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Bivahagumye L, Gosselet V, Cambier S, Puechmaille M, Gibold L, Saroul N. Cytobacteriological testing of drainage pus from peritonsillar abscess is not contributive in clinical practice: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00046-2. [PMID: 38631947 DOI: 10.1016/j.anorl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
PURPOSE Peritonsillar abscess (PTA) is a frequent pathology. Treatment consists in drainage of the collection, associated to probabilistic antibiotic therapy. The usefulness of cytobacteriological testing (CBT) of the drainage pus is controversial. MATERIAL AND METHODS A retrospective study of patients managed for PTA between 2013 and 2020 in our university hospital was performed. The main objective was to assess the usefulness of CBT in the management of PTA. The secondary objectives were to determine the bacteriological profile involved in the onset of PTA and to assess the rate of bacterial resistance to antibiotics prescribed on a probabilistic basis. RESULTS The study included 207 patients: 70 outpatients (33%) and 137 inpatients (67%). Probabilistic antibiotic therapy was implemented in 100% of patients. CBT was performed systematically and was negative in 106 patients, revealing oropharyngeal flora in 40% of cases, polymicrobial flora in 50% and sterile samples in 10%. In the 101 patients with positive CBT, the bacteria isolated were penicillin-sensitive in 99%. All patients were successfully treated. In the light of the bacteriological results, no changes were made to the probabilistic antibiotic therapy introduced on admission. CONCLUSION CBT on drainage pus had no impact on the management of PTA. CBT is therefore unnecessary in patients with no comorbidities and no signs of severity at admission.
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Affiliation(s)
- L Bivahagumye
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France; Inra, CRNH, unité de nutrition humaine, université Clermont Auvergne, Auvergne, Clermont-Ferrand, France.
| | - V Gosselet
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France
| | - S Cambier
- Service de biostatistiques, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Puechmaille
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France
| | - L Gibold
- Service de bactériologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - N Saroul
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France; Inra, CRNH, unité de nutrition humaine, université Clermont Auvergne, Auvergne, Clermont-Ferrand, France
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Chang N, Lennard K, Rao A, Elliott M, Dharan N, Wong J. Polymicrobial arcanobacterium haemolyticum intracerebral abscess: A case report and review of the literature. IDCases 2024; 36:e01960. [PMID: 38690576 PMCID: PMC11059456 DOI: 10.1016/j.idcr.2024.e01960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Objective This article describes a case of polymicrobial Arcanobacterium haemolyticum pharyngitis and sinusitis complicated by intracranial complications and reviews similar cases in the literature. Case summary A 21-year-old immunocompetent male presented with symptoms of sore throat, rhinorrhoea, lethargy, headache, and rash. Imaging demonstrated sinusitis, pre-septal sinusitis, peritonsillar abscess formation, subdural empyema and cerebritis. He was managed with endoscopic sinus surgery, craniotomy for evacuation of subdural empyema and antibiotics. Microbiological samples demonstrated growth of A. haemolyticum, strep. anginosus, and fusobacterium necrophorum. He subsequently developed a cerebral abscess requiring stereotactic needle drainage. After a prolonged course of antibiotics, the patient was discharge and made a good recovery. Discussion A. haemolyticum is an uncommon cause of non-streptococcal pharyngitis that may occur alongside other microorganisms and is rarely associated with severe intracranial complications. This organism and its antibiotic susceptibility patterns should be considered in complicated upper respiratory tract infections in immunocompetent hosts. Penicillins and macrolide antibiotics form the mainstay of therapy for A. haemolyticum.
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Affiliation(s)
- Nicholas Chang
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
| | - Kate Lennard
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
| | - Amshuman Rao
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Otolaryngology, Sydney, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- University of New South Wales, Faculty of Medicine and Health, Sydney, Australia
| | - Michael Elliott
- Royal Prince Alfred Hospital, Department of Otolaryngology, Sydney, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Nila Dharan
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
- University of New South Wales, Faculty of Medicine and Health, Sydney, Australia
| | - Johnny Wong
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
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Nygren D, Wasserstrom L, Torisson G, Holm K. Low usefulness of reporting tonsillar PCR Ct-values in pharyngeal infections with Fusobacterium necrophorum. Anaerobe 2024; 86:102831. [PMID: 38369049 DOI: 10.1016/j.anaerobe.2024.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
Tonsillar Fusobacterium necrophorum PCR Ct-values were higher in participants with asymptomatic tonsillar carriage than patients with pharyngeal infections. However, Ct-values were not associated with severity of disease or predictive of development of complications and hence lacked clinical usefulness. The reporting of F. necrophorum Ct-values in clinical samples is not recommended.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden.
| | - Lisa Wasserstrom
- Clinical Microbiology Laboratory, Infection Control and Prevention, Laboratory Medicine, Lund, Sweden; Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden; Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden
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Morioka H, Kaida H, Nishio M, Suga K. Peritonsillar abscess caused by Mycoplasma hominis and Fusobacterium necrophorum following oral sex. Auris Nasus Larynx 2024; 51:320-322. [PMID: 38042699 DOI: 10.1016/j.anl.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 12/04/2023]
Abstract
Mycoplasma hominis is a bacterium that colonizes the genital tract of some females and males, as well as their respiratory tracts. Although only two cases of deep neck infection have been reported, the associations between the onset and sexual intercourse have not been reported. A healthy 19-year-old female was diagnosed with a left peritonsillar abscess. The patient had sexual intercourse with a new partner, including oral sex, two days prior to symptom onset. It was not known whether the male partner had urethritis symptoms. M. hominis and Fusobacterium necrophorum were isolated from the abscess culture. The patient's condition improved after drainage, and sulbactam ampicillin was switched to oral clindamycin.
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Affiliation(s)
- Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital; Infection Control Team, Komaki City Hospital.
| | - Hideyuki Kaida
- Department of Otolaryngology, Head and Neck Surgery, Komaki City Hospital
| | - Mitsuru Nishio
- Infection Control Team, Komaki City Hospital; Department of Clinical Laboratory, Komaki City Hospital Komaki
| | - Kenji Suga
- Department of Otolaryngology, Head and Neck Surgery, Komaki City Hospital
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Gopalakrishnan DP, Vivekanandan S, Manickam S, Marisamy N. Anatomical Factor for Formation of Peritonsillar Abscess in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2024; 76:1755-1758. [PMID: 38566744 PMCID: PMC10982159 DOI: 10.1007/s12070-023-04401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Peritonsillar abscess is a polymicrobial infection with acute life threatening complications if not treated promptly. Primary objective is to find the anatomical factor for unilateral abscess formation and appropriate management protocols. Secondary objectives include the bacteriological study,antibiotic preference and comparison of crypt length of both tonsils post tonsillectomy to look for any significant association. A prospective study was carried out for one year in patients with peritonsillitis or peritonsillar abscess attending the Department of ENT in our hospital. Acute cases were treated by incision and drainage followed by IV antibiotics after taking pus or throat swab for culture and sensitivity. Patients further planned for interval tonsillectomy after 6 weeks followed by histopathological examination to compare the infected side and normal side. Crypt length measurements done to see any disparity which would have lead to the development of peritonsillar abscess unilaterally. In patients with peritonsillitis or peritonsillar abscess, histopathological examination of tonsils after interval tonsillectomy showed that risk of peritonsillitis or peritonsillar abscess were more on the tonsil with larger crypt length with more preponderance on left side and in males. This study concludes that deeper the crypt length,male sex, history of recurrent tonsillitis are main risk factors for development of peritonsillar abscess. Bacteriology showed Staphylococcus aureus against the most common Streptococcus Sp. Hence prompt use of antibiotics help in early recovery and reducing complications.
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Affiliation(s)
| | | | - Sivakumar Manickam
- Department of ENT, Coimbatore Medical College & Hospital, Tamil Nadu, Coimbatore, India
| | - Nallasivam Marisamy
- Department of ENT, Coimbatore Medical College & Hospital, Tamil Nadu, Coimbatore, India
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Zloczower E, Netanely K, Shapira-Galitz Y, Pinhas S, Aharonovich N, Lahav Y, Allon R. Outcomes of abscess tonsillectomy in patients awaiting tonsillectomy: A comparison with interval tonsillectomy. Am J Otolaryngol 2024; 45:104198. [PMID: 38104468 DOI: 10.1016/j.amjoto.2023.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Peritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet the indications for elective tonsillectomy even prior to the current PTA event. Abscess ("Quinsy") tonsillectomy (QT) could serve as definitive treatment in this specific subgroup, though it is not performed often. The purpose of this study was to compare the perioperative outcomes between immediate QT and tonsillectomy performed several days (delayed QT) or weeks (Interval tonsillectomy, IT) after incision and drainage (I&D) of the PTA in this specific subgroup. MATERIALS AND METHODS A retrospective perioperative outcomes analysis of patients undergoing tonsillectomy (2002-2022) compared QT to delayed QT and IT in patients with PTA meeting AAO-HNS elective tonsillectomy criteria. RESULTS 110 patients were included: 55 underwent IT, 36 underwent delayed QT, and 19 underwent immediate QT. Postoperative hemorrhage rates were 14.5 %, 11.1 %, and 5.3 % for IT, delayed QT, and immediate QT, respectively (P = 0.08). Mean hospitalization durations were 7.98, 6.92, and 5.37 days for IT, delayed QT, and immediate QT, respectively (P < 0.01). IT had a higher readmission rate due to pain compared to QT (14.5 % vs. 1.9 %, p = 0.032). CONCLUSION Immediate QT in PTA patients eligible for elective tonsillectomy is associated with lower postoperative hemorrhage, shorter admission time, and potentially reduced postoperative pain compared to I&D and delayed or interval tonsillectomy. These findings suggest that immediate QT should be considered as a primary treatment in this subgroup of eligible patients.
