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PubMed1986

Retropharyngeal calcific tendinitis: report of five cases and review of the literature.

Retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle tendon, which is located on the anterior surface of the vertebral column extending from the atlas to the third thoracic vertebra. Five cases of acute retropharyngeal calcific tendinitis seen in the emergency department (ED) over a 15-month period are reported. In addition, a retrospective review of four cases diagnosed as retropharyngeal abscess and admitted to the hospital revealed that two of these cases actually represented retropharyngeal calcific tendinitis. A review of the literature and potential differential diagnoses are presented. For those primary care physicians who must evaluate patients with acute cervical pain, sore throat, or odynophagia, an x-ray study of the neck revealing retropharyngeal calcium deposition should raise the question of the diagnosis of acute retropharyngeal tendinitis. Clinical characteristics of this entity include a painful condition which is treatable and is often mistaken for retropharyngeal abscess, pharyngitis, or peritonsillar abscess. In our opinion, this condition may be more prevalent than the literature suggests.

Adult↗

PubMed1996

[Hyperbaric oxygen therapy in case of the neck diffuse phlegmon with very hard clinical course].

A case of 56 year old woman, diabetic (non-diagnosed before), suffering from diffuse phlegmon of the neck and acute submucosal laryngitis as a peritonsillar abscess complication is presented. Tracheotomy, abscess tonsillectomy with evacuation of peritonsillar abscess and extensive skin incisions of the neck with separation of tissue layers followed by drainage were performed at the beginning of hospitalization. This was regarded as responsible for stopping the violent development of the disease and saving the life of patient. Pathological bacteria were Streptococci (anaerobic and aerobic). Apart from the application of antibiotics (piperacyl, amikin, metronidazole) the patient was treated by hyperbaric oxygen (pressure 2,5 ata, one hour per day, on 6-9 day of treatment). Furthermore she was treated with oxygen applied through the tracheotomy tube during 5 days. In the authors' opinion the early performance of surgical procedure is necessary in the phlegmon of the neck as in the presented case. It is to be remembered, that these patients may suffer from other diseases like diabetes, non-diagnosed earlier. It has been noticed that significant improvement may be obtained by using the hyperbaric oxygen in the treatment of such cases.

Abscess↗

PubMedDate not supplied

[Present-day aspects of tonsillar problems].

The analysis of 1247 case histories of chronic tonsillitis and peritonsillar abscesses of tonsillogenic origin has shown that annual number of tonsillectomies for chronic tonsillitis is decreasing while the number of patients with peritonsillar abscesses is going up. The tendency is explained by several factors, among them overestimation of the efficacy reached with conservative therapy of chronic tonsillitis. The authors promote wider use of tonsillectomy as an effective preventive tool for peritonsillar abscesses. The latter should be more frequently managed with abscess tonsillectomy.

Adolescent↗

PubMed1982

[Evaluation of clinical efficacy of a cephem antibiotic, cefmetazole, in inflammatory infections of the upper respiratory tract].

We had reported the fundamental study on the utility of a new cephem antibiotic, cefmetazole (CMZ). On the basis of the results we administered CMZ to patients to investigate its clinical utility in this study. 1. CMZ was administered to 53 patients including 4 infants. They consisted of 30 cases of acute tonsillitis, 10 of peritonsillar abscess, 10 of laryngitis or pharyngitis, and 3 of sinusitis. 2. One of 2 g CMZ was administered to an adult patient except for l case and 0.5 g to an infant patient once or twice daily for at least 3 days. The method of administration was one shot intravenous injection, intravenous drip infusion or intramuscular injection. 3. The strict criteria for evaluating the efficacy of a drug were made and used for judging the efficacy of CMZ. 4. CMZ was clinically effective in 100% of patients with acute tonsillitis, 100% of those with peritonsillar abscess, 90% of those with laryngitis or pharyngitis, and 67% of those with sinusitis. 5. Bacteriologically, a single sort of bacterium was isolated in most cases of acute tonsillitis, laryngitis and pharyngitis and in the half of cases of peritonsillar abscess. Two and more sorts of bacteria were isolated in the other cases. The main bacteria isolated were beta-Streptococcus, S. pneumoniae and H. influenzae. Anaerobic bacteria, mostly Peptococcus spp. and Peptostreptococcus spp., were detected in peritonsillar abscess. 6. The clinical results agreed with the clinicobacteriological results. All the bacteria detected before treatment of CMZ disappeared. CMZ also acted effectively in cases in which H. influenzae was suspected to be a causative organism. 7. The present results of CMZ treatment were similar to those of cefazolin (CEZ) treatment published so far. 8. Thus, CMZ was confirmed fundamentally and clinically to be a very useful drug for infection of the upper respiratory tract.

