Who ends up having tonsillectomy after peritonsillar infection?

Abstract

We wanted to explore how many patients will undergo tonsillectomy during the first 5 years after peritonsillar abscess or peritonsillar cellulitis, and why. In addition we sought predictive factors as to who would benefit from tonsillectomy. Medical records of 809 patients with peritonsillar infection (ICD-10 J36) aged over six were analyzed, and data on the history of tonsil infections and differences in treatment were collected. Data on patients who underwent tonsillectomy during the next 5 years were compared with data on patients needing no tonsillectomy. An abscess or planned interval tonsillectomy was performed on 159 patients. Of the conservatively treated 7- to 16.9-year-old patients, 42.5% required surgery later, of those aged 17-29.9 years, 31.3%, and those over 30, 13.2% (p < 0.001). Previous tonsillar infections led to increased (p = 0.067) probability of delayed tonsillectomy. Re-opening of the abscess cavity at the polyclinics, use of broad-spectrum antibiotics in the acute phase of infection, or being an outpatient or inpatient had no influence on the probability of later surgery. Overall one-fourth of the patients with peritonsillar infection underwent tonsillectomy during the next 5 years, even without being originally planned. Young age and previous tonsillar infections caused increased probability of delayed tonsillectomy.

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

“…Our data demonstrated that in Veneto more than 60 % of patients were treated conservatively. Although with some differences, this percentage of conservative treatment is quite similar in several studies [12][13][14][15]. Whenever tonsillectomy is indicated, interval tonsillectomy enables the surgery to be planned more carefully, and performed at a time when the patient is no longer acutely ill. On the other hand, delayed tonsillectomy may entail a more difficult dissection than quinsy tonsillectomy, and results in a longer recovery time overall.…”

“…Many authors recommend tonsillectomy even in the absence of the other classical indications for surgery (recurrent tonsillitis, dysphagia, snoring and sleep apnea), while others argue that the procedure may expose patients unnecessarily to the related risks of general anesthesia, surgery and post-operative hemorrhage, given the low recurrence rate of PTAs not treated surgically [12][13][14]. This means, as stated by Powell et al [15], that further good-quality evidence is needed on quinsy recurrence rates to enable betterinformed decision making regarding the need for tonsillectomy.…”

Variations in treatment of peritonsillar abscess in four Nordic countries

“…Respondent physicians followed guidelines when treating PTA in children, and the literature indeed describes such treatment well, taking into account that the preferred protocol usually depends on patient co-operation [4,8,9]. The opposite was true among adult patients; outpatient vs inpatient differences were especially large.…”

Cranial tonsillotomy for peritonsillar abscess: what a relief!

“…While this may be true for the initial therapy, it should be noted that NA was followed in 11.1 % by either an additional NA or ID in 117 patients of which 20 experienced a PTA recurrence within a minimum follow-up of 5 years, finally resulting in tonsillectomy in 13 of them [14]. Wiksten estimated a success rate of 75 % after NA or ID within a 5-year follow-up, 25 % of 639 patients finally underwent tonsillectomy [13]. Herzon analyzed 19 studies with a minimum time of follow-up of at least 1 year and identified a recurrence rate ranging between 0 and 23 % after NA or ID [2].…”

“…To date, no commonly accepted guidelines for the treatment of PTA exist and management protocols vary considerably among countries [10], even inside one country in different hospitals [13]. The lack of a gold standard for therapy indicates that there is no ''right'' or ''wrong''.…”