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Heilig Y, Sapir A, Yafit D, Ben-Shimol S, Kaplan DM, Cohen O. Impact of the COVID-19 era on clinical presentation, management and microbiology in paediatric peritonsillar abscess: A case-control study. Clin Otolaryngol 2024; 49:207-213. [PMID: 38100150 DOI: 10.1111/coa.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Peritonsillar abscess (PTA) is the most common soft-tissue infection of the head and neck. This potential complication of tonsillitis has demonstrated unique microbial trends during the COVID-19 pandemic. This era has resulted in a major shift in the hygiene and social habits of the general population, which has resulted in changes in the presentation, management and microbiology of several infectious diseases. To date, the impact of COVID 19 on PTA microbiology and clinical presentation in the paediatric population has yet to be investigated. DESIGN Retrospective chart review comparing all cases of paediatric (age 0-18) PTA in an academic tertiary centre during the COVID-19 pandemic (03/2020-02/2022) and compared them to two control groups: pre-COVID (03/2018-02/2020) and post-COVID (03/2022-03/2023). All patients were treated with either needle aspiration, incision and drainage or both means in addition to intravenous antibiotics. SETTING A large Ear Nose and Throat department in a tertiary referral center. PARTICIPANTS Consecutive children aged 18 years or under, admitted with a diagnosis of Peritonsillar abscess. MAIN OUTCOME MEASURES We analyzed the clinical and microbiologcal features of all cases of pediatric peritonsillar abscess during the COVID-19 era (03/2020-02/2022) and compared them to a pre and post control cases. RESULTS A total of 96 PTA cases were included (35 pre-COVID, 35 COVID and 26 post-COVID). The means of procedural treatment shifted in favour of incision and drainage versus needle aspiration during the COVID era. The length of hospitalisation increased during the COVID era (3.6 days vs. 2.1 and 3.1 pre and post-COVID respectively, p < .001). No other notable differences in the clinical and demographic features were found between the three eras. The COVID-19 era saw an increase in Fusobacterium (37.1% vs. 8.6% and 24% pre and post-COVID, respectively; p = .008) and Streptococcus Anginosus (31.4% vs. 5.7% and 7.7% pre and post-COVID, respectively; p = .007) species isolation. CONCLUSIONS The COVID-19 pandemic did not seem to impact the clinical presentation of paediatric PTA yet resulted in a change in microbiological pathogens. The choice of I&D as a means to shorten hospital stay during the pandemic may have led to an actual increase in hospital stay, suggesting that NA may be the preferred management approach.
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Affiliation(s)
- Yotam Heilig
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Sapir
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel Yafit
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oded Cohen
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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von Meyer F, Storck K. [Disproving the myth of "abscess weather" predisposing to peritonsillitis and peritonsillar abscess]. HNO 2024; 72:32-40. [PMID: 37932499 PMCID: PMC10781855 DOI: 10.1007/s00106-023-01384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Peritonsillar abscess (PTA) is often seen as a complication of acute tonsillitis and is defined as pus retention between the tonsillar capsule and the peritonsillar tissue. The etiology and pathogenesis have not yet been fully elucidated. A connection between certain weather conditions and temperature fluctuations and the occurrence of abscesses in the head and neck region has been discussed for years. The question here is whether higher temperature fluctuations are predisposing for the formation of abscesses. MATERIALS AND METHODS A retrospective evaluation of all patients hospitalized with peritonsillitis or PTA in the Department of Otorhinolaryngology of the Klinikum Rechts der Isar of the Technical University of Munich during a period of 10 years (2012-2021) was performed. Each patient was individually correlated with daily temperature data from the statistical meteorological office of the City of Munich. RESULTS A total of 1450 patients were included, 270 patients (18.62%) with peritonsillitis and 1180 patients (81.38%) with PTA. A correlation between the occurrence of peritonsillitis or PTA and major temperature fluctuations could be excluded in this large patient population. Moreover, a similar frequency of peritonsillitis and PTA was seen throughout the year. CONCLUSION The myth of a temperature dependence of the development of peritonsillitis or PTA and a so-called abscess weather could be negated in this study.
