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Singh H, Bhatt A, Kumar M, Deshmukh P. Tonsillitis and Sinusitis: A Narrative Review of Pathogenesis, Diagnosis, and Management. Cureus 2023; 15:e47192. [PMID: 38021555 PMCID: PMC10652663 DOI: 10.7759/cureus.47192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The review aims for a comprehensive examination of tonsillitis and sinusitis, covering their pathophysiology, diagnosis, and management, with a focus on recent breakthroughs and therapeutic practices. Tonsillitis, marked by inflammation of the tonsils, can result from viral or bacterial infections, particularly Streptococcus pyogenes, with attention to antibiotic resistance trends. This review discusses clinical manifestations, diagnostic criteria, and the importance of distinguishing viral from bacterial causes. Therapeutic interventions like antibiotics and tonsillectomy indications are evaluated within evolving guidelines. Regarding sinusitis, it explores its origins, contributing factors, and classification based on duration and pathophysiology. Viral infections, allergens, and structural anomalies' roles in pathogenesis are highlighted. Diagnostic modalities like imaging and endoscopic exams are assessed for their efficacy in guiding management decisions. The importance of precise diagnosis through clinical examination, microbiological testing, and imaging is emphasized for informed treatment choices. This review also delves into minimally invasive surgical procedures, particularly endoscopic sinus surgery and tonsillectomy, showcasing progress in these areas. In summary, it provides insights into tonsillitis and sinusitis, offering perspectives on their aetiology, diagnosis, and treatment while integrating current research and clinical standards to enhance patient care and healthcare resource utilization.
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Affiliation(s)
- Harshit Singh
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Asmi Bhatt
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayank Kumar
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rosi-Schumacher M, Nagy R, Virgen C, Carr MM. Peritonsillar abscess on NSQIP: Safety of indicated quinsy tonsillectomy. Int J Pediatr Otorhinolaryngol 2023; 171:111636. [PMID: 37352593 DOI: 10.1016/j.ijporl.2023.111636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/20/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To compare surgical outcomes for children with peritonsillar abscess (PTA) who are taken to the operating room (OR) for incision and drainage (I&D) or quinsy tonsillectomy. METHODS This is a multicenter retrospective study of pediatric patients who underwent I&D of a PTA between 2012 and 2017 included in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patient demographics, comorbidities, and 30-day postoperative events (reoperation, readmission, and complications) were assessed. RESULTS 777 patients were identified (mean age of 10.7 years, 54% female). 656 (84%) were admitted through the emergency department, and 395 (51%) met criteria for systemic inflammatory response syndrome or sepsis. Fifty-two (6.7%) had a quinsy tonsillectomy done at the time of incision and drainage. For quinsy tonsillectomy versus I&D alone, there was no statistically significant difference in length of stay (LOS) (1.9 v. 1.7 days, p = .523), readmission (17 v. 0, p = .265) or return to the OR (18 v. 1, p = .810). Patients younger than 5 years had a longer LOS (p < .001) while females (p = .003) and patients between 12 and 17 years of age (p = 0.021) were more likely to be readmitted. Of 725 patients treated with I&D alone, 10 (1.4%) patients required a repeat I&D and 6 (0.83%) went on to have an interval quinsy tonsillectomy. CONCLUSIONS Outcomes of I&D and quinsy tonsillectomy for pediatric PTA in the operating room are the same. If tonsillectomy is indicated in the case of recurrent tonsillitis or PTA, a quinsy tonsillectomy is a good option. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Mattie Rosi-Schumacher
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1237 Delaware Ave., Buffalo, NY 14209, USA.
| | - Ryan Nagy
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1237 Delaware Ave., Buffalo, NY 14209, USA
| | - Celina Virgen
- University of Arizona College of Medicine-Phoenix, 475 N 5th St., Phoenix, AZ, 85004, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1237 Delaware Ave., Buffalo, NY 14209, USA
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Samara P, Athanasopoulos M, Athanasopoulos I. Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery. Microorganisms 2023; 11:1624. [PMID: 37512798 PMCID: PMC10383913 DOI: 10.3390/microorganisms11071624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.