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Affiliation(s)
- Elchanan Zloczower
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katya Netanely
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noy Aharonovich
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Mejias CD, Hubbard D, Jeong E, Reddy A. CT-guided transcutaneous drainage of peritonsillar abscess after failed ultrasound-guided drainage: A case report. Radiol Case Rep 2024; 19:654-660. [PMID: 38111556 PMCID: PMC10726339 DOI: 10.1016/j.radcr.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/20/2023] Open
Abstract
Peritonsillar abscess (PTA) is the most common deep neck infection in the United States. Timely treatment of PTA with antibiotics and aspiration or drainage is paramount, as delay in management may lead to further complications. The oral approach is the preferred route of drainage however may not always be accessible, warranting consideration of other routes of drainage. To the best of our knowledge, CT guidance for aspiration or drainage of a PTA has not been previously described. We present a 50-year-old patient with a PTA who initially presented with throat pain and dysphagia, rapidly developed upper airway obstruction, and required intubation. After the failure of clinical improvement and unsuccessful PTA aspiration via the conventional oral route, successful CT-guided percutaneous needle aspiration was performed by neuroradiology. Shortly thereafter, the patient clinically improved and was discharged with an oral course of antibiotics and follow-up on an as-needed basis. Total hospital length of stay was seven days. The complex patient may not allow for simple incision and drainage or needle aspiration of a suspected PTA. Assistance with ultrasound guidance is often utilized, however, challenges may persist depending on the anatomical location of the PTA and patient comorbidities. In cases where external drainage is considered and conventional ultrasound imaging is particularly challenging, CT-guided percutaneous aspiration may provide a useful alternative. PTAs are common with the possibility of complication. Although the usual route of drainage is oral, there are instances in which this cannot be performed. This case exhibits an uncommon approach to PTA aspiration via an external CT-guided percutaneous approach with rapid subsequent clinical improvement, exhibiting the utility of CT guidance.
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Affiliation(s)
| | - Daniel Hubbard
- Department of Radiology, Medical College of Georgia at Augusta University, Augusta GA, USA
| | - Eun Jeong
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ambur Reddy
- Department of Radiology, Neuroradiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Klug TE, Greve T, Caulley L, Hillerup S. The impact of social restrictions on the incidence and microbiology of peritonsillar abscess: a retrospective cohort study. Clin Microbiol Infect 2024; 30:100-106. [PMID: 37562694 DOI: 10.1016/j.cmi.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA). METHODS We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark. RESULTS The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023). DISCUSSION Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Caulley
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sara Hillerup
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Vierula JP, Nurminen J, Jussila V, Nyman M, Heikkinen J, Pape B, Sorvettula K, Mattila K, Hirvonen J. Diagnostic performance of short noncontrast biparametric 3-T MRI for tonsillar infections: comparison with a full protocol including contrast-enhanced sequences. Eur Radiol Exp 2023; 7:65. [PMID: 37872406 PMCID: PMC10593634 DOI: 10.1186/s41747-023-00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We investigated whether a short, 5-min magnetic resonance imaging (MRI) protocol consisting of only axial T2-weighted and diffusion-weighted imaging (DWI) sequences can discriminate between tonsillar infections, peritonsillar abscesses and deeply extending abscesses in a retrospective, blinded, multireader setting. METHODS We included patients sent by emergency physicians with suspected pharyngotonsillar infections who underwent emergency neck 3-T MRI from April 1 2013 to December 31 2018. Three radiologists (with 10-16 years of experience) reviewed the images for abscesses and their extension into deep neck spaces. Data were reviewed first using only axial T2-weighted Dixon images and DWI (short protocol) and second including other sequences and contrast-enhanced T1-weighted Dixon images (full protocol). Diagnostic accuracy, interobserver agreement, and reader confidence were measured. Surgical findings and clinical course served as standard of reference. RESULTS The final sample consisted of 52 patients: 13 acute tonsillitis with no abscesses, 19 peritonsillar abscesses, and 20 deeply extending abscesses. Using the short protocol, diagnostic accuracy for abscesses across all readers was good-to-excellent: sensitivity 0.93 (95% confidence interval 0.87-0.97), specificity 0.85 (0.70-0.93), accuracy 0.91 (0.85-0.95). Using the full protocol, respective values were 0.98 (0.93-1.00), 0.85 (0.70-0.93), and 0.95 (0.90-0.97), not significantly different compared with the short protocol. Similar trends were seen with detecting deep extension. Interobserver agreement was similar between protocols. However, readers had higher confidence in diagnosing abscesses using the full protocol. CONCLUSIONS Short MRI protocol showed good-to-excellent accuracy for tonsillar abscesses. Contrast-enhanced images improved reader confidence but did not affect diagnostic accuracy or interobserver agreement. RELEVANCE STATEMENT Short protocol consisting only of T2-weighted Dixon and DWI sequences can accurately image tonsillar abscesses, which may improve feasibility of emergency neck MRI. KEY POINTS • The short 3-T MRI protocol (T2-weighted images and DWI) was faster (5 min) than the full protocol including T1-weighted contrast-enhanced images (24 min). • The short 3-T MRI protocol showed good diagnostic accuracy for pharyngotonsillar abscesses. • Contrast-enhanced sequences improved reader confidence but did not impact diagnostic accuracy or interobserver agreement.
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Affiliation(s)
| | - Janne Nurminen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Ville Jussila
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jaakko Heikkinen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Bernd Pape
- Department of Biostatistics, Turku University Hospital, Turku, Finland
- School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Kaarlo Sorvettula
- Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kimmo Mattila
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, Turku, Finland
- Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
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10
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Huo LM, Li LM, Peng HY, Wang LJ, Feng ZY. Kawasaki disease with peritonsillar abscess as the first symptom: A case report. World J Clin Cases 2023; 11:5391-5397. [PMID: 37621581 PMCID: PMC10445059 DOI: 10.12998/wjcc.v11.i22.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages. CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment. CONCLUSION Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
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Affiliation(s)
- Li-Man Huo
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Min Li
- Department of Paediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Hao-Yang Peng
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Jia Wang
- Department of Medical Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhang-Ying Feng
- Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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11
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Huo LM, Li LM, Peng HY, Wang LJ, Feng ZY. Kawasaki disease with peritonsillar abscess as the first symptom: A case report. World J Clin Cases 2023; 11:5385-5391. [DOI: 10.12998/wjcc.v11.i22.5385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSION Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
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Affiliation(s)
- Li-Man Huo
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Min Li
- Department of Paediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Hao-Yang Peng
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Jia Wang
- Department of Medical Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhang-Ying Feng
- Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Agerhäll M, Larsson S, Tano K, Berggren D. High rate of early recurrence of peritonsillar abscess among adolescents and young adults. Acta Otolaryngol 2023; 143:602-605. [PMID: 37452657 DOI: 10.1080/00016489.2023.2225555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Peritonsillar abscess (PTA) can be treated with aspiration or incision for drainage, but a subsequent PTA can occur if tonsillectomy is not performed. Better understanding is needed of when tonsillectomy should be performed to avoid PTA recurrence. OBJECTIVE This study investigated the recurrence rate of PTA following aspiration or incision for drainage and evaluated the risk factors for recurrence. METHODS The medical records of 292 patients treated for PTA were reviewed. Recurrence of PTA and elective or quinsy tonsillectomy were the primary endpoints. A Cox proportional hazards regression model for PTA recurrence was constructed with sex, age, and PTA history as predictors. RESULTS Young age was the only significant predictor of PTA recurrence. Patients aged 15 to 24 years had a 30-day recurrence rate of 15.5% and a total recurrence rate of 26.6%. The total recurrence rate among patients over 30 years of age was significantly less at 4.0% (Fisher's exact test, p < .05). CONCLUSION AND SIGNIFICANCE Based on our results, tonsillectomy should be considered for PTA patients between 15 and 25 years of age and, to effectively avoid future recurrence of PTA, should be performed urgently.
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Affiliation(s)
- Martin Agerhäll
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Sandra Larsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Krister Tano
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Diana Berggren
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
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14
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Vural S, Kuşdoğan M, Kaya HB, İkiz V, Albayrak L. Adalimumab (Humira®) Induced Recurrent Peritonsillar Abscess in A Patient Received Three Different Anti-TNF Therapies: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:1013-1015. [PMID: 37274971 PMCID: PMC10235369 DOI: 10.1007/s12070-022-03203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/23/2022] [Indexed: 12/12/2022] Open
Abstract
Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response. Therefore, physicians should be careful about recurrent infections in patients under anti-tumor necrosis factor agents.
