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PubMed2003

Peritonsillar abscess--critical analysis of abscess tonsillectomy.

The risk of secondary haemorrhage following abscess tonsillectomy is reported in the literature with differing rates. A retro- and prospective analysis of complication rates following abscess tonsillectomy was conducted in 142 patients (54 females, 88 males; mean age: 35 years). In 22% of patients, a secondary haemorrhage occurred. In half of these (11% of total), the haemorrhage had to be treated surgically. Secondary haemorrhage occurred most commonly on the 6th and 8th postoperative days. Reports in the literature are not in unison about the risk of secondary haemorrhage following abscess tonsillectomy and therefore allow no final judgement about an objective risk of this complication. This report strengthens the results of the 'Comparative Audit Service' analysis from 1997, which did show a high risk of secondary haemorrhage following tonsillectomy, as well as following abscess tonsillectomy.

Adolescent↗
PubMed1995

Eikenella corrodens: an unexpected pathogen causing a persistent peritonsillar abscess.

Eikenella corrodens is a known pathogen in head and neck infections, especially in wounds related to oral cavity contamination. It is uniformly resistant to clindamycin. It is frequently an indolent infectious process, and patients often have persistent or recurrent symptoms despite several weeks of what many would feel would be appropriate antibiotic therapy. A high index of suspicion is necessary to make the correct diagnosis, and culture and sensitivity results are paramount to confirm the diagnosis. Appropriate antibiotic therapy with penicillin, ampicillin, select cephalosporins, to the augumented penicillins is the treatment of choice in most cases, with surgical drainage of abscess cavities and/or debridement of nonviable tissue reserved for appropriate cases and indications.

Adolescent↗
PubMed1996

[Peritonsillar abscess after tonsillectomy].

The AA. report one instance of a Quinsy after some years elapsed since a tonsillectomy correctly done. No proper motive for the presentation of this phlegmonous condition could be suggested.

Adolescent↗
PubMed1976

Microbiological aspects on peritonsillar abscesses.

In 37 patients with unilateral quinsy put was collected with a syringe technique and bacteriologically examined. Beta-hemolytic streptococci were isolated from 17 abscesses; in 8 of these, however, together with other bacteria, mainly anaerobes. Anaerobic bacteria, often more than one species, were found in 28 abscesses. Streptococcal serology including AST-O, Streptozyme and separate ADNAse test showed high titres or titre rises in 22 out of 30 examined cases. There was one case with beta-hemolytic streptococci in the abscess but negative serology. In the remaining cases a possible primary etiological role of anaerobes is suggested. The effect of combined surgical drainage and treatment with antibiotics (ampicillin or penicillin V) was good.

Bacteriological Techniques↗
PubMed1992

[Post-tonsillectomy peritonsillar abscess].

Quinsy cases following tonsillectomy are very rare indeed, as proved by the scarce publications related to the subject. And all of them presented after a long term of years elapsed. From the perusal of the bibliography done by the AA. none of the cases presented close to the operation. The chance to see and treat one case starting from the fourth postoperative day compelled the AA. to report it.

Adrenal Cortex Hormones↗
PubMed1998

Infectious mononucleosis and bilateral peritonsillar abscesses resulting in airway obstruction.

Upper airway obstruction is an uncommon but recognized complication of infectious mononucleosis. The management depends upon the degree of airway compromise. In the case described, severe airway obstruction was treated by securing the airway with awake fibre-optic endoscopic intubation and then proceeding to tonsillectomy. Bilateral inferiorly loculated quinsies were encountered unexpectedly and drained. This is the first report of 'bilateral' quinsies, associated with infectious mononucleosis and severe airway obstruction. The association, pathogenesis and significance of this finding are also discussed.

Acute Disease↗
PubMed2002

National audit of the management of peritonsillar abscess.