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Affiliation(s)
- Pinelopi Samara
- Children's Oncology Unit "Marianna V. Vardinoyannis-ELPIDA", Aghia Sophia Children's Hospital, 11527 Athens, Greece
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Nesemeier R, Jones S, Jacob K, Cash E, Goldman J. Trends in Emergency Department Computed Tomography Usage for Diagnosis of Peritonsillar Abscess. EAR, NOSE & THROAT JOURNAL 2023; 102:NP35-NP39. [PMID: 33433233 DOI: 10.1177/0145561320984996] [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: 12/16/2022] Open
Abstract
OBJECTIVES Peritonsillar abscess (PTA) is the most common deep neck space infection and a frequent cause for otolaryngology consultation. Patients often undergo computed tomography (CT) scan for confirmation in addition to physical examination. Our aims were to determine whether patients unnecessarily undergo CT scans in the emergency department (ED) when presenting with sore throat and identify physical examination characteristics that predict PTA. METHODS The electronic medical records of all patients (>18 years) presenting to an ED between June 2014 and June 2015 with a primary diagnosis of acute pharyngitis, acute tonsillitis, or PTA were reviewed for presenting symptoms and diagnostic imaging use. RESULTS Four hundred eight patients met inclusion criteria; 21 were diagnosed with PTA, including 13 based on history and physical alone. A total of 21 CT scans were ordered, 11 (52.3%) of which did not demonstrate abscess. Soft palatal fullness, uvular deviation, drooling, and muffled voice were all significantly associated with increased CT usage (all P values <.02). Rising subjective pain scores were associated with increased use of CT imaging (P = .029). Multivariable analyses revealed that soft palatal fullness, uvular deviation, and drooling were all significant predictors of PTA (all P values <.001). CONCLUSIONS Patients with severe symptoms of PTA, including uvular deviation, drooling, and soft palatal fullness, were most likely to undergo CT imaging. Given the high likelihood of PTA, patients presenting with these symptoms could forego CT imaging, reducing exposure to ionizing radiation.
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Affiliation(s)
- Ryan Nesemeier
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shawn Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin Jacob
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Julie Goldman
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Norton L, Myers A. The treatment of streptococcal tonsillitis/pharyngitis in young children. World J Otorhinolaryngol Head Neck Surg 2021; 7:161-165. [PMID: 34430823 PMCID: PMC8356196 DOI: 10.1016/j.wjorl.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
Pharyngitis is common in children, accounting for nearly 12 million visits annually in the United States. Streptococcus pyogenes or group A streptococcus (GAS) is the most common bacterial cause of pharyngitis for which antibiotics are indicated. Antibiotic treatment of streptococcal pharyngitis virtually eliminates the presence of bacteria from the pharynx and thus removes the risk of subsequent rheumatic fever. GAS is spread from person to person via respiratory droplets with a short incubation period of 2∼5 days. GAS pharyngitis peaks in the late winter and early spring months when children are predominately indoors for school and sports. Colonization is also higher in winter months, and while up to 20% of school age children are colonized with GAS in their throat during this time, colonization has not been shown to contribute to the spread of disease. In low- and middle-income countries and other situations in which crowding is common (e.g., schools), outbreaks of pharyngitis are common. GAS pharyngitis can occur at all ages and it is most common in school-aged children with a peak at 7∼8 years of age. Pharyngitis caused by GAS is rare in children <3 years of age and becomes much less common in late adolescence through adulthood.
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Affiliation(s)
| | - Angela Myers
- Pediatrics Children's Mercy Hospital, USA
- Corresponding author.
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Abstract
This study was performed to establish the reference for tonsil size in children, including neonates, without tonsil-associated symptoms, in relation to anthropometric indices (sex/age/height/weight/body mass index).We evaluated the size of both tonsils in 362 children by ultrasonography. Tonsil size was calculated as 0.523abc (a, transverse diameter on the transverse image; b, longitudinal diameter on the transverse image; c, longitudinal diameter on the longitudinal image) and compared between each age year using the Wilcoxon signed rank sum test with Bonferroni correction. We evaluated the relationships between tonsil size and anthropometric indices.Among these children, tonsil size was significantly increased by the age of 3 years (0-1 vs 1-2 [volume (right) = 210.15 ± 205.27 vs 737.83 ± 335.72 mm, P (right) < 0.0001 and volume (left) = 218.26 ± 207.23 vs 645.33 ± 240.31 mm, P (left) < 0.0001]; 1-2 vs 2-3 [volume (right) = 737.83 ± 335.72 vs 1073.86 ± 468.21 mm, P (right) = 0.004 and volume (left) = 645.33 ± 240.31 vs 1109.73 ± 563.20 mm, P (left) < 0.0001]). Although there was a tendency for the tonsil size to increase in years 3-12, there was no significant difference. Using single linear regression analysis, we found a correlation between tonsil size and age (r right/left = 0.67/0.65), height (r right/left = 0.72/0.70), and weight (r right/left = 0.66/0.64), with height having the strongest correlation.In conclusion, tonsil size significantly increased by 3 years of age. Tonsil size was correlated with anthropometric indices, with height showing the strongest correlation.
