Bilateral peritonsillar abscesses

Abstract

In the discussion about the management of the peritonsillar abscess (PTA) in regard to the pros and cons of tonsillectomy à chaud versus à froid, the risk of obscure contralateral abscesses is often neglected. To the authors' knowledge, there are only a few series of PTA being analyzed for the abscess rate of bilateral PTA. A group of 541 abscess tonsillectomies was retrospectively analyzed for the presence of a bilateral manifestation of peritonsillar abscess. Twenty-one patients (3.88%) had bilateral abscesses. None of these had been detected prior to the operation. Of the 541 patients, 2.22% had postoperative hemorrhages that had to be arrested under general anesthesia. Within the discussion about abscess tonsillectomy versus stab incision followed by interval tonsillectomy (à froid), the rate of almost 4% bilateral abscesses should be taken into consideration as dangerous complications such as mediastinitis could develop from the remaining abscess formation of the contralateral side.

Bilateral Peritonsillar Abscesses: Our Experience and Clinical Features

“…The incidence of bilateral PTAs was slightly higher in the current report than in the reports by Dalton et al" and Lehnerdt et al 5 However, our conclusion on the incidence of bilateral PTAs was similar to that of Lehnerdt et al 5 Bilateral PTAs are not rare, and that fact must be considered in discussing therapeutic concepts.…”

A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation

“…Understanding factors that promote the growth and colonization of key PTA pathogens should not only lead to a more effective and standardized management of PTA, but also provide hormonal effect on local immunity and/or microfloral composition (8,57) lower incidences of GAS infections in those over 40 years of age (8) highest incidence of fusobacterial PTA infections is in young adults (35) lifestyle high incidence of other fusobacterial infections in young adults (8,42,44,64) tonsillar crypt size (41) Gender higher PTA incidence in males than females in a 3: 1 ratio retrospectively for: (27,58,63,65) males have larger oropharyngeal features (41) ear/nose/throat GAS infections are more common in males than females (8) fusobacterial infections suggested to be more common in males (8,64) high incidence of SMG infections in males (25,47) against (gender as a non-significant factor): (36,56,57,59,62) females have better oropharyngeal immunity prior to middle age (66) lifestyle (25) (5,10,25,36,51,69,(77)(78)(79) linked to periodontal disease and other head and neck infections (25,71,80) promotes growth (84) promotes growth (25) suppresses local humoral immunity (81) lower densities of normal flora (82, 83) disruption of mucosal barrier (5,…”

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.…”