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Affiliation(s)
- Sevilay Vural
- Department of Emergency Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Department of Emergency Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Mikail Kuşdoğan
- Department of Emergency Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Hasan Burak Kaya
- Department of Emergency Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Venhar İkiz
- Department of Emergency Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Levent Albayrak
- Department of Emergency Medicine, Yozgat Bozok University, Yozgat, Turkey
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15
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Kim MW, Choi MS. Drainage of Inferiorly Extended Peritonsillar Abscess Using an Endoscope and Radiofrequency Device: Technical note. Indian J Otolaryngol Head Neck Surg 2023; 75:540-546. [PMID: 37275022 PMCID: PMC10234925 DOI: 10.1007/s12070-022-03362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the larynx is atypical. Accurate diagnosis and prompt treatment are required because airway obstruction, descending mediastinitis, or thrombophlebitis may result. We evaluated surgical outcomes of inferiorly extended PTA (IEPTA) using an endoscope and a radiofrequency device for intraoral drainage. We retrospectively reviewed the medical records of 56 patients with IEPTA who underwent incisional drainage between 2013 and 2021. Two experienced surgeons performed intraoral drainage using an endoscope and a radiofrequency device (endoscopic group [EG]) or without such devices (WEG). Thirty (male: 26, female: four; mean age: 51.3 years), and 26 (male: 21, female: five; mean age: 55.9 years) patients in the EG and WEG, respectively, were evaluated. The mean hospitalization durations were 6.7 and 14.5 days for the EG and WEG, respectively (p<0.01). There were significant between-group differences regarding the number of tracheostomies conducted to secure an airway or surgical field (EG: four (13.3%); WEG: 16 (61.5%); p<0.01. The hospitalization duration for patients undergoing tracheostomy was significantly shorter in the EG than in the WEG (9.3 vs. 18.5 days, respectively; p=0.01). No significant difference in the mean hospital stay was observed for patients who did not undergo tracheostomy ([EG: 6.3, WEG: 8.2] days; p=0.081). IEPTA drainage using an endoscope and a radiofrequency instrument can reduce duration of hospitalization and tracheostomy procedures compared with the conventional method. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03362-0.
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Affiliation(s)
- Min Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, Daejeon Eulji Medical Center, Eulji University, Dunsanseoro 95, Seo-gu, 35233 Daejeon, Korea
| | - Myoung Su Choi
- Department of Otolaryngology-Head and Neck Surgery, Daejeon Eulji Medical Center, Eulji University, Dunsanseoro 95, Seo-gu, 35233 Daejeon, Korea
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Konishi T, Sakata A, Inokuchi H, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Treatments and outcomes of adult parapharyngeal and retropharyngeal abscess: 1882 cases from a Japanese nationwide database. Am J Otolaryngol 2023; 44:103770. [PMID: 36577172 DOI: 10.1016/j.amjoto.2022.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Although parapharyngeal and retropharyngeal abscesses are potentially fatal deep neck abscesses, there is limited evidence for the treatment courses for adult patients with these abscesses. We aimed to describe the practice patterns and clinical outcomes of adult patients undergoing an emergency surgery for parapharyngeal or retropharyngeal abscesses using a nationwide database. MATERIALS AND METHODS We identified patients aged ≥18 years who underwent emergency surgery for parapharyngeal (para group, n = 1148) or retropharyngeal (retro group, n = 734) abscesses from July 2010 to March 2020, using a nationwide inpatient database. We performed between-group comparisons of the baseline characteristics, treatment course, and outcomes. RESULTS Compared with the retro group, the para group was more likely to be older (median, 66 vs. 60 years; P < 0.001) and have several comorbidities, such as diabetes (21 % vs 16 %; P = 0.010) and epiglottitis (33 % vs. 26 %; P = 0.002), except for peritonsillar abscess (14 % vs. 22 %; P < 0.001) and tonsillitis (2.1 % vs. 13 %; P < 0.001). Regarding intravenous drugs administered within 2 days of admission, approximately half of the patients received steroids, non-antipseudomonal penicillins, and lincomycins. The para group received more comprehensive treatments, such as tracheostomy, intensive care unit admissions, and swallowing rehabilitation, within total hospitalization than the retro group. Moreover, it demonstrated higher in-hospital mortality (2.7 % vs. 1.1 %; P = 0.017) and morbidity (16 % vs. 9.7 %; P < 0.001), and longer length of hospitalization than the retro group. CONCLUSION The current nationwide study provided an overview of the characteristics, treatments, and outcomes for patients who underwent an emergency surgery for parapharyngeal or retropharyngeal abscess.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Aki Sakata
- Department of Otorhinolaryngology, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, Tokyo 158-8531, Japan
| | - Haruhi Inokuchi
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Studemeister L, Pai S, Walsh K, Cooper J. Acute Tonsillitis Due To Monkeypox. J Emerg Med 2023; 64:211-213. [PMID: 36822985 PMCID: PMC9943563 DOI: 10.1016/j.jemermed.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/24/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND The emerging 2022 human mpox virus outbreak has presented with unique disease manifestations challenging prior case definitions. CASE REPORT We present a case of a 42-year-old transgender woman with human immunodeficiency virus controlled on antiretroviral therapy, presenting with sore throat, who, after three emergency department visits, was found to have acute tonsillitis complicated by airway obstruction secondary to mpox. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Sore throat is a common presentation to the emergency department. mpox should be placed on the list of differential diagnoses when evaluating patients who present with pharyngitis to avoid complications or a missed diagnosis.
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Affiliation(s)
- Lucy Studemeister
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Sushma Pai
- Department of Internal Medicine, O'Connor Hospital, San Jose, California
| | - Kristin Walsh
- Division of AIDS Medicine, Infectious Diseases, Mycobacterial Diseases and International Health, Santa Clara Valley Medical Center, San Jose, California
| | - Joseph Cooper
- Division of AIDS Medicine, Infectious Diseases, Mycobacterial Diseases and International Health, Santa Clara Valley Medical Center, San Jose, California
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18
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Alrwashdeh AM, Saluja P, Hasan L, Kocurek E, Dare RK. Arcanobacterium haemolyticum bacteremia presenting as severe sepsis: A case report and review of the literature. IDCases 2022; 31:e01645. [PMID: 36579145 PMCID: PMC9791352 DOI: 10.1016/j.idcr.2022.e01645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objective to describe a case of severe sepsis and complicated bacteremia caused by Arcanobacterium haemolyticum and review similar cases in the literature. Case summary A 26-year-old gentleman with a history of epilepsy presented with symptoms of sore throat, productive cough, periumbilical abdominal pain, watery diarrhea, nausea and vomiting, subjective fevers along with progressive jaundice for seven days. The patient had acute fulminant liver failure, septic shock, and Multi-organ failure. He required vasopressors, underwent intubation, and had grown Arcanobacterium haemolyticum in the blood and Bronchoalveolar lavage samples. He developed a peritonsillar abscess and cavitary pneumonia and required chest tube drainage followed by thoracotomy for hemothorax. The patient improved on Ampicillin-Sulbactam treatment and was treated with a total antibiotic duration of 6 weeks. He fully improved on post-discharge follow-up. Discussion Arcanobacterium haemolyticum is a Gram-positive (sometimes Gram variable), catalase-negative facultatively anaerobic, non-motile, non-spore-forming, and variably β-hemolytic and is known to be a cause of pharyngitis and skin and soft tissue infections. Rarely A. Haemolyticum can be associated with severe systemic infections such as infective endocarditis, systemic abscesses, osteomyelitis, and septicemia. In previous literature reviews, the source of A. haemolyticum depended on the host, and pharyngeal and upper respiratory sources were likely to be associated with immunocompetent hosts. Conclusion A. haemolyticum should be included in the differential diagnosis of bacterial pharyngitis complicated by severe systemic illness. Penicillins are the most commonly used antibiotics for treating A. haemolyticum bacteremia, and macrolides can be used for Penicillin's treatment failure.
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Affiliation(s)
- Anas M. Alrwashdeh
- University of Arkansas for Medical Sciences, Department of Internal Medicine, Division of Infectious Diseases, 4301 West Markham Street, Little Rock, AR 72205, the United States of America,Correspondence to: 3321 S Bowman road, Little Rock, AR 72211, the United States of America.
| | - Prachi Saluja
- University of Arkansas for Medical Sciences, Department of Internal Medicine, 4301 West Markham Street, Little Rock, AR 72205, the United States of America
| | - Lana Hasan
- Cleveland Clinic Foundation, Department of Infectious Diseases, 9500 Euclid Avenue, G21, Cleveland, OH 44195, the United States of America
| | - Emily Kocurek
- University of Arkansas for Medical Sciences, Department of Internal Medicine, Division of Pulmonary and Critical Care, 4301 West Markham Street, Little Rock, AR 72205, the United States of America
| | - Ryan K. Dare
- University of Arkansas for Medical Sciences, Department of Internal Medicine, Division of Infectious Diseases, 4301 West Markham Street, Little Rock, AR 72205, the United States of America
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Revathishree K, Shyam Sudhakar S. Ageusia: A Symptom of Peritonsillar Abscess? Indian J Otolaryngol Head Neck Surg 2022; 74:5881-3. [PMID: 33718102 DOI: 10.1007/s12070-021-02506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Peritonsillar abscess is a known complication of tonsillitis. The patient usually presents with typical symptoms of odynophagia, fever and difficulty in mouth opening. The diagnosis is established by clinical examination that commonly revealed unilateral peritonsillar swelling. Aspiration of pus will confirm the diagnosis. We report an atypical presentation of peritonsillar abscess case which presented only with loss of taste sensation without dysphagia, fever, odynophagia or trismus.