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Affiliation(s)
- Franziska von Meyer
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - Katharina Storck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
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Su WH, Yu SS, Wu TC, Chang SL. Effects of temperature and humidity on peritonsillar abscess volume of emergency patients. Medicine (Baltimore) 2022; 101:e31881. [PMID: 36482583 PMCID: PMC9726312 DOI: 10.1097/md.0000000000031881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Climate and temperature have long been considered in relation to human diseases and mortality. In this study, we investigated whether daily temperature and humidity and patients' personal history affect the volume of peritonsillar abscesses (PTAs). We included 52 patients with PTAs who were admitted to the emergency department of the study hospital; their computed tomography data were analyzed, and PTA volume was measured. We investigated the possible correlation between PTA volume and mean/minimum/maximum temperature and humidity. Furthermore, we obtained personal history data, including information on drinking status, smoking status, dental problems, and patients' treatment experiences at local clinics before visiting the emergency department. The mean PTA volume was 3.93 mL, which was significantly correlated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization (P < .05) and also with a lack of treatment experience at local clinics (P < .001). However, no significant correlation was noted between PTA volume and the mean/minimum/maximum temperature and humidity on the day of hospitalization (P > .05). Similar findings were obtained for drinking status, smoking status, and dental problems (P > .1). PTA volume appears to be strongly associated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization. Patients with treatment experience at local clinics exhibited substantial increases in PTA volume. Thus, an increased PTA volume may be observed in patients who visit the emergency department without any treatment experience at local clinics or from environments that differ considerably from their current environment in terms of temperature.
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Affiliation(s)
- Wei-Hsiang Su
- Department of Otorhinolaryngology, Chi-Mei Medical Center, Yongkang District, Tainan, Taiwan
| | - Shiou-Shyan Yu
- Department of Otorhinolaryngology, Chi-Mei Medical Center, Yongkang District, Tainan, Taiwan
| | - Tai-Ching Wu
- Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Lun Chang
- Department of Otorhinolaryngology, Chi-Mei Medical Center, Yongkang District, Tainan, Taiwan
- *Correspondence: Shih-Lun Chang, Department of Pet Care and Grooming, Chung Hwa University of Medical Technology, Tainan, Taiwan (e-mail: )
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Hathi K, Lees MX, Chandra K, Lewis D, McMullin B, Chin CJ. Seasonal Variation of Peritonsillar Abscess Presentation to an Emergency Department in an Atlantic Canadian Climate: A Retrospective Review. Ann Otol Rhinol Laryngol 2022:34894221127485. [PMID: 36217949 PMCID: PMC10359955 DOI: 10.1177/00034894221127485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Patients with a peritonsillar abscess (PTA) often present to emergency departments as the first point of medical contact. Upper respiratory tract infections (URTIs) are more frequent in the winter. Therefore, we hypothesize that the incidence of PTAs will be more frequent in colder winter months as well. This is the first study assessing the seasonal variation and epidemiology of PTA presentations to an emergency department in Atlantic Canada, home to a unique maritime climate. METHODS A retrospective cohort study was conducted through a chart review of all patients who presented to the Saint John Regional Hospital Emergency Department from January 1, 2015, to December 31, 2020. Patient characteristics, treatment, and microbiology were reported. A chi-square goodness-of-fit test assessed the seasonal variation of PTA. Pearson correlations assessed PTA incidence per mean monthly temperature and humidity. RESULTS A total of 75 patients were included. 57.3% were male and 42.7% were female, with a mean age (±SD) of 35.9 ± 14.0. Most patients presented afebrile (82.7%, cutoff ≥ 38.0°C). Approximately half of all patients had an elevated WBC count (49.3%, cutoff ≥ 10.9 × 109). The most common bacteria isolated were Streptococcus species followed by anaerobic bacteria (17.9%). No significant variation was found with respect to season (X2(3) = 1.0, P = .801), temperature (r(70) = 0.198, P = .096), or humidity, (r(70) = 0.063, P = .599). CONCLUSION This study did not find a seasonal variation of PTA in a maritime climate. These findings question the anecdotal hypothesis that PTA is associated with progression from acute URTIs and therefore would be more common in the winter months.
