Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Evidence-based indication for tonsil surgery in patients with recurrent acute tonsillitis (RAT) is an ongoing matter of debate. Since introduction of the German tonsillitis guideline in 2015, the indication criteria for tonsil surgery have become much stricter. It is unclear, if this has changed the indication policy. A retrospective population-based study was performed including all 1398 patients with RAT admitted for tonsil surgery in all Thuringian hospitals in 2011, 2015, and 2019. Changes over the years concerning patients' characteristics, number of tonsillitis episodes in the last 12 months treated with antibiotics (T12), and decision for tonsillectomy or tonsillotomy were analyzed using univariable and multivariable statistics. The surgical rates decreased from 28.56/100,000 population in 2011 to 23.57 in 2015, and to 11.60 in 2019. The relative amount of patients with ≥ 6 T12 increased from 14.1% in 2011 over 13.3% in 2015 to 35.9% in 2019. Most patients received a tonsillectomy (98% of all surgeries). Decision for tonsillotomy was seldom (1.2%). Multinomial logistic regression analysis with the year 2011 as reference showed that compared to the year 2015, the age of the patients undergoing surgery increased in 2015 (Odds ratio [OR] = 1.024; 95% confidence interval [CI] = 1.014-1.034; p < 0.001), and also in 2019 (OR 1.030: CI 1.017-1.043; p < 0.001). Compared to 2011, the number T12 was not higher in 2015, but in 2019 (OR 1.273; CI 1.185-1.367; p < 0.001). Stricter rules led to lower tonsil surgery rates but to a higher proportion of patients with ≥ 6 T12 before surgery. Tonsillectomy remained the dominating technique.

Effects of temperature and humidity on peritonsillar abscess volume of emergency patients

Climate and temperature have long been considered in relation to human diseases and mortality. In this study, we investigated whether daily temperature and humidity and patients' personal history affect the volume of peritonsillar abscesses (PTAs). We included 52 patients with PTAs who were admitted to the emergency department of the study hospital; their computed tomography data were analyzed, and PTA volume was measured. We investigated the possible correlation between PTA volume and mean/minimum/maximum temperature and humidity. Furthermore, we obtained personal history data, including information on drinking status, smoking status, dental problems, and patients' treatment experiences at local clinics before visiting the emergency department. The mean PTA volume was 3.93 mL, which was significantly correlated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization (P < .05) and also with a lack of treatment experience at local clinics (P < .001). However, no significant correlation was noted between PTA volume and the mean/minimum/maximum temperature and humidity on the day of hospitalization (P > .05). Similar findings were obtained for drinking status, smoking status, and dental problems (P > .1). PTA volume appears to be strongly associated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization. Patients with treatment experience at local clinics exhibited substantial increases in PTA volume. Thus, an increased PTA volume may be observed in patients who visit the emergency department without any treatment experience at local clinics or from environments that differ considerably from their current environment in terms of temperature.

[Small salivary glands in the paratonsillar space in children]

Was to study the changes in the small salivary glands in chronic tonsillitis and paratonsillar abscess in children. A histological examination of the palatine tonsils of 22 children aged 5 to 14 years old who had a paratonsillar abscess and 18 children suffering from chronic tonsillitis was carried out. Fragments of small salivary glands, located both superficially, in the mucous membrane between the stratified squamous non-keratinizing epithelium and the lymphoid tissue of the palatine tonsils, and between the muscles of the amygdala were found in 42 of the 80 (52.5%) tonsils studied. Along with the unchanged glandular structure, 26 (61.9%) samples revealed areas of destruction foci in small salivary glands with signs of inflammatory and compensatory regenerative activity. The presence of separate interlobular ducts of the salivary glands with pronounced periductal lymph - macrophage infiltration was noted. The subepithelial lymph-macrophage infiltrates found in the lamina propria are associated with the exit of the excretory ducts of the salivary glands to the surface of the mucous membrane. Many thin-walled veins are surrounded by perivascular lymphocellular infiltrates. The inflammatory and post-inflammatory changes in the small salivary glands revealed by us in children with chronic tonsillitis do not exclude their participation in the pathogenesis of paratonsillitis. At the same time, inflammation in the salivary gland can be both primary, as a result of its infection with live microorganisms from the tissues of the tonsil, and secondary, due to the compression of the excretory ducts by the edematous tissue of the tonsil in acute tonsillitis.

A series of unusual complications of the presternal peritoneal dialysis catheter

An ongoing problem for peritoneal dialysis (PD) patients has been complications associated with an indwelling PD catheter. The indwelling catheter has been through many modifications aimed at reducing complications and providing effective delivery of dialysis solution. In this report, we review four cases of rare complications associated with presternal PD catheters and a brief review of the Tenckhoff, Toronto Western Hospital, and Missouri swan-neck abdominal and presternal PD catheters.

[A fatal outcome of false croup in lacunar angina complicated by peritonsillar abscess]

The paper reports a lethal outcome of false croup in a 62-year-old man. In pathogenetic chain of the disease the leading role belonged to purulent tonsillitis with peritonsillar abscess and epiglottitis with phlegmone of the adjacent soft tissues including the vocal cords. A severe edema of the latter provoked a complete obstruction in the larynx and asphyxia with all its macro- and microscopic morphological features. Chronic alcoholic intoxication seemed to cause immunodeficiency and slow progression of the disease. Tonsillitis, chronic with exacerbation, was alleviated by chronic alcoholic intoxication leading to weak symptoms, delayed reactions and "strange" outcome. Hyperergia could be due to intake of alcohol surrogate.

Deep neck space infections

The incidence of deep neck space infections has dramatically decreased since the advent of antibiotics, but with delayed treatment they carry the potential for significant morbidity and mortality. Odontogenic infections with involvement of the submandibular space are the most common source of deep neck space infections in adults, whereas in the pediatric population the most common cause is acute tonsillitis with involvement of the peritonsillar space. The newest group of patients at risk for deep neck space infections are intravenous drug abusers who inject the major vessels of the neck. Knowledge of neck spaces and fascial relationships is important in understanding the presentation, treatment, and complications of deep neck space infections. The spaces, which are created by various fasciae of the head and neck, are only potential spaces in that under normal conditions they cannot be examined clinically or radiographically. As the spaces are invaded by bacteria, a cellulitis or abscess occurs, and this infection may travel through paths of least resistance from one space to another.

Recognition and emergency management of infectious causes of upper airway obstruction in children

Infections represent one of the most common causes of upper airway obstruction in the pediatric age group. Because obstructive processes may lead to respiratory failure and subsequent cardiopulmonary arrest, prompt recognition is crucial. This discussion provides a brief review of the unique anatomic and physiological characteristics of the child's airway, which may contribute to obstructive processes, followed by basic principles of pediatric airway management. Finally, we review many of the infectious causes of upper respiratory obstruction, with emphasis on early recognition and acute management.