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

Tachibana, Tomoyasu; Orita, Yorihisa; Abe-Fujisawa, Iku; Ogawara, Yuya; Matsuyama, Yuko; Shimizu, Aiko; Nakada, Michihiro; Sato, Yasuharu; Nishizaki, Kazunori

doi:10.1016/j.jiac.2014.07.018

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…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.…”

Section: Discussioncontrasting

confidence: 99%

“…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.…”

Section: Discussionsupporting

confidence: 86%

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Cranial tonsillotomy for peritonsillar abscess: what a relief!

Windfuhr

Nematian

Ziogou

2016

Eur Arch Otorhinolaryngol

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Peritonsillar abscess (PTA) is a common infection of the oropharynx resulting in painful swallowing, sometimes associated with fever, trismus and a typical voice alteration. Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy. However, a gold standard of surgical therapy still does not exist. The aim of this study was to evaluate the outcome in patients who had undergone ID supplemented by cranial tonsillotomy (IDTT) as first-line treatment. A retrospective chart review of all patients who had undergone IDTT at our department in 2015 was performed. Demographic data, clinical findings, pain intensity on a 10-point visual analog scale, operation time and routine bloods before and after IDTT were collected. In addition, a 10-point visual analog scale (VAS) was utilized to measure personal satisfaction 2 weeks and 2 months after surgery. A total of 104 procedures were performed in 65 male and 38 female patients (median age 35 years), including one patient with a contralateral PTA 2 weeks after IDTT. Three patients had experienced abscess formation after admittance for antibiotic treatment of acute tonsillitis. 57.7 % of all patients denied intake of antibiotic therapy in their history at initial presentation. Patients were hospitalized for 3 days (median). The median pain intensity (VAS) within the first three postoperative days was 2, 1 and 1, respectively. Two weeks and 2 months after surgery patients were highly satisfied with the procedure (median value 10). Bleeding complications did not occur. IDTT is a novel surgical concept and associated with great patient comfort. It is safe, easy to learn and associated with an early return to normal diet and physical activity. These findings are supported by a rapid normalization of white blood cell count and C-reactive protein. IDTT eliminates the necessity of painful re-draining of the wound cavity and is free of bleeding complications. In contrast to ID and NA, histological examination of tonsillar tissue is feasible to disclose a previously undetected malign disease. Further analysis is warranted to verify the success rate in the long-term.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 86%

Cranial tonsillotomy for peritonsillar abscess: what a relief!

Windfuhr

Nematian

Ziogou

2016

Eur Arch Otorhinolaryngol

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“…On the other hand, some authors have recommended needle aspiration rather than abscess incision and drainage, as sufficient and cost-effective treatment measures, while others observed that incision and drainage may overcome pain faster than aspiration [10,12,27,28]. Therefore, conclusions are still controversial.…”

Section: Discussionmentioning

confidence: 99%

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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“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

Indications for tonsillectomy stratified by the level of evidence

Windfuhr

2016

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 15:Doc09

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

Cited by 15 publications

References 19 publications

Cranial tonsillotomy for peritonsillar abscess: what a relief!

Cranial tonsillotomy for peritonsillar abscess: what a relief!

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

Indications for tonsillectomy stratified by the level of evidence

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