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Affiliation(s)
- Kalpesh Hathi
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Miranda X Lees
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Kavish Chandra
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Department of Emergency Medicine, Horizon Health Network, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - David Lewis
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Department of Emergency Medicine, Horizon Health Network, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Ben McMullin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Christopher J Chin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Ando Y, Hirai T, Takemoto K, Go K, Sera T, Hattori T, Fukushima N, Masuda S, Takeno S. Peritonsillar abscesses in infants requiring intratracheal intubation: Two case reports. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kim SY, Kong IG, Min C, Choi HG. Association of Air Pollution With Increased Risk of Peritonsillar Abscess Formation. JAMA Otolaryngol Head Neck Surg 2020; 145:530-535. [PMID: 31021373 DOI: 10.1001/jamaoto.2019.0742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Several studies reported an association between peritonsillar abscess formation and climate conditions, including seasonal changes; however, the results were inconsistent. Objective To evaluate the association between meteorological conditions and/or air pollution and peritonsillar abscess formation. Design, Setting, and Participants In this nested case-control study, 3819 participants with peritonsillar abscesses were matched (1:4) for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 15 276 control participants. The Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC) data from 2002 through 2013 were used. Exposures and Main Outcomes and Measures The meteorological data included the mean daily temperature (°C), highest daily temperature (°C), lowest daily temperature (°C), daily temperature difference (°C), relative humidity (%), spot atmospheric pressure (hPa), sulfur dioxide ([SO2], parts per million [ppm]), nitrogen dioxide (NO2, ppm), ozone (O3, ppm), carbon monoxide (CO, ppm), and particulate matter less than 10 μg (PM10, μg/m3) for the previous 14 days, 10 days, 7 days, 5 days, or 3 days before the matched index date. These factors were measured in 94 or 273 locations hourly. The crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of meteorological data for peritonsillar abscess formation were analyzed using unconditional logistic regression analysis. Subgroup analyses were conducted according to age and sex. Results The male to female ratio of study participants was 1.43 (11 260 to 7835). Because the age groups were classified using 5-year intervals, the mean age could not be defined. The mean differences of NO2 and PM10 concentrations for the 14 days between peritonsillar abscess group and control group were 1.78 ppb (95% CI, 1.47-2.09) and 1.33 μg/m3 (95% CI, 0.67-1.99), respectively. The aORs of NO2 (0.1 ppm) and PM10 (10 μg/m3) during the 14 days prior to the index date for peritonsillar abscess formation were 12.8 (95% CI, 8.4-19.5) and 1.04 (95% CI, 1.02-1.06), respectively. The other meteorological conditions did not reach statistical significance. Conclusions and Relevance Peritonsillar abscess formation was associated with high concentrations of NO2 and PM10.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Il Gyu Kong
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
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Slouka D, Hanakova J, Kostlivy T, Skopek P, Kubec V, Babuska V, Pecen L, Topolcan O, Kucera R. Epidemiological and Microbiological Aspects of the Peritonsillar Abscess. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114020. [PMID: 32516939 PMCID: PMC7312574 DOI: 10.3390/ijerph17114020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
Peritonsillar abscess (PTA) is the most common complication of tonsillitis. Cultivation usually reveals a wide spectrum of aerobic and anaerobic microbiota. This retrospective study compared PTA incidence and the spectrum of individual microbial findings in groups of patients divided by gender, age, and season. Of the 966 samples cultivated, a positive cultivation finding was detected in 606 patients (62.73%). Cultivation findings were negative in 360 (37.27%), meaning no pathogen was present or only common microbiota was cultivated. The highest incidence of PTA was found in group I patients (19–50 years) (p ≤ 0.0001) and the most frequently cultured pathogens was Streptococcus pyogenes (36.23%). Gender seemed to have an influence on the results, with higher incidence found in males (p ≤ 0.0001). The analysis of correlation between PTA incidence and season did not yield statistically significant results (p = 0.4396) and no statistically significant differences were observed in individual pathogen frequency. PTA had a higher incidence in adult males and a slightly higher incidence in girls in childhood. The following findings are clinically significant and have implications for antibiotic treatment strategy: (1) the most frequently cultivated pathogen was Streptococcus pyogenes; (2) an increased incidence of anaerobes was proven in the oldest group (>50 years).
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Affiliation(s)
- David Slouka
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (D.S.); (J.H.); (T.K.); (P.S.); (V.K.)
| | - Jana Hanakova
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (D.S.); (J.H.); (T.K.); (P.S.); (V.K.)
| | - Tomas Kostlivy
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (D.S.); (J.H.); (T.K.); (P.S.); (V.K.)
| | - Petr Skopek
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (D.S.); (J.H.); (T.K.); (P.S.); (V.K.)
| | - Vojtech Kubec
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (D.S.); (J.H.); (T.K.); (P.S.); (V.K.)
| | - Vaclav Babuska
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic;
| | - Ladislav Pecen
- Department of Immunochemistry Diagnostics, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (L.P.); (O.T.)
| | - Ondřej Topolcan
- Department of Immunochemistry Diagnostics, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (L.P.); (O.T.)
| | - Radek Kucera
- Department of Immunochemistry Diagnostics, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, 300 00 Pilsen, Czech Republic; (L.P.); (O.T.)