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Peritonsillar Abscess in an Infant. J Pediatr 2020; 227:320-321. [PMID: 32835661 DOI: 10.1016/j.jpeds.2020.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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Forner D, Curry DE, Hancock K, MacKay C, Taylor SM, Corsten M, Trites JR, Rigby MH. Medical Intervention Alone vs Surgical Drainage for Treatment of Peritonsillar Abscess: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 163:915-922. [PMID: 32482146 DOI: 10.1177/0194599820927328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dennis E Curry
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristy Hancock
- W. K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin MacKay
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R Trites
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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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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Pericleous A, Wilkinson S, Gerrish A, Daniel M. Peritonsillar abscess in an infant with congenital bone marrow failure. Int J Pediatr Otorhinolaryngol 2019; 124:200-202. [PMID: 31212167 DOI: 10.1016/j.ijporl.2019.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 11/16/2022]
Abstract
Peritonsillar abscess is extremely rare in infants and is potentially life-threatening. We report the case of a 3 month old infant with a background of congenital bone marrow failure who presented with sepsis and desaturation requiring intubation and PICU care. Ultrasound and CT scan revealed an inflammatory mass. Examination in theatre revealed a self-draining quinsy. Following formal drainage in theatre, the child improved and was extubated uneventfully 1 day later. Prompt surgical and medical management as well as the presence of a well-coordinated multidisciplinary team are crucial in ensuring the adequate management of complex paediatric patients.
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Affiliation(s)
- Agamemnon Pericleous
- Department of Paediatric Otorhinolaryngology, Nottingham Children's Hospital, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK.
| | - Sophie Wilkinson
- Department of Paediatric Otorhinolaryngology, Nottingham Children's Hospital, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Amy Gerrish
- Department of Radiology, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - Mat Daniel
- Department of Paediatric Otorhinolaryngology, Nottingham Children's Hospital, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
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Comparison of inpatient versus outpatient management of pediatric peritonsillar abscess outcomes. Int J Pediatr Otorhinolaryngol 2019; 123:47-50. [PMID: 31063948 DOI: 10.1016/j.ijporl.2019.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Peritonsillar abscess (PTA) in pediatric patients is a challenging condition to diagnose and treat, and recurrence can occur in up to 15% of patients. This condition can be managed in various settings and there may be outcome differences depending on the choice of inpatient/outpatient management. The objective of this study was to evaluate immediate and long-term outcomes, specifically recurrence, after PTA management in the inpatient versus outpatient setting as well as specific patient characteristics leading to hospital management decisions. METHODS We conducted a retrospective cohort study of all suspected cases of PTA seen at a tertiary pediatric hospital from 2008 to 2017, and 566 confirmed cases of PTA were included in this study. Demographics, PTA management, recurrence, and subsequent tonsillectomy (immediate or within 1 year of diagnosis) were ascertained from patient medical records. We compared characteristics of patients seen in the inpatient and outpatient setting using Chi-squared and Wilcoxon-Mann-Whitney tests. RESULTS Patients treated in the outpatient setting were more likely to be older and have a lower rate of recurrent ear infections (p < 0.0001 and p = 0.01 respectively). Additionally, no differences in gender, Down Syndrome, or autism were found. Patients who were admitted were more likely to undergo immediate tonsillectomy within a month or tonsillectomy within one year (p < 0.0001 and p = 0.02 respectively), whereas patients in the outpatient setting were more likely to receive antibiotics alone (p < 0.0001). Outpatient management was associated with no differences in recurrence rate within 30 days (p = 0.56). However, recurrence was associated with older age, a history of recurrent tonsillitis, but not a history of ear infections (p = 0.005, p < 0.0001, and p = 0.49 respectively). A history of recurrent ear infections, recurrent tonsillitis and recurrent PTAs were associated with the decision to pursue a tonsillectomy (p = 0.003, p = 0.03, and p < 0.0001 respectively). CONCLUSIONS Patients seen in the outpatient setting are more likely to receive antibiotics alone as their initial treatment, likely a result of certain clinical characteristics and presenting features as well as uncertain diagnosis. Inpatient status was associated with a younger age and a history of ear infections while recurrence was associated with a history of recurrent tonsillitis and older age. The recurrence rates for outpatient management were not statistically different than inpatient, suggesting that triaging and treatment of patients was occurring appropriately. The association of tonsillectomies in the inpatient group within 12 months is likely due to the higher rate of preexisting tonsil issues considering that recurrent tonsillitis, ear infections and a higher rate of PTA recurrence were all statistically correlated.