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20
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Cheng GCH, Wong JWM. Managing limitations of the LMA Classic laryngeal mask as a conduit for tracheal intubation in impending paediatric airway obstruction: a case report. Hong Kong Med J 2022; 28:321-323. [PMID: 35989433 DOI: 10.12809/hkmj219435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- G C H Cheng
- Department of Anaesthesia and Operating Theatre Services, Kwong Wah Hospital, Hong Kong
| | - J W M Wong
- Department of Anaesthesia and Operating Theatre Services, Kwong Wah Hospital, Hong Kong
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Lochbaum R, Tewes S, Hoffmann TK, Greve J, Hahn J. [Typical emergencies in otorhinolaryngology-a monocentric analysis of the seasonal course]. HNO 2022; 70:601-608. [PMID: 35657418 PMCID: PMC9164187 DOI: 10.1007/s00106-022-01185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Inzidenz der Akutdiagnosen im Hals-Nasen-Ohren(HNO)-Bereich wird durch multiple Parameter beeinflusst, unter anderem meteorologische und saisonale Einflüsse. Durch ein besseres Verständnis dieser Faktoren könnten prophylaktische Ansätze entwickelt werden. Material und Methoden Über 6 Jahre erfolgte eine retrospektive Analyse aller Patienten, die sich aufgrund von typischen und weniger komplexen HNO-ärztlichen Krankheitsbildern wie Cerumen obturans, akuter Otitis externa und media, Nasenpyramidenfraktur, Epistaxis nasi, akuter Tonsillitis, akuter Rhinosinusitis oder eines Peritonsillarabszess in einer südwestdeutschen Universitätsklinik vorgestellt haben. Ergebnisse 32.968 Fälle wurden ausgewertet. Mit 24,5 % (8082 Fälle) war die Epistaxis nasi die häufigste Notfalldiagnose. Diese, wie auch die akute Otitis media und die akute Rhinosinusitis, traten signifikant häufiger in der kälteren Jahreshälfte auf. Es bestand keine signifikante Korrelation der Diagnose Nasenpyramidenfraktur mit besonderen Zeiten wie Feiertagen. Die akute Otitis externa korrelierte signifikant mit dem Zeitraum der Sommerferien. In Kalenderwoche 38 gab es die wenigsten und in der Kalenderwoche 52 die meisten Notfallvorstellungen. Schlussfolgerung Saisonale und meteorologische Faktoren spielen eine Rolle in der Krankheitsentstehung verschiedener HNO-ärztlicher Notfalldiagnosen.
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Affiliation(s)
- R Lochbaum
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - S Tewes
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Greve
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Hahn
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
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22
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Tsikopoulos A, Fountarlis A, Tsikopoulos K, Dilmperis F, Garefis K, Tsikopoulos I, Skoulakis C, Karkos P, Triaridis S. Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:2245-2257. [PMID: 35169892 DOI: 10.1007/s00405-022-07294-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/28/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. METHODS The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. RESULTS Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively). CONCLUSIONS This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.
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Affiliation(s)
- Alexios Tsikopoulos
- 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, 546 21, Thessaloniki, Greece.
| | - Athanasios Fountarlis
- Department of Otorhinolaryngology, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | | | - Fotios Dilmperis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Garefis
- 2nd Department of Otorhinolaryngology-Head and Neck Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsikopoulos
- Department of Urology, 424 Army General Training Hospital, Thessaloniki, Greece
| | - Charalampos Skoulakis
- Department of Otorhinolaryngology, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Petros Karkos
- 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, 546 21, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, 546 21, Thessaloniki, Greece
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Isaacson G, Pankey A. Reprint of: Needle aspiration for confirmation and treatment of peritonsillar abscess. Dis Mon 2022;:101390. [PMID: 35489830 DOI: 10.1016/j.disamonth.2022.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Windfuhr JP, Günster C. Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany. Eur Arch Otorhinolaryngol 2022; 279:4157-4166. [PMID: 35218385 PMCID: PMC8881894 DOI: 10.1007/s00405-022-07308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
Abstract
Purpose To longitudinally evaluate the impact of the COVID-19-pandemic on the incidence of inpatient tonsil surgery and outpatient primary care of sore throat in Germany. Methods A retrospective interrupted time-series analysis was conducted. The national database of the Hospital Remuneration System was used to retrieve the number of operations performed between January 2019 and September 2021 including elective and non-elective cases with the exception of malign diseases. Three episodes were compared on a weekly basis: before, during, and after the first national lockdown (March 16–May 3, 2020). We also analysed the number of outpatient doctor contacts of sore throat patients in 2019 and 2020. Results Overall, 144,069 surgical cases were included in the analysis. The first lockdown resulted in an abrupt and significant decrease of all types of tonsil surgery (p < 0.01). The incidence of tonsillectomy decreased from 556 (before) to 111 (during) and 326 (after) cases per week (relative risk 0.24; 95% CI 0.19–0.30, and 0.82; 95% CI 0.73–0.92). After the lockdown, the incidence persisted on a lower level compared to 2019. The number of doctor contacts decreased from 2,967,322 in 2019 to 1,976,617 in 2020 (− 33.4%). Conclusions The first lockdown was associated with a significant decrease of all types of tonsil surgery. A return to pre-pandemic surgical activity was not identified. The findings were accompanied by a significant decrease of outpatient doctor contacts of sore throat patients in primary care, particularly in the subgroup of children and adolescents. The impact of the second lockdown, starting in December 2020, was by far not comparable. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07308-8.
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Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany.
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Centor RM, Atkinson TP, Xiao L. Fusobacterium necrophorum oral infections - A need for guidance. Anaerobe 2022;:102532. [PMID: 35122953 DOI: 10.1016/j.anaerobe.2022.102532] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022]
Abstract
F. necrophorum, a gram-negative obligate anaerobe, causes pharyngotonsillitis, peritonsillar abscess and the Lemierre Syndrome as well as other significant infections. Clinical information on this bacterium has increased dramatically over the past 20 years, yet no standard guidance exists for treating these infections. While data support F. necrophorum as a cause of pharyngotonsillitis, no consensus exists on the clinical importance of these findings especially in the 15-30 age group. Similarly, recent data find this bacterium the most frequent and most likely to recur in peritonsillar abscess for that age group. Should this impact how we treat these patients? Finally, we have no studies of either antibiotics or anticoagulation for the Lemierre Syndrome. Thus, each physician making the diagnosis of the Lemierre Syndrome chooses antibiotics (and their duration) and whether or not to anticoagulate without guidance. Infectious disease specialists and hospitalists would benefit from consensus expert opinions based on reviewing data on these infections.
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Demongeot N, Akkari M, Blanchet C, Godreuil S, Prodhomme O, Leboucq N, Mondain M, Jeziorski E. Pediatric deep neck infections: Clinical description and analysis of therapeutic management. Arch Pediatr 2021; 29:128-132. [PMID: 34955300 DOI: 10.1016/j.arcped.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of our study was to describe clinical presentations, bacteriological results, and therapeutic management in a pediatric population presenting with acute pharyngeal suppuration. A further aim was to identify clinical, bacteriological, and radiological predictors of success associated with exclusive medical treatment. METHOD A retrospective study was carried out including patients under 18 years of age hospitalized between January 1, 2015 and December 31, 2017 in our center for acute pharyngeal suppuration. We identified three groups of patients: group A, treated with exclusive intravenous antibiotics; group B, surgically treated after 48 h of appropriate antibiotic therapy, due to persistent fever and/or clinical worsening and/or persistence of a collection on follow-up imaging; group C, surgically treated as first-line therapy in association with intravenous antibiotics. A total of 83 patients were included: 36 in group A, 12 in group B, and 35 in group C. These three groups were compared for several variables: age of the patients, polynuclear neutrophil counts, diameter of the collections (the largest diameter found on imaging), duration of antibiotic therapy, delay before return to apyrexia, and hospitalization duration. RESULTS A neck mass and torticollis were present, respectively, in 48.8 and 47.6% of cases. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism. The average diameter of the collections from patients treated surgically as first-line therapy (group C) was significantly larger than that of the patients treated with antibiotics (group A) (27.89 mm vs. 18.73 mm, respectively, p = 0.0006). All the patients who required surgery despite 48 h of appropriate antibiotic therapy (group B) had collections with diameters greater than or equal to 15 mm. There was no significant difference between the groups concerning hospitalization duration. CONCLUSION Exclusive medical treatment is associated with a high cure rate, mainly for collections with small diameter. We recommend special attention to patients treated with first-line exclusive intravenous antibiotic therapy and with a collection diameter greater than or equal to 15 mm.