- Correspondence:
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Lee CH, Hsu WC, Ko JY, Yeh TH, Kang KT. Trends in the management of peritonsillar abscess in children: A nationwide population-based study in Taiwan. Int J Pediatr Otorhinolaryngol 2019; 125:32-37. [PMID: 31238159 DOI: 10.1016/j.ijporl.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/16/2019] [Accepted: 06/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Population-based studies analyzing peritonsillar abscess in children are lacking. In this study, a population-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted. METHODS This cross-sectional study was conducted using the Taiwan National Health Insurance Research Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender, hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during the study period were analyzed. RESULTS A total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion of treatments involving incision and drainage or needle aspiration increased significantly (1.3%-4.1% and 49.4%-65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%-29.0%). The use of computed tomography (CT) increased (1.4%-12%, ptrend < 0.001). The use of nonsteroidal anti-inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays increased from 3.78 to 4.67 days. CONCLUSIONS The incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan. Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle aspiration procedures, and the length of hospital stay in this study cohort.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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Tsai YW, Liu YH, Su HH. Bacteriology of peritonsillar abscess: the changing trend and predisposing factors. Braz J Otorhinolaryngol 2018; 84:532-539. [PMID: 28756939 PMCID: PMC9452268 DOI: 10.1016/j.bjorl.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors. Objective To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration. Methods This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration. Results A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p = 0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age > 65 years) with an odds ratio (OR) of 2.76 (p = 0.03), and decreased in the hot season (mean temperature > 26 °C) (OR = 0.49, p = 0.04). No specific microorganism was associated with prolonged hospital stay. Conclusion The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.
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Affiliation(s)
- Yi-Wen Tsai
- Kaohsiung Veterans General Hospital, Department of Medical Education and Research, Kaohsiung, Taiwan
| | - Yu-Hsi Liu
- Kaohsiung Veterans General Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung, Taiwan
| | - Hsing-Hao Su
- Kaohsiung Veterans General Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung, Taiwan; Tajen University, Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Pingtung, Taiwan.
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Infections of the Upper and Middle Airways. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152082 DOI: 10.1016/b978-0-323-40181-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Peritonsillar abscess: epidemiology and relationship with climate variations. The Journal of Laryngology & Otology 2017; 131:627-630. [DOI: 10.1017/s0022215117000895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractBackground:Peritonsillar abscess is the most common deep infection of the head and neck in young adults. It is considered a purulent complication of acute tonsillitis, but other mechanisms have been proposed. There is no consensus as to whether seasonality affects peritonsillar abscess incidence.Methods:This observational, descriptive, retrospective study explored the epidemiology of peritonsillar abscess and its relationship with seasonality. The cases were selected from the emergency otolaryngology service of a tertiary hospital.Results:The sample comprised 528 patients (42.61 per cent males, mean age = 26.63 years). A moderate positive correlation was found between peritonsillar abscess incidence and monthly average temperature. No associations were found with insolation, precipitation or humidity.Conclusion:In this sample, peritonsillar abscess was more likely to occur in warmer months. The findings corroborate the theory that peritonsillar abscess is not a direct complication of acute tonsillitis and may improve understanding of peritonsillar abscess aetiology.
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Windfuhr JP. Indications for tonsillectomy stratified by the level of evidence. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc09. [PMID: 28025609 PMCID: PMC5169082 DOI: 10.3205/cto000136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: One of the most significant clinical trials, demonstrating the efficacy of tonsillectomy (TE) for recurrent throat infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of evidence-based medicine. Material and methods: A systematic Medline research was performed using the key word of "tonsillectomy" in combination with different filters such as "systematic reviews", "meta-analysis", "English", "German", and "from 1984/01/01 to 2015/05/31". Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the "Trip Database" were researched for "tonsillectomy" and "indication" and "from: 1984 to: 2015" in combination with either "systematic review" or "meta-analysis" or "metaanalysis". Results: A total of 237 papers were retrieved but only 57 matched our inclusion criteria covering the following topics: peritonsillar abscess (3), guidelines (5), otitis media with effusion (5), psoriasis (3), PFAPA syndrome (6), evidence-based indications (5), renal diseases (7), sleep-related breathing disorders (11), and tonsillitis/pharyngitis (12), respectively. Conclusions: 1) The literature suggests, that TE is not indicated to treat otitis media with effusion. 2) It has been shown, that the PFAPA syndrome is self-limiting and responds well to steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications, or with a significant history of tonsillitis. In particular, interval-tonsillectomy is not justified as a routine. 4) TE, with or without adenoidectomy, is efficacious to resolve sleep-related breathing disorders resulting from (adeno)tonsillar hypertrophy in children. However, the benefit is reduced by co-morbidities, such as obesity, and further research is required to identify prognostic factors for this subgroup of patients. Further research is indicated to clarify selection criteria not only for this subpopulation that may benefit from less invasive procedures such as tonsillotomy in the long-term. 5) Further trials are also indicated to evaluate the efficacy of TE on the clinical course in children with psoriasis guttata as well as on psoriasis vulgaris in adults, not responding to first-line therapy. 6) Conflicting results were reported concerning the role of TE in the concert to treat Ig-A nephropathy, mandating further clinical research. 7) Most importantly, randomized-controlled clinical trials with an adequate long-term follow-up are desirable to clarify the benefit of TE in patients with recurrent episodes of tonsillitis, with or without pharyngitis. Factors like age, spontaneous healing rate and postoperative quality of life have to be included when comparing TE with antibiotic therapy.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otolaryngology, Head & Neck Surgery, Allergology, Kliniken Maria Hilf, Mönchengladbach, Germany
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13
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Windfuhr JP, Nematian M, Ziogou S. Cranial tonsillotomy for peritonsillar abscess: what a relief! Eur Arch Otorhinolaryngol 2016; 273:4507-4513. [PMID: 27324889 DOI: 10.1007/s00405-016-4158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 01/17/2023]
Abstract
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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Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology, Plastic Head & Neck Surgery, Kliniken Maria Hilf Mönchengladbach, Sandradstr. 43, 41061, Mönchengladbach, Germany.