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Giurintano JP, Kortebein S, Sebelik M, Thompson J, McLevy-Bazzanella J. Intratonsillar abscess: A not-so-rare clinical entity. Int J Pediatr Otorhinolaryngol 2019; 119:38-40. [PMID: 30665174 DOI: 10.1016/j.ijporl.2018.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the prevalence of intratonsillar abscess in the pediatric population at our institution and demonstrate that intratonsillar abscess is a more commonly encountered diagnosis than previously reported. METHODS A retrospective chart review was performed that included patients presenting to our pediatric tertiary referral academic emergency department from January 1, 2014 to December 31, 2014 diagnosed with intratonsillar abscess on computed tomography. RESULTS In the year 2014, 22 children were diagnosed with intratonsillar abscess by radiological criteria. The majority of patients (82%) required no surgical intervention and were successfully treated with antibiotics and supportive measures. All patients recovered from the infection uneventfully, and there were no treatment complications recorded. CONCLUSION Even in recent literature, intratonsillar abscess is described as a rare entity, with few cases reported. In our experience, CT imaging demonstrating the presence of intratonsillar abscess is more common than previously described. Regardless of treatment method, in our experience children with intratonsillar abscess do well clinically.
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Affiliation(s)
- Jonathan P Giurintano
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Sarah Kortebein
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Merry Sebelik
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Jerome Thompson
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Jennifer McLevy-Bazzanella
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
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14
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Varelas AN, LoSavio PS, Misch E, Casey PE, Jeffe JS. Utilization of emergency department computed tomography and otolaryngology consultation in the diagnosis of pediatric peritonsillar abscess. Int J Pediatr Otorhinolaryngol 2019; 117:189-193. [PMID: 30579080 DOI: 10.1016/j.ijporl.2018.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether obtaining a computed tomography (CT) scan in the emergency department (ED) is predictive of peritonsillar abscess (PTA) in the pediatric population, and to evaluate for clinical characteristics that may suggest whether a CT is beneficial in the diagnosis of pediatric PTA. METHODS Single-institution retrospective chart review at Rush University Hospitals. Study included pediatric patients, aged 17 or younger, who presented to the ED with suspected PTA over a 6-year period. Patients received a neck CT and/or an official otolaryngology consultation. Relevant demographic and study parameters were collected and statistically analyzed using SPSS. RESULTS A total of 36 pediatric patients with suspected PTA. Of these, 47.2% (17/36) received a diagnosis of PTA while 52.8% (19/36) received an alternative diagnosis. Patients with PTA were more likely to have trismus (41.2% vs 5.3%; p < .01), uvular deviation (94.1% vs 15.8%; p < .01), and palatal edema (52.9% vs 10.5%; p < .01), compared to patients without PTA. Fewer CT scans were ordered when comparing PTA positive versus negative cohorts (35% vs 63.2%; p = .10), however this was not statistically significant. An otolaryngology consult prior to imaging did significantly reduce the frequency of ordered CT scans (12.5% vs 63.6%; p < .01). CONCLUSION This is the first study to investigate the benefit of CT imaging in the diagnosis of pediatric PTA and impact of an otolaryngology consult on the frequency of CT scans. Pediatric patients at high risk for PTA based on clinical findings may not require CT imaging for diagnosis. Patients at lower risk may benefit from imaging based on the availability of an otolaryngology consult or expertise of the examiner.
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Affiliation(s)
- Antonios N Varelas
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Phillip S LoSavio
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Emily Misch
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paul E Casey
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jill S Jeffe
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.