Adolescent↗

PubMed1984

Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations.

The medical records of 1150 tonsillectomized patients were retrospectively reviewed for registration of the frequency of post-tonsillectomy haemorrhage in relation to sex and age of the patients, the indications for tonsillectomy, and the operative experience of the surgeon. The number of post-operative bleeds requiring surgery was 32 (2.8%) and occurred most frequently in young men and in patients with a history of previous peritonsillar abscess undergoing cold tonsillectomy. The frequency of haemorrhage in abscess tonsillectomy was not higher than expected. As previous studies have demonstrated that abscess tonsillectomy is associated with a minimal risk of spreading the infection or other serious complications, it is suggested that abscess tonsillectomy should be the preferable treatment of peritonsillar abscess.

Adolescent↗

PubMed2006

[Peritonsillar and retropharyngeal abscesses: study of 13 years].

INTRODUCTION: Peritonsillar and retropharyngeal abscesses are the most common deep head and neck infections. We present a series of patients with these infections. MATERIAL AND METHODS: We performed a retrospective study of peritonsillar and retropharyngeal abscesses in children admitted to the Infectious Diseases Unit of our hospital between January 1991 and January 2004. Diagnosis was based mainly on clinical and laboratory findings. RESULTS: We studied 54 patients, 10 with retropharyngeal abscess and 44 with peritonsillar abscess. The mean age was 6.7 and 7.5 years respectively. There was a slight predominance of boys (1.45:1). The number of cases diagnosed increased from 1997, with a maximum (nine cases) in 2002. Twenty-nine children had received previous antibiotic therapy. The main symptoms and signs were: fever, odynophagia, cervical lymphadenitis, and asymmetric tonsillar hypertrophy. All children received intravenous antibiotic therapy. Puncture-aspiration was carried out in seven patients. Eleven children underwent tonsillectomy, two with retropharyngeal abscess and nine with peritonsillar abscess. Of these 11 patients, five had had several episodes of tonsillitis and three had previously had a peritonsillar abscess. Three children who developed an abscess had previously undergone tonsillectomy. In most patients, outcome was favorable. CONCLUSIONS: In the last few years the frequency of peritonsillar and retropharyngeal abscesses has increased in the pediatric population. Most of the children have a good response to conservative treatment. The main risk factor for abscess recurrence is a previous history of repeated tonsillitis. Consequently, these patients are candidates for tonsillectomy.

Adolescent↗

PubMed2005

Inside-out complete tonsillectomy: extended intracapsular tonsillectomy for severe sore throat.

OBJECTIVES: This consecutive case series is presented to describe inside-out complete tonsillectomy and to assess its effects on postoperative pain and bleeding and its initial effectiveness in controlling recurrent sore throat and peritonsillar abscess formation. METHODS: Bipolar electrosurgical scissors are used for bloodless resection of 90% of the tonsillar mass. During controlled resection, tonsil tissue is intentionally left at the superior and inferior poles and at the deepest part of the tonsillar fossa to provide coverage for nutrient arteries and the tonsillar plexus of veins. This tissue is then electrodesiccated and removed under direct vision and indirect mirror guidance to achieve complete tonsillectomy. RESULTS: One hundred eighty-three consecutive tonsillectomies were performed by a single surgeon in a 16-month period, 47 of which were for the indication of recurrent sore throat (44) or recurrent peritonsillar abscess (3). Among these 47 children, there were 2 readmissions for dehydration. There were no immediate or delayed bleeding episodes. The average child required 4 days of narcotic pain medication. The mean annualized number of severe sore throats decreased from 5.24 before operation to 0.36 after operation (p < .0001, Student's paired t-test). There were no recurrent peritonsillar abscesses. CONCLUSIONS: Inside-out complete tonsillectomy achieves the surgical goal of complete tonsillectomy with the smallest possible wound and minimal injury to the surrounding tissue. The perioperative morbidity is markedly decreased compared to that of historical controls. The initial results suggest effectiveness similar to that of extracapsular tonsillectomy.

Child↗

PubMed1996

A case of multiple post-anginal complications.

The paper presents an unusual case of multiple post-anginal complications in a 21-year old male patient that included a peritonsillar abscess, parapharyngeal space phlegmon, a deep intrafascial phlegmon of the neck, internal jugular vein thrombophlebitis, septicopyemia, lung abscess and pneumonia, and a pyothorax. The patient was cured surgically and with broad-spectrum antibiotics and antifungal medication. The unusual course of the disease with presumed mycotic etiology as a complication of antibiotic therapy is discussed.

Adult↗

PubMed1979

Abscess tonsillectomy à tiède.

