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A prospective study was carried out on 25 patients showing symptoms suggestive of peritonsillar abscess. Twelve patients were treated with i.v. antibiotics and three months later underwent tonsillectomy. Thirteen patients underwent acute tonsillectomy within 24-48 hours. In order to evaluate the benefits of acute tonsillectomy we compared three parameters; operation length, intraoperative bleeding and overall length of hospitalization.
Necrotizing fasciitis is a potentially fatal soft-tissue infection that occurs only rarely in the head and neck region. Broad-spectrum parenteral antibiotics and surgical debridement are the mainstays of treatment. Until now, only eight cases of necrotizing fasciitis secondary to peritonsillar abscess have been described in the English-language literature. In this article, we report a new case that occurred in an otherwise healthy 43-year-old woman. In addition to standard treatment, the patient underwent a hot tonsillectomy. After 23 months of follow-up, she is in good health.
Infectious mononucleosis (IM) is characterized as a viral disease; thus, no antibiotic treatment is recommended. However, some of these patients tend to develop a long-lasting, painful disease, which can be relieved by antibiotic administration. Due to this bed-side knowledge, we re-evaluated 928 patients with peritonsillar abscess (PA), treated during a 5.5-year period in the Department of Otorhinolarygology of Turku University Central Hospital. Of these patients 15 (1.6%) also had infectious mononucleosis (IM). During this period, 64 patients with severe pharyngeal IM were treated in our department and thus the proportion of PA in patients with IM was 23.4%. A control of 15 age- and sex-matched patients with PA but without mononucleosis was formed in order to evaluate the possible differences in patient history, clinical symptoms and findings. Such differences were small and did not affect the chosen treatment of PA, abscess tonsillectomy. There was no peri- or postoperative difference in complications or recovery, but the hospitalization time was longer in IM patients with PA (3.1 days) than in patients with PA only (2.4 days). IM patients referred to ENT departments make a special group of patients, who may also need surgical treatment.
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BACKGROUND: Acute tonsillitis is an extremely common infection seen in children and adults. In most cases, the family doctor is initially consulted. Intratonsillar, peritonsillar and retrotonsillar abscesses are frequent complications in the course of tonsillitis. In those cases, oropharyngeal infection may lead to a descending process with consecutive mediastinitis as a life-threatening condition. PATIENTS AND METHODS: We report the case of a 67-year old man who died of a mediastinitis resulting from a peritonsillar abscess. Clinical findings, radiological diagnostics and antibiotic as well as surgical therapy are illustrated. RESULTS: The patient died due to a septic multi-organic failure despite aggressive antibiotic and surgical therapy by a combined enoral and cervical approach with thoracic drainage. DISCUSSION: Peritonsillar abscess is a potentially life-threatening complication of acute tonsillitis. This must be kept in mind and should therefore lead to an adequate and directed management of this pathology. We discuss the stepwise diagnosis and therapy within the framework of scientific literature.
Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), Staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. Review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.
A prospective clinical study was performed on 62 patients with peritonsillar abscesses at Ben Taub General Hospital, Houston. The abscesses were treated with either incision and drainage or needle aspiration alone. The recovery period was similar in both groups, but two of the 41 patients initially treated with aspiration had an immediate recurrence. These were successfully treated with subsequent incision and drainage. The advantages of needle aspiration alone as the primary drainage procedure outweigh the acceptably low failure rate, making it the initial procedure of choice.
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OBJECTIVE: Peritonsillar sepsis (PTS) can be divided into abscess and cellulitis. It is the most common deep neck infection in the paediatric age group. In this article we discuss the clinical issues related to peritonsillar sepsis in children. METHOD: This study involves 185 cases of peritonsillar that were treated at the Montreal Children's Hospital in the last 10 years. The symptoms, signs, laboratory and radiological data as well as the medical and surgical therapies are included. RESULTS: Seventy-five cases were peritonsillar cellulitis (PTC) and the rest were abscesses. The age at presentation varied between 2.5 months and 18 years. The majority of the cases diagnosed as peritonsillar abscess (PTA) occurred from age 12 to 18 years. Trismus was the only complaint that was statistically associated with PTA. Uvular deviation combined with trismus was also important in differentiating PTA from PTC. Our data revealed a lower percentage of anaerobic bacteria and the majority of cultures grew Streptococcus pyogenes group A. CONCLUSIONS: Clinical picture is important in differentiating PTA from PTC. Recurrence of peritonsillar sepsis was higher in children with a history of recurrent tonsillitis. Needle aspiration of PTA resulted in a higher incidence of recurrence compared to incision and drainage. A management algorithm is suggested for the child presenting with peritonsillar sepsis.
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Descending necrotic mediastinitis is a serious illness which, among others, follows acute bacterial infections located in a cervical area. One of the most frequent causes of this illness, not connected with surgical interventions, is a peritonsillar and peridental abscess. The process originally placed in the peritonsillar area spreads along the cervical fascia engulfs mediastinum. Inflammatory process of the mediastinum considerably worsens the prognosis and obligates to decisive surgical (mediastinum drainage) and pharmacological (antibiotic therapy) treatments. The following works presents the course of the illness of a 55-year-old man who was diagnosed with severe sepsis in the course of the peritonsillar abscess. After surgical provision of the abscess (incision) the patient was qualified for the therapy with activated protein C (Xigris, Lilly). The patient condition initially improved, however, after 8 days a descending necrotic mediastinitis with ambilateral pleural abscess was diagnosed. The administration of the treatment within 48 days of hospitalization (antibiotic therapy, thoracotomy, flow drainage of the mediastinum, tracheotomy, respirotherapy) brought about the effect of complete recovery.
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