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Affiliation(s)
- N Demongeot
- Department of Pediatrics, University Hospital Arnaud de Villeneuve, University of Montpellier, France
| | - M Akkari
- Department of Ear Nose and Throat and Head and Neck surgery, University Hospital Gui de Chauliac, 80 avenue Augustin Fliche, University of Montpellier, Montpellier 34295 Cedex 5, France.
| | - C Blanchet
- Department of Ear Nose and Throat and Head and Neck surgery, University Hospital Gui de Chauliac, 80 avenue Augustin Fliche, University of Montpellier, Montpellier 34295 Cedex 5, France
| | - S Godreuil
- Department of Bacteriology, University Hospital Arnaud de Villeneuve, UMR MIVEGEC, UMR IRD 224-CNRS INSERM 1058, University of Montpellier, Montpellier, France
| | - O Prodhomme
- Department of Pediatric imaging, University Hospital Arnaud de Villeneuve, University of Montpellier, France
| | - N Leboucq
- Department of Bacteriology, University Hospital Arnaud de Villeneuve, UMR MIVEGEC, UMR IRD 224-CNRS INSERM 1058, University of Montpellier, Montpellier, France
| | - M Mondain
- Department of Ear Nose and Throat and Head and Neck surgery, University Hospital Gui de Chauliac, 80 avenue Augustin Fliche, University of Montpellier, Montpellier 34295 Cedex 5, France
| | - E Jeziorski
- Department of Pediatrics, University Hospital Arnaud de Villeneuve, University of Montpellier, France; Pathogenesis and Control of Chronic Infections, INSERM, University of Montpellier, Montpellier, France
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Gilley DR, Virdi GS, Namin AW, Dooley LM. Utility of CT in the workup of adults with sore throat in the emergency department. Am J Emerg Med 2021; 50:739-743. [PMID: 34879496 DOI: 10.1016/j.ajem.2021.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The goal of this study was to determine if computed tomography (CT) added any clinical information that was incorporated into the decision regarding treatment for patients who presented to the Emergency Department (ED) with sore throat. METHODS A retrospective chart review of adult patients who presented to the ED with a chief complaint of sore throat who subsequently underwent CT during that ED visit between 1/1/18 and 12/31/18 at our tertiary academic health center was performed. The association between palatal bulge on Otolaryngology physical exam with successful drainage procedure was examined. The mean Hounsfield units (HU) and maximum dimension of measurable fluid collection on CT were compared between patients who underwent a successful drainage procedure and those who did not undergo a drainage procedure or attempted drainage was unsuccessful. RESULTS Ninety-four patients met inclusion criteria, with 53% (50/94) men. Of the 22 patients with a palatal bulge on physical examination by Otolaryngology, 86% (19/22) underwent a successful drainage procedure (p < 0.001) when compared to those not undergoing successful drainage. Notably, 56% (53/94) of CT scans were interpreted as normal or tonsillitis. The mean HU was 42.0 in those patients who underwent a successful drainage procedure and 74.1 in those who did not undergo a drainage procedure (p < 0.001). Overall, 21/35 fluid collections had a palatal bulge (p < 0.001). CONCLUSION Palatal bulge is a reliable finding in identifying patients with a drainable peritonsillar abscess, and CT scans could largely be avoided in patients without physical exam findings suggestive of more extensive deep neck space abscesses. If a CT scan is obtained, HU should be measured and incorporated into the shared decision-making process with the patient.
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Affiliation(s)
- David R Gilley
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
| | - Gurpal S Virdi
- University of Missouri School of Medicine, Degree Program, Columbia, MO, USA
| | - Arya W Namin
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Laura M Dooley
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Sideris G, Malamas V, Tyrellis G, Maragkoudakis P, Delides A, Nikolopoulos T. Ubi pus, ibi evacua: a review of 601 peritonsillar abscess adult cases. Ir J Med Sci 2021; 191:1849-1853. [PMID: 34617243 PMCID: PMC8494509 DOI: 10.1007/s11845-021-02796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Background Peritonsillar abscess (PTA) is the most common deep neck infection, occurring as a consequence of bacterial acute tonsillitis or as a result of infection of the Weber glands, with frequent and life-threatening complications. Aim To investigate several factors associated with complications and worse prognosis, such as defining the method of surgical drainage and treatment of a PTA which remains an area of controversy in the literature Methods The purpose of this retrospective study is to examine the epidemiological, clinical, and laboratory findings of 601 adult patients and to discuss them along with their treatment plan. Results Pharyngalgia was the most common reported symptom, followed by trismus, odynophagia, fever, hot potato voice, malaise, and cervical lymphadenopathy. Sixty-eight patients developed complications. Streptococcus species were the most common pathogens. A statistically significant difference was found in days of hospitalization, WBC and CRP levels, age, and the pre-existing systemic diseases between patients with and without complications. A comparison of patients treated with intravenous and oral antibiotics revealed no statistically significant difference. Conclusion Οver 10% of PTA cases may develop complications, the most common of which is extension into deep neck spaces. Comorbid conditions increase the risk of complications. Despite the wide range of treatment strategies, incision and drainage remain the cornerstone of surgical treatment. In patients with no comorbidities, intravenous antibiotics appear to have no advantage over oral antibiotics.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece.
| | - Vangelis Malamas
- Department of Infomatics, University of Peiraeus, Peiraeus, Greece
| | - George Tyrellis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
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von Beckerath M, Svensson J, Landström F. Feasibility of an inexperienced examiner using trans-cervical ultrasound in the diagnosis of peritonsillar abscesses. Acta Otolaryngol 2021; 141:847-850. [PMID: 34392793 DOI: 10.1080/00016489.2021.1960421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A peritonsillar abscess (PTA) is a common complication to acute tonsillitis. Needle aspiration (NA) is the gold standard for diagnosis of PTA. NA is usually painful and not risk-free. Ultrasound (US) is a noninvasive, portable radiological modality that could potentially be used in the diagnosis of PTA and selection of patients for NA. The reliability of US is dependent on the experience of the examiner which limits is usefulness. AIM To evaluate the reliability of US in the diagnosis of PTA by an inexperienced examiner. METHODS Thirty patients with suspected PTA were included. They were first examined with trans-cervical US by a medical student then clinically examined by a physician that performed a NA if clinically motivated. They were then followed for at least two days. RESULTS Three patients were excluded from analysis because no NA was performed. In these patients, US correctly classified them as negative for PTA. In the remaining 27 patients, the sensitivity and negative predictive value was 100%. The specificity was 64.3% and the positive-predictive value was 72.2%. CONCLUSION US can be very useful in the diagnosis of PTA and the selection for NA even with an inexperienced examiner. SIGNIFICANCE The results highlight the usefulness of ultrasound in otolaryngology.
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Affiliation(s)
- Mathias von Beckerath
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden
- Örebro University, Örebro, Sweden
| | - Joacim Svensson
- Department of Anesthesiology, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Landström
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden
- Örebro University, Örebro, Sweden
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Todsen T. Otorhinolaryngologist performed transcervical versus transoral ultrasonography in the management of peritonsillar abscess. Am J Otolaryngol 2021; 42:102768. [PMID: 33109415 DOI: 10.1016/j.amjoto.2020.102768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tobias Todsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark.
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Zebolsky AL, Dewey J, Swayze EJ, Moffatt S, Sullivan CD. Empiric treatment for peritonsillar abscess: A single-center experience with medical therapy alone. Am J Otolaryngol 2021; 42:102954. [PMID: 33581462 DOI: 10.1016/j.amjoto.2021.102954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Compare the use of medical therapy alone (MTA) with surgical therapy (ST) for the empiric treatment of peritonsillar abscess (PTA). MATERIALS AND METHODS A consecutive cohort of patients treated for PTA at our institution from May 2013 to February 2019 was analyzed. Demographics, disease characteristics, management strategies, and treatment outcomes were compared between treatment groups. Primary outcomes included treatment failure, defined as the need for follow-up surgical intervention, and complications within 2-weeks of empiric treatment. RESULTS 306 patients (72.7%) received MTA while 115 (27.3%) underwent ST. There was no significant difference in the rate of treatment failure between the MTA (7.2%) and ST (6.1%) groups (p = 0.879). Complications were rare in both groups (1.6% with MTA versus 0.9% with ST; p = 0.898). Dysphagia (p = 0.011), trismus (p = 0.045), larger abscesses (p < 0.001), and hospital admission (p < 0.001) were more common in the ST group. Corticosteroid prescriptions were a common component of MTA (53.3%) and less often used with ST (33.9%; p = 0.001). After adjusting for abscess size, there remained no significant difference in the rate of treatment failure between groups. Univariate analyses demonstrated no significant independent predictors of treatment failure including age, sex, race, tonsillitis history, smoking history, presenting signs and symptoms, abscess size, hospital admission, and corticosteroid prescriptions. CONCLUSIONS MTA may be a safe and effective alternative to surgical drainage for the empiric treatment of PTA, warranting larger-scale prospective analyses. Abscess size did not appear to influence treatment failure; however, careful patient selection is likely to optimize treatment outcomes.
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Affiliation(s)
- Aaron L Zebolsky
- Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America
| | - John Dewey
- Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America
| | - Emma Jane Swayze
- Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America
| | - Seth Moffatt
- Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America
| | - Corbin D Sullivan
- Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America.