| | - M Nematian
- Department of Otorhinolaryngology, Plastic Head & Neck Surgery, Kliniken Maria Hilf Mönchengladbach, Sandradstr. 43, 41061, Mönchengladbach, Germany
| | - S Ziogou
- Department of Otorhinolaryngology, Plastic Head & Neck Surgery, Kliniken Maria Hilf Mönchengladbach, Sandradstr. 43, 41061, Mönchengladbach, Germany
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14
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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. THE LANCET. INFECTIOUS DISEASES 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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15
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Klug TE, Rusan M, Fuursted K, Ovesen T. Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection? Otolaryngol Head Neck Surg 2016; 155:199-207. [PMID: 27026737 DOI: 10.1177/0194599816639551] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the literature concerning the 2 primary hypotheses put forth to explain the pathogenesis of peritonsillar abscess: "the acute tonsillitis hypothesis" (peritonsillar abscess is a complication of acute tonsillitis) and "the Weber gland hypothesis" (peritonsillar abscess is an infection of Weber's glands). DATA SOURCES PubMed, EMBASE. REVIEW METHODS Data supporting or negating one hypothesis or the other were elicited from the literature. CONCLUSIONS Several findings support the acute tonsillitis hypothesis. First, the 2 main pathogens in peritonsillar abscess have been recovered from pus aspirates and bilateral tonsillar tissues with high concordance rates, suggesting that both tonsils are infected in patients with peritonsillar abscess. Second, studies report signs of acute tonsillitis in the days prior to and at the time of peritonsillar abscess. Third, antibiotic treatment reduces the risk of abscess development in patients with acute tonsillitis. However, some findings suggest involvement of the Weber's glands in peritonsillar abscess pathogenesis. First, high amylase levels have been found in peritonsillar pus. Second, the majority of peritonsillar abscesses are located at the superior tonsillar pole in proximity of the Weber's glands. We propose a unified hypothesis whereby bacteria initially infect the tonsillar mucosa and spread via the salivary duct system to the peritonsillar space, where an abscess is formed. IMPLICATIONS FOR PRACTICE Our findings support the rationale for antibiotic treatment of patients with severe acute tonsillitis to reduce the risk of abscess development. Improved understanding of peritonsillar abscess pathogenesis is important for the development of efficient prevention strategies.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Rusan
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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16
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Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 2016; 273:989-1009. [DOI: 10.1007/s00405-016-3904-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
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17
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Takeda T, Ito T, Kawashima Y, Hatanaka A, Watanabe S, Kitamura K, Tsutsumi T. Clinical Characteristics of Pediatric Deep Neck Abscesses. ACTA ACUST UNITED AC 2016. [DOI: 10.3950/jibiinkoka.119.1379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Takamori Takeda
- Department of Otolaryngology, Tsuchiura Kyodo General Hospital
- Department of Otolaryngology, Tokyo Medical and Dental University
| | - Taku Ito
- Department of Otolaryngology, Tsuchiura Kyodo General Hospital
- Department of Otolaryngology, Tokyo Medical and Dental University
| | | | - Akio Hatanaka
- Department of Head and Neck Surgery, Saitama Cancer Center
| | | | - Ken Kitamura
- Department of Otolaryngology, Chigasaki Central Hospital
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University
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18
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El-Saied S, Kaplan DM, Zlotnik A, Abu Tailakh M, Kordeluk S, Joshua BZ. A comparison between amylase levels from peritonsillar, dental and neck abscesses. Clin Otolaryngol 2015; 39:359-61. [PMID: 25117975 DOI: 10.1111/coa.12298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pus of peritonsillar abscess (PTA) contains very high amylase levels in some patients. The objective of this study was to further test this finding and to check whether high amylase levels in peritonsillar abscess originate from contamination by saliva during aspiration. STUDY DESIGN Prospective study. SETTING Tertiary care university hospital. PARTICIPANTS The study includes 64 patients with PTA, 8 patients with a neck abscess and 12 patients with a dental abscess. MAIN OUTCOME MEASURE Amylase levels of pus and serum were compared between the groups. Clinical data regarding hospitalisation length, recurrence rate and previous antibiotic treatment were also collected. RESULTS Mean amylase levels in the pus of the PTA group were 3045 U/L (median 59 U/L), 13 U/L in the neck abscess group (P = 0.001) and 22 U/L in the dental abscess group (P = 0.001). Mean serum amylase was higher in the PTA group; PTA - 50 U/L, neck abscess - 37 U/L (P = 0.002) and dental abscess - 26 U/L (P < 0.002). All of the patients with amylase levels above 65 U/L had a first episode of PTA. In contrast, 40% of patients with amylase lower than 65 U/L had recurrent PTA (P = 0.003). CONCLUSION A clear association is seen between minor salivary glands and peritonsillar abscess. The high amylase level in peritonsillar pus is not from contamination with saliva.
