Epidemiology, clinical history and microbiology of peritonsillar abscess

Abstract

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA). A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken. A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5–78) years. Smokers comprised 22.0 % of the study group. The seasonal variation of PTA was statistically insignificant (p = 0.45). Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1–148.7, p = 0.001]. Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0–10.9, p = 0.0005) and had significantly longer hospital stay (p = 0.03). Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures. PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease. The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

Cranial tonsillotomy for peritonsillar abscess: what a relief!

“…There was a slight preponderance of the right side in our study which is contradictory to the findings of a balanced affection of both sides [27,30], or a preponderance of the left side [31,32]. No patient of our patient population had presented with a bilateral PTA, while others reported rates ranging between 0.8 and 4.9 % [27,30,[32][33][34]. In accordance with most studies [6,[35][36][37][38][39][40][41][42][43] smoking habits were overrepresented (43.8 %) in our patient population.…”

“…Seasonal variations were not identified in our study as by other authors [32,53]. The median CRP-values and findings in white blood cell count were well within the range of contemporary studies [11,32,33]. It has been doubted that tonsillitis is the causative factor for PTA [28] which is confirmed by the findings of our study; no single patient reported such a history and only three patients had developed a PTA during inpatient treatment of an acute episode of tonsillitis.…”

“…A male to female ratio of 1.71 confirms the finding of a male predominance in PTA patients [21,[27][28][29]. There was a slight preponderance of the right side in our study which is contradictory to the findings of a balanced affection of both sides [27,30], or a preponderance of the left side [31,32]. No patient of our patient population had presented with a bilateral PTA, while others reported rates ranging between 0.8 and 4.9 % [27,30,[32][33][34].…”

“…In contrast to other studies, none of our patients had presented with a concomitant infectious mononucleosis [11,[44][45][46] or Kawasaki's disease [37,[44][45][46][47][48][49][50][51][52]. Seasonal variations were not identified in our study as by other authors [32,53]. The median CRP-values and findings in white blood cell count were well within the range of contemporary studies [11,32,33].…”

Indications for tonsillectomy stratified by the level of evidence

“…The symptoms are commonly very different from acute tonsillitis and usually occur in patients with a specific susceptibility [255] as well as preferably in smokers [256], [257], [258], [259], [260], [261], [262], [263], [264], [265], [266], [267], [268], which, however, was not obligatorily observed [269], [270]. Infectious mononucleosis, compromised immune system, and Kawasaki’s syndrome are acknowledges as risk factors for PTA [259], [267], [271], [272], [273], [274], [275], [276], [277], [278], [279].…”