An anonymous postal survey of 200 consultants was used to audit the current prevalent practices in the management of quinsy in the UK; 101 responded. The findings reveal that on average an otolaryngology department treats 29 cases per year, the vast majority (94%) on an inpatient basis. The main initial treatment was needle aspiration combined with intravenous antibiotics. Interestingly, those departments treating more than 20 cases a year are more likely to use needle aspiration, while departments in England and Wales use significantly more incision and drainage than those in Scotland. Incision and drainage (52%) was the most common form of treatment of non-resolving patients. The median hospital stay was two days.

Anti-Bacterial Agents↗
PubMed1997

Peritonsillar abscess--an unusual presentation of Kawasaki disease.

Kawasaki disease (KD) is a paediatric illness characterised by prolonged high fever, mucocutaneous lesions and lymphadenopathy. It is potentially fatal as coronary arteritis occurs in up to a third of affected children. We present a seven-year-old child who was admitted to hospital with neck pain and fever. Despite intravenous antibiotic therapy and a quinsy right tonsillectomy on the sixth day after admission, the patient's symptoms persisted. With the appearance of further signs and symptoms the diagnosis of KD was made two days after operation. The patient's symptoms resolved with aspirin and intravenous gammaglobulin therapy. A literature review of the various aspects of KD is presented.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Internal carotid artery pseudoaneurysm masquerading as a peritonsillar abscess.

Blunt carotid arterial injuries are uncommon. Motor vehicle crashes are the most frequent cause, but this type of vascular injury can be secondary to any direct blow to the neck, intraoral trauma, or strangulation. Types of vascular injuries include dissection, pseudoaneurysm, thrombosis, rupture, and arteriovenous fistula formation. Patients with pseudoaneurysm of the internal carotid artery will usually present with neurologic complaints, ranging from the minor to complete stroke. On physical examination, neck hematoma, bruits, pulsatile neck mass, or a palpable thrill may be found. However, in 50% of cases, no external signs of neck trauma are observed. Onset of symptoms may occur within a few hours to several months after the initial injury. Angiography is considered the gold standard for diagnosis, but carotid Doppler ultrasound recently has been shown to be very sensitive in detecting these types of injuries. Treatment of pseudoaneurysm is often surgical, with endovascular stenting.

Adult↗
PubMed1997

[A case of acute mediastinitis with pyothorax secondary to peritonsillar abscess].

A 41-year-old man was admitted to a hospital elsewhere because of tonsillitis with high grade fever. On the 9th day of hospitalization, the patient complained of dysphagia and dyspnea. A chest X-ray film and a CT scan showed right pleural effusion and pericardial effusion, and he was referred to our hospital. Immediately after admission, he underwent pericardiotomy to relieve cardiac tamponade, and a right thoracic tube was inserted for pyothorax. Next day, mediastinal drainage was accomplished through a cervical incision and a right thoracotomy. Eight drainage tubes were left in place. Cultures revealed alpha-Streptococcus, Neisseria and group F Streptococci. Continuous closed irrigation with diluted Isodine (povidone iodine) solution was performed. The last extubation of the drainage tube was done on the 140th day after operation. He was cured and discharged on the 162nd day after operation. In patients with extensive acute mediastinitis secondary to deep cervical infection, early complete mediastinal drainage via a cervical and a transthoracic incision is essential.

Acute Disease↗
PubMed1999

Peritonsillar abscess (PTA) in children.

1. PTA is more common in young adults, but does occur in young children. The average age in this present series was 8 years. 2. Children with progressive sore throat, sometimes despite antibiotics, should cause suspicion of a PTA. Edema and erythema of the affected tonsil with edema of the uvula and displacement toward the opposite side are classically seen. 3. In older or more cooperative children, fine needle aspiration of the affected tonsil allows prompt diagnosis of PTA. 4. Antibiotic therapy should consist of a cephalosporin owing to high tissue concentration within the inflamed peritonsillar tissue. 5. Definitive treatment is a Quinsy tonsillectomy. Immediate tonsillectomy not only drains the abscess, but also eliminates the potential for an occult inferior pole or contralateral abscess. It also spares the child a future hospitalization and surgical procedure.

Adolescent↗