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Hahn J, Barth I, Wigand MC, Mayer B, Hoffmann TK, Greve J. The Surgical Treatment of Peritonsillar Abscess: A Retrospective Analysis in 584 Patients. Laryngoscope 2021; 131:2706-2712. [PMID: 34111309 DOI: 10.1002/lary.29677] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES There are three surgical treatment options for patients with peritonsillar abscess (PTA): needle aspiration, incision and drainage (ID), and abscess tonsillectomy (ATE). The updated German national guideline (2015) included changes in the treatment of PTA. The indication for tonsillectomy (TE) in patients became more stringent and preference was given to ID in certain cases. STUDY DESIGN Retrospective analysis. METHODS We performed a retrospective systematic analysis of patient data using the in-house electronic patient records and considered a 4-year period from 2014 to 2017. About 584 patients were identified. Our aim was to analyze the influence of the updated guideline on clinical practice. RESULTS 236 of 584 patients (40.4%) underwent ATE with contralateral TE. In 225 patients (38.5%), unilateral ATE was performed. Mean surgery time was significantly shortened when only unilateral ATE was performed. Concerning postoperative bleeding, we noted a tendency toward a lower incidence after ATE in comparison to ATE with contralateral TE. Less than 1% of patients who underwent ATE had to be revised surgically due to postoperative hemorrhage. After the revision of the guideline, unilateral ATE and ID were conducted more frequently. CONCLUSION These results support that ATE in an inpatient setting is a considerably safe and effective primary therapeutic option. ID represents a favorable treatment option for patients with PTA and comorbidities, nevertheless, patient compliance is required and insufficient drainage or recurrence of PTA may occur. The revision of the guideline had a significant impact on the choice of interventions (P < .001), which is reflected by the increased number of unilateral ATE. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Janina Hahn
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Ina Barth
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Marlene C Wigand
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Akhavan M. Ear, Nose, Throat: Beyond Pharyngitis: Retropharyngeal Abscess, Peritonsillar Abscess, Epiglottitis, Bacterial Tracheitis, and Postoperative Tonsillectomy. Emerg Med Clin North Am 2021; 39:661-675. [PMID: 34215408 DOI: 10.1016/j.emc.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.
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Affiliation(s)
- Mahsa Akhavan
- Goryeb Children's Hospital, Morristown Medical Center/Atlantic Health System, 100 Madison Ave, Morristown, NJ 07960, USA.
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Centor RM, Huddle TS. Should the risk of Fusobacterium necrophorum pharyngotonsillitis influence prescribing empiric antibiotics for sore throats in adolescents and young adults? Anaerobe 2021; 71:102388. [PMID: 34089856 DOI: 10.1016/j.anaerobe.2021.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022]
Abstract
Fusobacterium necrophorum, a gram-negative anaerobe, causes pharyngotonsillitis primarily in adolescents and young adults (approximately 15-30 years old). The same age group has the highest incidence of peritonsillar abscess and the Lemierre syndrome. The same organism, F. necrophorum, is the most common cause of peritonsillar abscess in this age group and causes at least 80% of Lemierre syndrome cases. We outline the case for empiric antibiotic treatment of some patient in this age group who have a significant probability that F. necrophorum is the cause of their pharyngotonsillitis.
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Affiliation(s)
- Robert M Centor
- UAB, FOT 720, 1530 3rd Ave S, Birmingham, AL, 35294-3407, USA.
| | - Thomas S Huddle
- UAB, FOT 720, 1530 3rd Ave S, Birmingham, AL, 35294-3407, USA
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35
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Sievert M, Miksch M, Mantsopoulos K, Goncalves M, Rupp R, Mueller SK, Traxdorf M, Iro H, Koch M. The value of transcutaneous ultrasound in the diagnosis of tonsillar abscess: A retrospective analysis. Auris Nasus Larynx 2021; 48:1120-1125. [PMID: 33906745 DOI: 10.1016/j.anl.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify the appropriate treatment in the tonsillar region's infections, a distinction between tonsillitis with or without abscess formation is essential. Ultrasound proved to be a valuable method in identifying abscess formation in the head and neck region. However, no report described the assessment of the tonsil region. This study aims to determine the feasibility of transcervical ultrasound for abscess visualization in the palatal tonsillar region. METHODS Retrospective analysis of 354 patients presenting with clinical suspicion of tonsillar abscess to a tertiary referral center and university hospital. All patients received a transcervical ultrasound to establish a primary diagnosis. The existence of an abscess was confirmed by puncture and incision, or final tonsillectomy. If no abscess could be delineated, non-abscessing tonsillitis was supposed, and conservative primary therapy and closed follow-up examinations were performed. RESULTS After the first diagnostic ultrasound examination, in 257 cases (72.59%), the diagnosis of an abscess could be established, but in 97 cases (27.40%), due to missing abscess formation criteria, non-abscessing tonsillitis was documented. Overall, ultrasonography demonstrated an overall accuracy of 78.8% in this selected cohort. The sensitivity, specificity, PPV, and NPV after the first ultrasound examination were calculated with 75.1%, 88.6%, 94.6%, and 57.3%, respectively. CONCLUSION The presented data confirm that an abscess formation due to tonsillitis can be detected by transcervical ultrasound, enabling prompt, adequate management. As transcervical ultrasound can be conducted fast and is not associated with radiation, it can be regarded as a first-line diagnostic tool in this condition.
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Affiliation(s)
- Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Malin Miksch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Maximilian Traxdorf
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany, Waldstrasse 1, 91054 Erlangen, Germany
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Sanders O, Bolton L, Nemeth Z, Hardy A, Meghji S. A 4-year retrospective study of tonsillectomy rate and admission rate of tonsillitis and complications in the East of England and nationally. Eur Arch Otorhinolaryngol 2021; 278:2613-2618. [PMID: 33420839 DOI: 10.1007/s00405-020-06591-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Guidance set out by Scottish Intercollegiate Guidelines Network (SIGN) sought to restrict the frequency of elective tonsillectomy in reaction to the recognised and substantial risks of the procedure, namely pain and bleeding. With stricter criteria in place before a patient can undergo tonsillectomy, patients must endure more episodes of tonsillitis than was previously the case. The cost of managing tonsillitis and its complications as an inpatient is substantial to the NHS and also to the economy as a whole in missed work days. The authors sought to establish if the reduced rate of tonsillectomy performed had any effect on the rate of acute hospital admission for tonsillitis or the associated abscesses-peritonsillar, parapharyngeal and retropharyngeal. METHODS A retrospective multi-centre study reviewed admission data across a 4-year period. The rate of tonsillectomies performed for recurrent tonsillitis across four trusts in Mid-Essex was compared with the number of admissions for tonsillitis, peritonsillar, parapharyngeal and retropharyngeal abscesses. National hospital episode statistics data over a 5-year period was also analysed. RESULTS For the regional data in 2015, 979 tonsillectomies were performed across the four centres, reducing to 875 in 2018. There was no trend in the rates of acute tonsillitis requiring admission but the rates of peritonsillar abscess increased from 156 to 192 cases per year in the same period. This correlation was found not to be statistically significant in the measured sample size. The National hospital episode statistics data showed a significant correlation between tonsillectomy rates and admissions from complications of tonsillitis as well as the associated abscesses. CONCLUSION This study shows that the reduced tonsillectomy rate was correlated with an increased number of admissions with peritonsillar abscess regionally. Nationally reduced tonsillectomy rate is significantly associated with increased admissions with tonsillitis and all its complications. A decreased rate of tonsillectomy may be increasing the rate of serious tonsillitis. This has an impact on patient morbidity, an increasing financial burden on the NHS and the UK economy.
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Affiliation(s)
- O Sanders
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK.
| | - L Bolton
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Z Nemeth
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - A Hardy
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
| | - S Meghji
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
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Levi JM, Nassif SJ, Shetty K, McKee-Cole KM, Barth PC. A pilot study on pediatric mononucleosis presenting with abscess. Am J Otolaryngol 2020; 41:102716. [PMID: 32979664 DOI: 10.1016/j.amjoto.2020.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT To describe this new clinical entity, diagnosis, and potential management of pediatric intratonsillar/peritonsillar abscesses in children affected by infectious mononucleosis. METHODS After institutional review board approval, a retrospective chart review of patients who underwent testing for infectious mononucleosis and also had a computed tomography scan of the head and neck was completed. Those who did not have imaging showing the palatine tonsils and those with insufficient testing to diagnose infectious mononucleosis were excluded. MAIN FINDINGS One hundred patients were included in the study; 15 had a peritonsillar abscess and 29 had an intratonsillar abscess. Four of the patients with a peritonsillar abscess (26.7%) had a positive Monospot or Epstein-Barr virus IgM result, and two of 15 (13.3%) had positive rapid strep or culture results. Of the 29 patients with an intratonsillar abscess, eight (27.6%) had a positive Monospot or Epstein-Barr virus IgM result while two (6.9%) had a positive rapid strep or culture result. Of those with bilateral intratonsillar abscess, five of 12 (41.7%) patients showed laboratory markers for infectious mononucleosis compared with three of 17 (17.6%) with unilateral intratonsillar abscess. This difference was not statistically significant (Fischer's, p = 0.218). CONCLUSION In our cohort of patients undergoing computed tomography scan and acute infectious mononucleosis testing, patients with intratonsillar and peritonsillar abscess tested positive for mononucleosis markers more commonly than for streptococcus markers. Recognizing uncomplicated intratonsillar and peritonsillar abscess in the setting of infectious mononucleosis in these pediatric patients may help tailor management in this population.
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Affiliation(s)
- Jessica M Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA; Department of Otolaryngology/ENT, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Samih J Nassif
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA.
| | - Kunal Shetty
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA.
| | - Katherine M McKee-Cole
- Department of Otolaryngology/ENT, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA; Thomas Jefferson University, 130 S. 9th St., Philadelphia, PA 19107, USA
| | - Patrick C Barth
- Department of Otolaryngology/ENT, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA; Thomas Jefferson University, 130 S. 9th St., Philadelphia, PA 19107, USA.