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15
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Ahmed Ali S, Kovatch KJ, Smith J, Bellile EL, Hanks JE, Truesdale CM, Hoff PT. Predictors of intratonsillar abscess versus peritonsillar abscess in the pediatric patient. Int J Pediatr Otorhinolaryngol 2018; 114:143-146. [PMID: 30262353 DOI: 10.1016/j.ijporl.2018.08.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the incidence of intratonsillar abscess (ITA) patients within the population of patients diagnosed with peritonsillar abscess (PTA) and to further characterize the differences in symptomatology and successful treatment strategies between the two groups. METHODS This study is a retrospective chart review of patients diagnosed with PTA or ITA at our institution from 2000 to 2017. Descriptive and inferential statistics are reported, including univariate and multivariate analyses. RESULTS A total of 335 pediatric (<18 years) patients presenting with a PTA or ITA were identified, 31 (9%) of whom were diagnosed with ITA. Patients with ITAs had significantly lower proportions of trismus, otalgia, and dysphagia and were less likely to experience acute progression from their initial symptoms. The ITA group had fewer attempted aspiration and drainage attempts, with those attempts significantly less successful than for the PTA group. Recurrence was uncommon in ITA patients in comparison to PTA patients. CONCLUSIONS Intratonsillar abscess should be considered in the differential diagnosis for patients presenting with sore throat and concern for a pharyngeal infection or abscess. These patients have a significantly lower proportion of otalgia, trismus, vocal changes, and dysphagia. Given the low success rate of drainage attempts and lower recurrence rate, diagnosing physicians should consider medical management rather than procedural drainage in this patient population.
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Affiliation(s)
- S Ahmed Ali
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States.
| | - Kevin J Kovatch
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
| | - Josh Smith
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
| | - Emily L Bellile
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
| | - John E Hanks
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
| | - Carl M Truesdale
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
| | - Paul T Hoff
- Michigan Medicine, Department of Otolaryngology, Head & Neck Surgery, Ann Arbor, MI, United States
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16
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Confluent Retropharyngeal, Lateral Pharyngeal, and Peritonsilar MRSA Abscess in an Infant. Pediatr Emerg Care 2018; 34:e161-e164. [PMID: 30180105 DOI: 10.1097/pec.0000000000001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neck abscesses such as retropharyngeal, peritonsilar, and lateral pharyngeal are well described, typically cause a characteristic illness, and have a known epidemiology. We present a rare occurrence of case of confluent, mixed retropharyngeal, lateral pharyngeal, and peritonsilar abscess in a 9-month-old female infant. The symptoms at presentation were very mild and not expected in association with this extensive an abscess. The causative organism was methicillin-resistant Staphylococcus aureus.
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17
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Bochner RE, Gangar M, Belamarich PF. A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses. Pediatr Rev 2017; 38:81-92. [PMID: 28148705 DOI: 10.1542/pir.2016-0072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Risa E Bochner
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Mona Gangar
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.,Department of Otorhinolaryngology/Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, NY
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18
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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19
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Bacon E, Tabbut M. When a peritonsillar abscess is not a peritonsillar abscess: using bedside emergency ultrasound to change the diagnosis. Am J Emerg Med 2016; 34:1186.e5-7. [DOI: 10.1016/j.ajem.2015.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/07/2015] [Indexed: 12/01/2022] Open
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20
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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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21
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Tachibana T, Orita Y, Abe-Fujisawa I, Ogawara Y, Matsuyama Y, Shimizu A, Nakada M, Sato Y, Nishizaki K. Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess. J Infect Chemother 2014; 20:722-5. [DOI: 10.1016/j.jiac.2014.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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22
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Ormond A, Chao S, Shapiro D, Walner D. Peritonsillar abscess with rapid progression to complete airway obstruction in a toddler. Laryngoscope 2014; 124:2418-21. [PMID: 24912933 DOI: 10.1002/lary.24770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 11/06/2022]
Abstract
Peritonsillar abscess in children younger than 5 years old has rarely been reported in the literature. We present the case of a 22-month-old child with a right peritonsillar abscess with parapharyngeal spread that was complicated by airway obstruction secondary to rapid epiglottic swelling. The severity of the airway obstruction necessitated an urgent tracheostomy, incision and drainage of the peritonsillar abscess and right lateral pharyngeal space, and a right tonsillectomy. Here we report the case and review the literature regarding peritonsillar space infections, their potential complications, and treatment.
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Affiliation(s)
- Andrew Ormond
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
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23
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Wang SM. Peritonsillar abscess: cool "hot potato". Pediatr Neonatol 2012; 53:325-6. [PMID: 23276433 DOI: 10.1016/j.pedneo.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022] Open
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