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Affiliation(s)
- S El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Clinical Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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19
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Kim DK, Lee JW, Na YS, Kim MJ, Lee JH, Park CH. Clinical factor for successful nonsurgical treatment of pediatric peritonsillar abscess. Laryngoscope 2015; 125:2608-11. [DOI: 10.1002/lary.25337] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/01/2015] [Accepted: 03/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
- Nano-Bio Regenerative Medical Institute; Hallym University College of Medicine; Chuncheon Republic of Korea
| | - Jung Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
| | - Yoon Sung Na
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
| | - Myung Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
- Nano-Bio Regenerative Medical Institute; Hallym University College of Medicine; Chuncheon Republic of Korea
| | - Chan Hum Park
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital; Chuncheon Republic of Korea
- Nano-Bio Regenerative Medical Institute; Hallym University College of Medicine; Chuncheon Republic of Korea
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20
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Peritonsillar abscess: remember to always think twice. Eur Arch Otorhinolaryngol 2015; 273:1269-81. [DOI: 10.1007/s00405-015-3582-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/24/2015] [Indexed: 01/12/2023]
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21
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Bovo R, Barillari MR, Martini A. Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy? Eur Arch Otorhinolaryngol 2015; 273:225-30. [DOI: 10.1007/s00405-014-3454-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 12/28/2022]
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Nosulya EV, Kim IA, Chernykh NM, Karnoukhova OA. [Acute tonsillopharyngitis: the effectiveness of topical therapy]. Vestn Otorinolaringol 2015; 80:71-76. [PMID: 26525477 DOI: 10.17116/otorino201580571-76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present study was to evaluate the clinical effectiveness of a furasol sore throat gargle solution for the treatment of acute tonsillopharyngitis. Forty patients presenting with acute tonsillopharyngitis were allocated to two groups, 20 subjects in each, by means of independent sequential randomization. Prior to the onset of the treatment, all the patients were examined for determining the species composition of pharyngeal microflora with the use of an «AutoScan4 System» analyzer («Siemens», USA) and estimating the resistance to antibacterial preparations (by the disk diffusion method). All the participants of the study were prescribed antibacterial therapy. In the patients of group 1 (study group), the antibacterial treatment of acute tonsillopharyngitis was supplemented by a furasol sore throat gargle solution whereas those of group 2 (controls) were treated without topical therapy. The quantitative evaluation of the severity of manifestations of the disease before and after the treatment was based on a 5-point visual-analog scale. It was shown that systemic antibacterial therapy resulted in the consistent decrease of the frequency of occurrence of pathogenic and potentially pathogenic microflora in the patients comprising both groups. Treatment with a furasol sore throat gargle solution did not lead to the appearance of bacterial species alien to the oropharynx, nor was it accompanied by the impairment of resistance of its mucous membrane to the colonization by microorganisms. The results of the study give evidence of the well apparent regression of the subjective signs of tonsillopharyngitis and the inflammatory changes in the mucous membrane of the pharynx in the patients given the topical treatment in the form of a furasol sore throat gargle solution in addition to antibacterial therapy. It is concluded that a furasol sore throat gargle solution can be recommended for the introduction into the combined treatment of the patients presenting with acute tonsillopharyngitis.