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Selwyn D, Yang D, Heward E, Kerai A, Thompson E, Shommakhi A, Faulkner S, Siau R, Walijee H, Hampton T, Chudek D, Singhera S, Din W, Lau AS. A prospective multicentre external validation study of the Liverpool Peritonsillar abscess Score (LPS) with a no-examination COVID-19 modification. Clin Otolaryngol 2020; 46:229-233. [PMID: 32997893 PMCID: PMC7646663 DOI: 10.1111/coa.13652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022]
Abstract
Objectives Our primary aim was to validate the Liverpool Peritonsillar abscess Score (LPS) externally in a new patient cohort. Our secondary aim was to modify the LPS in the light of the COVID‐19 pandemic to produce a no‐examination variant for use in this instance. Design Prospective multicentre external validation study. Setting Six different secondary care institutions across the United Kingdom. Participants Patients over 16 years old who were referred to ENT with any uncomplicated sore throat such a tonsillitis or peritonsillar abscess (PTA). Main outcome measures Sensitivity, specificity, positive predictive value and negative predictive value for both the original LPS model and the modified model for COVID‐19. Results The LPS model had sensitivity and specificity calculated at 98% and 79%, respectively. The LPS has a high negative predictive value (NPV) of 99%. The positive predictive value (PPV) was slightly lower at 63%. Receiver operating characteristic (ROC) curve, including the area under the curve (AUROC), was 0.888 which indicates very good accuracy. Conclusions External validation of the LPS against an independent geographically diverse population yields high NPV. This may support non‐specialist colleagues who may have concerns about mis‐diagnosing a PTA. The COVID‐19 modification of the LPS has a similar NPV, which may be of use where routine oral examination is to be avoided during the COVID‐19 pandemic.
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Affiliation(s)
| | - Ding Yang
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | | | | | | | | | | | | | - Tom Hampton
- Mersey ENT Research Collaborative (MERC), Merseyside, UK
| | | | | | - Waqas Din
- Bradford Royal Infirmary, Bradford, UK
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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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Ohori J, Miyashita K, Harada M, Nagano H, Makise T, Umakoshi M, Iuchi H, Jimura T, Kawabata M, Kurono Y. Unilateral arytenoid swelling in acute epiglottitis suggests the presence of peritonsillar abscess. Auris Nasus Larynx 2020; 47:1023-1026. [PMID: 32690229 DOI: 10.1016/j.anl.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/20/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the incidence of acute epiglottitis (AE) and the clinical features of patients with AE complicated by peritonsillar abscess (PTA), considering that PTA, especially inferior-type PTA, is often a comorbidity of AE. METHODS We retrospectively reviewed the medical records of patients who were diagnosed as having AE by otolaryngologists and referred to our hospital between January 2009 and December 2017. All the patients underwent laryngeal endoscopy and contrast-enhanced computed tomography (CT) for examination of the severity of AE and its complications by other infections, including PTA. The clinical characteristics of patients with PTA were compared with those of patients without PTA. RESULTS A total of 139 patients were enrolled, of whom 21 (15%) were found to have PTA. Among the 21 patients, only one had a superior-type PTA and the others had an inferior-type PTA. The patients with complicated AE by an inferior Cap-type PTA frequently showed unilateral arytenoid swelling. CONCLUSION PTA is a comorbidity of AE, and unilateral arytenoid swelling is considered to suggest the presence of inferior-type PTA.
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Affiliation(s)
- Junichiro Ohori
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan.
| | - Keiichi Miyashita
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Mizue Harada
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Hiromi Nagano
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Takao Makise
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Mizuo Umakoshi
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Hiroyuki Iuchi
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Tomohiro Jimura
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Masaki Kawabata
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
| | - Yuichi Kurono
- Department of Otorhinolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8520, Kagoshima, Japan
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Tasli H, Ozen A, Akca ME, Karakoc O. Risk of internal carotid injury due to peritonsillar abscess drainage. Auris Nasus Larynx 2020; 47:1027-1032. [PMID: 32580906 DOI: 10.1016/j.anl.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Peritonsillar abscess (PTA) is one of the most commonly seen ear nose and throat (ENT) emergencies. The most catastrophic complication that may occur due to surgical treatment of PTA is injury of internal carotid artery. The aim of this study is to determine distance and angle between PTA with ICA; and to prevent possible complications. METHODS A total of 34 adult patients with PTA were enrolled in this study. Neck computed tomographies of the patients with PTA were evaluated by a radiologist. The distance between PTA and ICA (DIP), and contralateral tonsil side and ICA (DIT) were measured and compared with each other. Also angle between PTA and ICA (AIP) was examined. RESULTS This study contained 20 (58.8%) males and 14 (41.2%) females with a mean age of 32.20 ± 12.75 years (range 18-60 years). Mean DIP and DIT scores were 13.39 ± 3.7 mm (min: 5.32, max: 19.07) and 9.61 ± 3.17 mm (min: 4.95, max: 16.35) respectively, and the difference was statistically significant (p<0.05). Mean distance between anterior border of PTA and ICA was 36.18 ± 6.42 mm (min: 17.12 max: 47.43). The AIP was 33.40 ± 2.29° (min: 30.10° and max: 40.71°). According to risk classification system, the 28 (82.4%) patients constituted low risk, and 6 (%17.6) patients constituted moderate risk. CONCLUSION According to the distance between the PTA and ICA, the risk of ICA injury was found to be mild and moderate in PTA patients. It is crucial for the surgeon to pay attention to the depth and angle of the incision during drainage of the abscess.
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Affiliation(s)
- Hamdi Tasli
- University Of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya 43000, Turkey.
| | - Alptug Ozen
- Mersin City Hospital, Department Radiology, Mersin, Turkey
| | - Mehmet Ege Akca
- University Of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya 43000, Turkey
| | - Omer Karakoc
- Gulhane Medical School, Department of Otolaryngology, Head and Neck Surgery, Ankara, Turkey
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Gabelica M, Tafra R, Martinić MK, Kontić M, Markić J, Kovačević T, Čagalj IČ, Ninčević Ž. Feather foreign body caused periparotid and peritonsillar abscess in a 9-month-old girl. Auris Nasus Larynx 2020; 48:1023-1025. [PMID: 32536499 DOI: 10.1016/j.anl.2020.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
Migratory foreign body appeared to be bird feather, caused peritonsillar and periparotid abscess in a nine-month-old infant. Patient presented painful, tender and fluctuating red neck mass on the left neck region II, and refusal of oral intake, with no fever. Azithromycin was introduced four days before presentation for suspected urinary tract infection. ENT examination revealed left peritonsillar abscess; ultrasound confirmed periparotid abscess, MSCT verified both diagnoses. Under general anaesthesia, we performed abscess incision, after pus drainage, small foreign body spontaneously came through the wound. After washing it with saline, it appeared like a bird feather. Subsequently, peritonsillar abscess was incised and drained. After 24-hour postoperative care on pediatric intensive care unit, the patient continued three-day parenteral antibiotic treatment on the otolaryngology department; it was discharged with a recommendation to continue seven days of oral antibiotic therapy. Suggested mechanism was ingestion of bird feather from stuffed bedding, that got trapped in the tonsillar crypt. Afterwards, it started to migrate through the neck tissue. Households with children younger than three years should not have feather stuffed clothes or beddings.
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Affiliation(s)
- Mirko Gabelica
- Department of Otolaryngology with Head and Neck Surgery, University Hospital Centre Split, Split, Croatia.
| | - Robert Tafra
- Department of Otolaryngology with Head and Neck Surgery, University Hospital Centre Split, Split, Croatia; University of Split, School of Medicine, Soltanska 2, Split, Croatia
| | - Marina Krnić Martinić
- Department of Otolaryngology with Head and Neck Surgery, University Hospital Centre Split, Split, Croatia
| | - Mirko Kontić
- Department of Otolaryngology with Head and Neck Surgery, University Hospital Centre Split, Split, Croatia; University of Split, School of Medicine, Soltanska 2, Split, Croatia
| | - Joško Markić
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia; University of Split, School of Medicine, Soltanska 2, Split, Croatia
| | - Tanja Kovačević
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia
| | - Ivana Čulo Čagalj
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia
| | - Željko Ninčević
- Department of Anaesthesiology and intensive care, University Hospital Centre Split, Split, Croatia; University of Split, School of Medicine, Soltanska 2, Split, Croatia
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Abstract
The number of operations for tonsillectomy have been significantly decreasing for many years in Germany. In children the number of adenotonsillectomies has decreased by two thirds within a decade. This phenomenon is mirrored by a significant increase in the number of annually performed tonsillotomies, a surgical procedure which is preferably performed for volume reduction in cases of tonsillar hypertrophy. The aim of this article is to elucidate the different interventional procedures, their typical indications and risks.