During recent years, primary tonsillectomy, tonsillectomy à chaud, has again become popular as the standard therapy for the peritonsillar abscess, whereas the traditional tonsillectomy à froid, made 4--6 weeks after the incision, has been partially eclipsed. It seems, however, that the intermediate form between these two, tonsillectomy à tiède, an abscess tonsillectomy made 3--4 days after the incision, would be highly practical in many cases, compared with the other two mentioned above. The tonsillectomy à chaud requires such a high state of readiness for anaesthesia, even during the emergency hours, that it is not practical in all otolaryngological departments. Tonsillectomy à tiède needs a longer hospitalization, yet requires fewer days off work than does the classical tonsillectomy à froid method. Furthermore, a significant proportion of the patients fail to present themselves for tonsillectomy at the agreed time and consequently get a recurrence of the disease later on. Tonsillectomy à tiède is almost as easy an operation as the normal tonsillectomy, both for the surgeon as for the patient. During the years 1976--77, 153 cases of peritonsillar abscess were seen. 105 cases were treated with the tonsillectomy à tiède method. The average duration of treatment was 6 1/2 days. The only complications were 6 cases of light secondary bleeding. A tonsillectomy à chaud was performed on 9 children in the age group 3--9 years.

Adolescent↗

PubMed2001

Immediate abscess tonsillectomy--a safe procedure?

OBJECTIVE: Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients. METHODS: A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using chi(2)-test, the age distribution was compared by Mann-Whitney U-test. RESULTS: Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson chi(2)-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance (P<0.001) in elder patients after immediate tonsillectomy. CONCLUSIONS: We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.

Adolescent↗

PubMed1993

A case of quinsy in a fifteen-month old child.

A case of peritonsillar abscess in an infant is described, which is a rare lesion in infants and young children. To our knowledge this is the youngest child described in the English literature. The clinical presentation and treatment of peritonsillar abscess in infants and young children are discussed. Serious complications can occur early in the course of the disease because of physiological and anatomical factors and thus early aggressive treatment is required.

Anti-Bacterial Agents↗

PubMed1986

[Post-angina septicemia caused by Fusobacterium necrophorum in a 7-year-old child].

A fusobacterium necrophorum septicemia due to a neglected peritonsillar abscess is reported in a 7 year-old boy with no significant past medical history. Osteo-articulary, hepatic and pleuro-pulmonary septic localizations, with an otherwise favourable outcome left severe orthopedic sequelae in the right hip. This resembles the post-peritonsillar abscess septicemia described by Lemierre in 1936 which was due to an anaerobic bacillus (fusobacterium). The reappearance of this pathology should lead to systematic anaerobic blood and abscess studies. Penicillin G and Metronidazole are still efficient in controlling this organism.

Child↗

PubMed1999

[Clinical, bactericidal and pharmacological evaluation of the effects of netromycin].

AIM: To analyze clinical, bactericidal effectiveness and pharmacokinetics of wide-spectrum antibiotic netromycin (NM). MATERIALS AND METHODS: The trial entered 29 patients: 21 with bronchopulmonary diseases (pneumonia and chronic bronchitis), 5 with exacerbation of chronic pyelonephritis, 2 with infectious endocarditis and 1 with peritonsillar abscess. RESULTS: Microbiologically, most of the agents (80.36%) showed sensitivity to NM. Pharmacologically, NM persisted long in blood serum and sputum irrespective of the administration mode. Positive clinical dynamics after NM treatment was achieved in all the patients but one who had a peritonsillar abscess. CONCLUSION: NM is highly active against both gram-positive and gram-negative flora. Side effects are minimal.

Adult↗

PubMed2004

Management of descending necrotizing mediastinitis.

PURPOSE: One of the most dreaded and the most lethal form of mediastinitis is descending necrotizing mediastinitis (DNM). PATIENTS AND METHODS: Between January 1990 and June 2001, 6 patients (mean age, 54.5 years; age range, 19 to 72 years) with DNM were treated in the Department of Thoracic Surgery of General Hospital of Attica "K.A.T." The primary etiology was odontogenic abscess in 3 patients and peritonsillar abscess in the other 3. Diagnosis was confirmed by computed tomography of the neck and chest. All patients underwent surgical drainage of the involved cervical region and mediastinum by monolateral cervicotomy and left thoracotomy. RESULTS: The delay between the occurrence of thoracic symptoms and mediastinal drainage varied from 1 to 4 days. The thoracic approach and the side of the thoracotomy depended on the involved mediastinal compartments and side of pleural effusion. The duration of mediastinal drainage varied from 8 to 22 days (mean, 12.5 days). One patient died of multiorgan failure related to postoperative septic shock. CONCLUSION: Delayed diagnosis and inadequate drainage are the main causes of the high mortality rate of DNM. Routine use of the computed tomography scan is highly recommended in patients with a deep cervical infection for early detection of mediastinitis at a time when the chest roentgenogram is still normal. If one realistically hopes to avoid the high mortality rate, aggressive surgical drainage and debridement of the neck and drainage of the mediastinum via a posterolateral thoracotomy by a multidisciplinary team of surgeons are required.