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Affiliation(s)
- E V Nosulya
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125367
| | - I A Kim
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125367
| | - N M Chernykh
- Irkutsk State Medical University, Irkutsk, 664003
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Stelter K. Tonsillitis and sore throat in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc07. [PMID: 25587367 PMCID: PMC4273168 DOI: 10.3205/cto000110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life-threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All "hot" techniques with laser, radiofrequency, coblation, mono- or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17-point-checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT). Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents.
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Affiliation(s)
- Klaus Stelter
- Dep. of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, University of Munich, Munich, Germany
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24
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Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis 2014; 34:549-54. [PMID: 25322910 PMCID: PMC4356895 DOI: 10.1007/s10096-014-2260-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
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.
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Klug TE. Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis 2014; 33:1163-7. [PMID: 24474247 DOI: 10.1007/s10096-014-2052-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
To explore the correlations among the incidence, microbiology, season, gender, and age in patients with peritonsillar abscess (PTA) in order to identify risk factors for PTA development. All patients with PTA treated at private ENT practices in Aarhus County and in the Ear-Nose-Throat Departments at Aarhus University Hospital and Randers Hospital from January 2001 to December 2006 were included in the study. Age- and gender-stratified population data for Aarhus County for the same 6 years were obtained. The incidence rate of PTA increased from childhood to peak in teenage life and declined afterward gradually until old age. Girls predominated over boys until the age of 14 years. Subsequently, men were more frequently affected than women. Fusobacterium necrophorum (FN) was significantly more prevalent than group A Streptococcus (GAS) among patients aged 15-24 years (P < 0.001). In contrast, GAS was significantly more frequently recovered among children aged 0-9 years and adults aged 30-39 years compared with FN (P < 0.001 and P = 0.017 respectively). The seasonal variation of PTA was statistically insignificant (P = 0.437). However, GAS was significantly more frequently recovered in the winter and spring than in the summer (P = 0.002 and P = 0.036 respectively). There was a trend toward a higher incidence of FN infection during the summer than the winter (P = 0.165). Although the collected PTA incidence was stable throughout the year, the microbiology fluctuated with seasons. Patients aged 15-24 years are at an increased risk of PTA due to FN, which may have clinical implications for the diagnostic work-up and treatment of patients with acute tonsillitis.
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Affiliation(s)
- T E Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, NBG, Building 10, Noerrebrogade 44, Aarhus C, 8000, Denmark,
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Hsiao HJ, Huang YC, Hsia SH, Wu CT, Lin JJ. Clinical features of peritonsillar abscess in children. Pediatr Neonatol 2012; 53:366-70. [PMID: 23276441 DOI: 10.1016/j.pedneo.2012.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/09/2012] [Accepted: 02/02/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Peritonsillar abscess is an acute infection located between the capsule of the palatine tonsil and the superior constrictor muscle of the pharynx. The reports regarding pediatric cases have been scanty. METHODS A retrospective study was conducted to investigate the patients less than 18 years of age hospitalized at a medical center with a final diagnosis of peritonsillar abscess from January 1999 through December 2009. Only those who were confirmed by the drainage of pus from the peritonsillar spaces or confirmed by a computed tomography (CT) scan were enrolled. RESULTS In total, 56 children, 31 male and 25 female, were included. The mean age was 12.9 ± 4.6 years, ranging from 9 months to 17.9 years. Nineteen (34%) were less than 12 years of age. All 37 children ≧12 years of age complained of sore throat, but only 68% of children less than 12 years of age complained of sore throat. Thirty-one patients (55%) with a characteristic presentation of fever and sore throat plus an asymmetric swollen/bulging tonsil with or without uvular deviation suggestive of the diagnosis received surgical drainage at emergency department immediately, and 87% of them were older than 12 years of age. Twenty-five (45%) children needed a CT scan to confirm the diagnosis. The most common empirical antibiotics were penicillin-containing regimens. The predominant organisms identified were Streptococcus species. Eight children were treated successfully with antibiotics alone. No case was fatal. CONCLUSION Two-thirds of the children with peritonsillar abscess were ≥12 years of age. Not every patient <12 years of age had a characteristic presentation, and a CT scan was usually needed to confirm the diagnosis.
