Bilateral Peritonsillar Abscesses: A Case Presentation and Review of the Current Literature with regard to the Controversies in Diagnosis and Treatment

Abstract

Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.

Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess

“…Needle aspiration alone may sometimes represent an appropriate treatment regimen, but a higher rate of recurrence will occur and incision and drainage may still be required [18]. Immediate tonsillectomy should be considered, particularly in cases of bilateral PTA [15,19]. In the present study, early surgical drainage was the most important factor for both early relief of symptoms and shorter stay in the hospital.…”

“…However, the definitive treatment of PTA remains controversial. Conservative treatment is performed before taking the risk of surgical drainage, particularly in patients with inferior pole peritonsillar abscess who are immunocompetent and have no significant systemic diseases [14,15]. Although some cases can be treated successfully using conservative treatment alone, the length of the hospital stay is likely to be longer [6].…”

Indications for tonsillectomy stratified by the level of evidence

“…According to Templer, diagnosis of PTA is based on the evidence of pus, otherwise the term of peritonsillitis should be used [289]. Bilateral PTA has been reported in rates of 0.8% [260], [266], [290], 1.0% [267], [291], 1.8% [270], 3.88% [292] and even 4.9% [293], [294], respectively.…”

Absceso periamigdalino bilateral en pediatría: reporte de un caso

“…La bibliografía se limita a reporte de casos. 1,4,[7][8][9][10] Se ha informado con mayor frecuencia (el 1,9-24 %) el hallazgo de una colección contralateral, no manifiesta clínicamente, durante amigdalectomías "en caliente" realizadas por abscesos unilaterales. Se postula que este hallazgo puede corresponderse a diferentes momentos evolutivos de la patología presente en ambos espacios periamigdalinos.…”

“…Además, la incidencia de esta forma atípica de presentación es mayor en los adultos y es poco común en los niños. 4 Clínicamente, presenta síntomas sistémicos de infección, odinofagia, trismus, sialorrea y voz gutural, y se evidencia, en el examen físico, abombamiento de ambos pilares anteriores, edema del paladar blando y la úvula, la cual se ubica en la línea media. A diferencia de su presentación unilateral, no se evidencian asimetrías en la exploración de las fauces, situación que puede generar dificultades en la sospecha diagnóstica, con la consiguiente demora en el inicio del tratamiento.…”