Medical Intervention Alone vs Surgical Drainage for Treatment of Peritonsillar Abscess: A Systematic Review and Meta‐analysis

Abstract

Objective Peritonsillar abscesses (PTAs) are common emergency consultations for otolaryngologists. Medical management alone may offer satisfactory treatment without the risk associated with surgical drainage. Therefore, we performed a systematic review of medical treatment alone compared to surgical drainage for the treatment of PTA. Data Sources MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov. Review Methods Studies comparing the outcomes of medically treated to surgically treated patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. All screening and data extraction were completed by 2 independent reviewers. Meta-analysis was performed using a random-effects model. Subgroup and sensitivity analyses were performed. Results Ten cohort studies and 2 randomized studies were included (ntotal = 33,468). Study quality was low, with only 1 study providing multivariable analysis. The combined rate of treatment failure in patients initially treated with medical management alone was 5.7% compared to 5.5% in the surgical group. There was no statistically significant difference in the odds of treatment failure between interventions through random-effects meta-analysis (odds ratio [OR], 1.10; 95% CI, 0.53-2.26; I 2 = 41%; P = .13). Subgroup analysis excluding pediatric-specific studies revealed similar odds of treatment failure when initially managed with medical intervention (OR, 0.92; 95% CI, 0.56-1.50; P = .39; I 2 = 0%). Conclusion Meta-analysis of available studies demonstrated no difference in odds of treatment failure for patients with PTA managed through medical intervention alone compared to surgical intervention. These findings should be interpreted with caution due to high probability of bias and overall low quality of studies.

Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States

“…In a recent meta-analysis of observational studies, there was similarly no difference in treatment failure rates between those treated with surgery or medical management alone. 3 This was again confirmed in a recent large retrospective cohort study. 15 Despite evidence to suggest the utility of medical management alone, we found relatively little uptake of this practice as first-line management in the currently presented study.…”

“…Recent evidence indicates that medical treatment alone may result in less pain and faster return to normal oral intake and daily living without an increase in treatment failure or PTA-associated sequelae. 2 , 3 …”

Improving the management of suspected tonsillitis and peritonsillar abscess referred to ENT – a coronavirus disease 2019 service improvement

“…https://doi.org/10.1017/S0022215121001213 of peritonsillar abscess. 19 Similarly, conservative medical management is reported as an effective treatment for co-existent peritonsillar abscess and Covid-19. 20 Given the relative contraindication of corticosteroids in those at higher risk of Covid-19, we recorded more cases of suspected quinsy in group 2 that were managed with antibiotics alone.…”

“…However, although we did not perform further subgroup analysis of confirmed cases of quinsy, recent evidence indicates no significant difference in outcomes between medical management and surgical drainage of peritonsillar abscess. 19 Similarly, conservative medical management is reported as an effective treatment for co-existent peritonsillar abscess and Covid-19. 20 Given the relative contraindication of corticosteroids in those at higher risk of Covid-19, we recorded more cases of suspected quinsy in group 2 that were managed with antibiotics alone.…”

Peritonsillar Abscess Size as a Predictor of Medical Therapy Success

“…They also reported no difference in failure rate between therapies, but trismus was significantly more prevalent in the ST group. Most recently, in April 2020, Forner et al 6 performed a systematic review and meta-analysis of 33 000 patients from 10 retrospective and 2 randomized, prospective studies further corroborated these findings, reporting no statistically significant difference in the odds of treatment failure for patients treated medically (5.7%) versus surgically (5.5%). Forner et al identified a "major limitation in the current literature" that patients treated medically may be diluted by patients with peritonsillar cellulitis or less severe abscess, as definitive abscess formation may be difficult to confirm based on history and physical examination alone.…”