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Affiliation(s)
- Hsiang-Ju Hsiao
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Álvarez Marcos C, Llorente-Pendás JL. Peritonsillar Infections: Prospective Study of 100 Consecutive Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2012.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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El-Saied S, Puterman M, Kaplan DM, Cohen-Lahav M, Joshua BZ. Involvement of minor salivary glands in the pathogenesis of peritonsillar abscess. Otolaryngol Head Neck Surg 2012; 147:472-4. [PMID: 22547556 DOI: 10.1177/0194599812445552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. STUDY DESIGN Prospective population-based study. SETTINGS Tertiary care university hospital. SUBJECTS AND METHOD Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. RESULTS Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group (P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L (P = .01). CONCLUSION High amylase in the pus lends further support for involvement of minor salivary glands. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection. It is possible that both minor salivary glands as well as tonsillar infection play a role in the pathogenesis of peritonsillar infections.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Alvarez Marcos C, Llorente-Pendás JL. [Peritonsillar infections: prospective study of 100 consecutive cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:212-7. [PMID: 22425204 DOI: 10.1016/j.otorri.2012.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/23/2011] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.
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Affiliation(s)
- María Costales-Marcos
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Principado de Asturias, España.
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Pham V, Gungor A. Bilateral peritonsillar abscess: case report and literature review. Am J Otolaryngol 2012; 33:163-7. [PMID: 21371779 DOI: 10.1016/j.amjoto.2010.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/29/2022]
Abstract
Although uncommon, bilateral peritonsillar abscess (PTA) may still present with symptoms found in unilateral cases but lack hallmark findings such as an asymmetric tonsillar bulge and uvular deviation. We present the case of an 18-year-old woman deemed to have a bilateral PTA based on physical examination and radiographic imaging. She underwent successful surgical drainage with needle aspiration, followed by incision and drainage. A computed tomography with intravenous contrast should be obtained when a patient displays signs suggestive of a bilateral PTA but the diagnosis is not certain. To our knowledge, this is the first report of 2 different bacterial species cultured from contralateral abscesses during the same encounter.
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Affiliation(s)
- Viet Pham
- The University of Texas Medical Branch, Department of Otolaryngology, Galveston, TX 77555-0521, USA.
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Bast F, Köhler H, Sparr KD, Schrom T. [Bilateral peritonsillar abscess with lymph node abscess in a infant. A rare case]. HNO 2011; 59:1022-4. [PMID: 21424137 DOI: 10.1007/s00106-010-2247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Peritonsillar abscess (PTA) comprises approximately 30% of soft tissue head and neck abscesses. Bilateral occurrence in infants is rare. The present case demonstrates a bilateral peritonsillar abscess with a lymph node abscess in a 10.5-month-old infant without the typical clinical findings of PTA. This report highlights the importance of including peritonsillar abscesses in the differential diagnosis of abscess-forming cases of lymphadenitis colli refractory to therapy, even if the classical symptoms are absent. In individual cases, the indication for image-guided procedures to establish the diagnosis of PTA should be made generously.
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Affiliation(s)
- F Bast
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie/Plastische Operationen, Helios-Klinikum Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Deutschland.
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Keith T, Saxena S, Murray J, Sharland M. Risk-benefit analysis of restricting antimicrobial prescribing in children: what do we really know? Curr Opin Infect Dis 2010; 23:242-8. [PMID: 20375892 DOI: 10.1097/qco.0b013e328338c46d] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Most childhood respiratory infections including acute otitis media (AOM), sore throat, upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance, antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in children. RECENT FINDINGS From a key observational study reporting antibiotic use in children, the calculated excess risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of antibiotics upon the risk of brain abscess after sinusitis in children. SUMMARY New information from observational studies suggests antibiotics show little benefit in preventing complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for antibiotic prescription.
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Affiliation(s)
- Tamara Keith
- Department of Primary Care and Social Medicine, Imperial College London, London, UK
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Shulman ST, Tanz RR. Group A streptococcal pharyngitis and immune-mediated complications: from diagnosis to management. Expert Rev Anti Infect Ther 2010; 8:137-50. [PMID: 20109044 DOI: 10.1586/eri.09.134] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Group A streptococcal pharyngitis remains the most important bacterial pharyngitis because of its frequency and potential complications. Group A streptococcal pharyngitis is most common in children 5-11 years of age in winter-spring, and a rapid test or culture is necessary for accurate diagnosis. We propose a management strategy for those geographic areas with very low acute rheumatic fever rates, emphasizing selective testing that avoids testing those patients with viral-like features (e.g., rhinorrhea and cough). Acute rheumatic fever is the most important immune-mediated sequela and has become rare in most areas of the USA and Western Europe, most probably due to decreased circulation of highly rheumatogenic group A streptococcal strains.
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Affiliation(s)
- Stanford T Shulman
- Northwestern University, The Feinberg School of Medicine, Chicago, IL, USA.
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