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Affiliation(s)
- Jochen P Windfuhr
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Deutschland.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Allen DZ, Rawlins K, Onwuka A, Elmaraghy CA. 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] [What about the content of this article? (0)] [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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Rawlins KW, Allen DZ, Onwuka AJ, Elmaraghy CA. Computed tomography use patterns for pediatric patients with peritonsillar abscess. Int J Pediatr Otorhinolaryngol 2019; 123:22-25. [PMID: 31054537 DOI: 10.1016/j.ijporl.2019.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study is to examine the impact that an institution-wide policy to reduce radiation exposure in pediatric patients had on the use of computed tomography (CT) imaging in children presenting with suspected peritonsillar abscess (PTA)1. METHODS A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA. RESULTS A total of 317 patients with suspected PTA were seen prior to policy implementation, with an additional 275 patients seen in the years after. The frequency of CT use was 41% (131/317) in pre-policy patients, and 28% (77/275) in post-policy patients (p = 0.004). The most common specialty of ordering physician was Pediatrics in the pre-policy patients (45%), and Otolaryngology in the post-policy patients (41%) (p = 0.0003). Of the 131 patient who underwent CT scanning before policy implementation, 36 patients (27%) required incision and drainage (I&D) of their PTA in the OR. This is in comparison to 42/77 patients (55%) in the post-policy group who underwent I&D in the OR (p < 0.0001). CONCLUSION An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.
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Affiliation(s)
- Kasey W Rawlins
- The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA
| | - David Z Allen
- The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA
| | - Amanda J Onwuka
- The Research Institute at Nationwide Children's Hospital, Center for Surgical Outcomes Research, Columbus, OH, USA
| | - Charles A Elmaraghy
- The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Pediatric Otolaryngology-Head and Neck Surgery, Columbus, OH, USA.
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Ohori J, Iuchi H, Nagano H, Umakoshi M, Matsuzaki H, Kurono Y. The usefulness of abscess tonsillectomy followed by intraoral drainage for parapharyngeal abscess concomitant with peritonsillar abscess in the elderly. Auris Nasus Larynx 2019; 47:697-701. [PMID: 31239095 DOI: 10.1016/j.anl.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/15/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022]
Abstract
Parapharyngeal abscess (PPA) may cause life-threatening complications and peritonsillar abscess (PTA) and tonsillitis frequently precede PPA. The optimal management of PPA caused by PTA has been the subject of debate with respect to the surgical approach. We present three cases of PPA concomitant with PTA in elderly patients. In two cases, the abscesses in parapharyngeal space were drained by abscess tonsillectomy followed by intraoral incision of the tonsillar bed. On the other hand, the third case did not undergo abscess tonsillectomy because of his refusal of surgery and needed extraoral drainage after the aggravation of PPA. Based on the experience of those three cases, it was suggested that abscess tonsillectomy followed by intraoral incision of the tonsillar bed might be a useful surgical approach for the drainage of PPA concomitant with PTA, especially in elderly patients.
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Affiliation(s)
- Junichiro Ohori
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | - Hiroyuki Iuchi
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiromi Nagano
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Mizuo Umakoshi
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hirohisa Matsuzaki
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Yuichi Kurono
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
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Vaikjärv R, Mändar R, Kasenõmm P. Peritonsillar abscess is frequently accompanied by sepsis symptoms. Eur Arch Otorhinolaryngol 2019; 276:1721-5. [PMID: 30993467 DOI: 10.1007/s00405-019-05424-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/07/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate how many patients with peritonsillar abscess (PTA) fulfill sepsis criteria and if there is any difference in risk factors and treatment results between patients with and without sepsis symptoms. We also aimed to evaluate the utility of several clinical and laboratory markers for diagnosing PTA. METHODS Study group consisted of 92 patients with PTA undergoing bilateral emergency tonsillectomy. Blood samples, pus samples and clinical data were collected. Patients were evaluated for sepsis criteria based on 2001 International Sepsis Definitions Conference. RESULTS Sepsis diagnostic criteria were fulfilled in half of patients (51.1%). Smokers (p = 0.016) and patients who had not received antibiotic treatment (p = 0.003) had more sepsis symptoms. Procalcitonin levels were moderate and there was no difference between the groups. In majority of the patients, the pus samples contained undetectable or mild levels of amylase while 12 patients had pus amylase at least twice higher than in blood serum and among them, the levels were remarkably high in 9 patients. CONCLUSION Half of the patients with PTA meet the diagnostic criteria for sepsis. The risk factors for the latter include current smoking and not receiving antibiotic treatment before hospitalization. PTA treatment outcome does not differ between the patients with and without sepsis clinical picture in case of surgical treatment. C-reactive protein appears to be better diagnostic marker for PTA than procalcitonin. A portion of the PTA patients have remarkably high amylase level in the pus indicating possible association with Weber's salivary glands infection.
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Chisholm AG, Little BD, Johnson RF. Validating peritonsillar abscess drainage rates using the Pediatric hospital information system data. Laryngoscope 2019; 130:238-241. [PMID: 30761539 DOI: 10.1002/lary.27836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the accuracy of the Children's Hospital Association's Pediatric Health Information System (PHIS) registry data in determining surgical drainage rates as compared to a chart review on the same cohort of children with diagnosis of peritonsillar abscess. STUDY DESIGN Retrospective analysis. METHODS Our analysis included 200 children, ages 2 to 17 years, treated for a peritonsillar abscess from 2011 to 2016. The primary outcome was to determine the sensitivity, specificity, predictive values, receiver operating characteristics (ROC), and likelihood ratios of surgical drainage rates comparing the PHIS database to manual chart review of the same patients. RESULTS One hundred and fifteen (58%) children underwent drainage by chart review, whereas 87 (44%) had a drainage procedure by PHIS data. Age was a significant predictor of abscess drainage by chart review (age coefficient = 0.10; standard error = 0.04; 2 = 5.8; P = 0.02; odds ratio = 1.1; 95% confidence interval [CI] = 1.01-1.19). When using the chart review as the reference value for surgical drainage, the PHIS data had a sensitivity of 76% and 100% specificity. The positive and negative predictive values were 100% and 75%, respectively. The ROC area was 0.88 (95% CI, 84 to 92). Cases that lacked a clear procedure note composed the false negative cases in the PHIS. CONCLUSION At our institution, the PHIS Administrative data was adequate at predicting surgical drainage of the peritonsillar abscess when compared to chart review. LEVEL OF EVIDENCE 4 Laryngoscope, 130:238-241, 2020.
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Affiliation(s)
- Allison G Chisholm
- Pediatric Otolaryngology, Cook Children's Medical Center, Fort Worth, Texas, U.S.A
| | - Benjamin D Little
- American University of Antigua School of Medicine, Coolidge, Antigua
| | - Romaine F Johnson
- Department of Otolaryngology-Pediatric Otolaryngology Division, UT Southwestern Medical Center and Children's Medical Center Dallas, Dallas, Texas, U.S.A
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Seyhun N, Çalış ZAB, Ekici M, Turgut S. Epidemiology and Clinical Features of Peritonsillar Abscess: Is It Related to Seasonal Variations? Turk Arch Otorhinolaryngol 2019; 56:221-225. [PMID: 30701118 DOI: 10.5152/tao.2018.3362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Peritonsillar abscess (PTA) is defined as pus accumulation between the tonsillar capsule and constrictor pharyngeal muscle. It can be seen as a complication of acute tonsillitis, but other mechanisms have also been proposed. In this study we aimed to reveal the seasonal variations and epidemiologic features of PTA. Methods This is a retrospective, observational study. We reviewed 221 patients, and together with 24 recurrent cases, 245 admissions were reviewed in total. Age, gender, the duration of admission, seasonal and monthly distribution of cases, diabetes and smoking status, white blood cell count, and C-reactive protein (CRP) levels were recorded. Monthly and seasonal incidences of PTA were reviewed to see if there is any association of climate variations and PTA incidence rate. Features associated with the length of hospitalization and recurrence were also analyzed. Results A total of 245 PTA cases were admitted to our clinic between June 2014 and June 2017. The highest amount of cases was observed in spring and winter. The C-reactive protein and white blood cell count (WBC) levels were found to be positively correlated with the length of hospitalization. There was no statistically significant correlation with recurrence and smoking, the WBC levels, CRP levels, and length of prior hospitalization. Diabetes status was not found to be associated with length of hospitalization and CRP levels. Conclusion The present study reflects the epidemiologic and clinical features of PTA in İstanbul. Our findings showed that seasonal variation was not significant, consistent with previous studies. The highest incidence rate was observed in spring and winter. Length of hospitalization was found to be positively correlated with C-reactive protein and white blood cell count (WBC) levels. Recurrence was not statistically correlated with and smoking, the WBC levels, CRP levels, and length of hospitalization. More studies are recommended to reveal the different epidemiologic factors affecting the incidence of PTA.
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Affiliation(s)
- Nurullah Seyhun
- Department of Otorhinolaryngology and Head & Neck Surgery, Şişli Hamidiye Eftal Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Aslı Batur Çalış
- Department of Otorhinolaryngology and Head & Neck Surgery, Şişli Hamidiye Eftal Training and Research Hospital, İstanbul, Turkey
| | - Merve Ekici
- Department of Otorhinolaryngology and Head & Neck Surgery, Şişli Hamidiye Eftal Training and Research Hospital, İstanbul, Turkey
| | - Suat Turgut
- Department of Otorhinolaryngology and Head & Neck Surgery, Şişli Hamidiye Eftal Training and Research Hospital, İstanbul, Turkey
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