.9 years [range, 18-62 years]) were recruited, and 16 patients (51.6%) had a PTA. Comparing otolaryngologists' predictions with PTA status by the criterion standard, the prediction was consistent with that of the criterion standard 81% of the time averaged across otolaryngologists (mean diagnostic accuracy, 0.81). Similarly, the mean diagnostic accuracy was 0.83 when comparing the otolaryngologist's suggestion for a prompt in-person evaluation with actual PTA status by the criterion standard. Comparing patients who were deemed to require prompt otolaryngology evaluation and those with PTA by the criterion standard, mean sensitivity was 90%. Videos were rated as of sufficiently high quality to make a diagnosis in 154 of 155 videos (99.4%). CONCLUSIONS AND RELEVANCEThis study suggests that telemedical consultation is a viable, cost-conscious, efficient, and safe approach to PTA management. Despite having some difficulty diagnosing PTAs based on "history concerning for PTA" and oropharyngeal video alone, otolaryngologists are able to determine, with high sensitivity, which patients require prompt otolaryngology evaluation. The recording of consistently high-quality video using a standard smartphone camera is achievable without formal training.

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An evidence‐based review of peritonsillar abscess

Cited by 128 publications

References 49 publications

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

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

Peritonsillar Abscess with Internal Carotid Artery Stenosis

Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage

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