Abscess↗

PubMed2006

Diagnosis and management of pharyngitis in a pediatric population based on cost-effectiveness and projected health outcomes.

BACKGROUND: Pharyngitis is a common childhood complaint. Current management for children and adolescents includes 1 of 6 strategies, ie, (1) observe without testing or treatment, (2) treat all suspected cases with an antibiotic, (3) treat those with positive throat cultures, (4) treat those with positive rapid tests, (5) treat those with positive rapid tests and those with positive throat cultures after negative rapid tests, or (6) use a clinical scoring measure to determine the diagnosis/treatment strategy. The sequelae of untreated group A hemolytic streptococcal (GAS) pharyngitis are rare, whereas antibiotic treatment may result in side effects ranging from rash to death. The cost-utility of these strategies for children has not been reported previously. METHODS: A decision tree analysis incorporating the total cost and health impact of each management strategy was used to determine cost per quality-adjusted life-year ratios. Sensitivity analyses and Monte Carlo simulations assessed the accuracy of the estimates. RESULTS: From a societal perspective with current Medicaid reimbursements for testing, performing a throat culture for all patients had the best cost-utility. For private insurance reimbursements, rapid antigen testing had the best cost-utility. Observing without testing or treatment had the lowest morbidity rate and highest cost from a societal perspective but the lowest cost from a payer perspective. The model was most sensitive to the incidence of acute rheumatic fever and peritonsillar abscess after untreated GAS pharyngitis. Monte Carlo simulations demonstrated considerable overlap among all of the options except for treating all patients and observing all patients. CONCLUSIONS: Observing patients with pharyngitis had the lowest morbidity rate. The costs of this option were primarily from parental time lost from work. Before recommending observation rather than treatment of GAS pharyngitis, accurate estimates of the risk of developing acute rheumatic fever and peritonsillar abscess after GAS pharyngitis are needed.

Child↗

PubMed1994

Quinsy tonsillectomy or interval tonsillectomy--a prospective randomised trial.

Fifty-one patients with peritonsillar abscesses were randomised to undergo either quinsy tonsillectomy (QT) or interval tonsillectomy (IT), and the two groups were compared. The QT group lost fewer (10.3 v. 17.9) working days and less blood during the operation (158.6 ml v. 205.7 ml); haemostasis was easier and the operation was technically simpler in this group. There was no significant difference in length of hospital stay and neither group had intra- or postoperative complications. Only 64% of the IT group returned for tonsillectomy. In this study QT had distinct advantages over drainage and IT in the management of peritonsillar abscesses.

Absenteeism↗

PubMed2003

Current status of bacterial resistance in the otolaryngology field: results from the Second Nationwide Survey in Japan.

The study reported here was a nationwide assessment of otitis media (466 patients with acute suppurative otitis media and 476 with chronic suppurative otitis media), sinusitis (447 with acute sinusitis and 426 with chronic sinusitis), acute tonsillitis (724 patients), and peritonsillar abscess (141 patients) performed between November 1998 and March 1999. Eighty university hospitals, 79 affiliated hospitals, and 103 general practitioners participated. Methicillin-resistant Staphylococcus aureus(MRSA) comprised 15.6% of the 786 isolated strains of S. aureus. MRSA was frequently detected in patients with suppurative otitis media, but was uncommon in those with acute tonsillitis or peritonsillar abscess, and it was more common in those who had already been treated than in those who had not, with a significant difference between the groups. Vancomycin (VCM) showed the highest antimicrobial activity against MRSA and no VCM resistance was detected. Penicillin-sensitive Streptococcus pneumoniae(PSSP), penicillin-intermediate-resistant S. pneumoniae (PISP), and penicillin-resistant S. pneumoniae (PRSP) accounted for 49.6%, 28.5%, and 21.9% of the 228 isolated strains of S. pneumoniae, respectively. PISP and PRSP were frequently detected in children aged 5 years or younger. beta-Lactamase was produced by 96 of the 100 strains (96%) of Moraxella (Branhamella) catarrhalis. The 281 strains of Haemophilus influenzae isolated consisted of 199 beta-lactamase-negative, ampicillin-sensitive (BLNASe) strains (70.8%), 65 beta-lactamase-negative ampicillin-resistant (BLNAR) strains (23.1%), and 17 beta-lactamase-producing strains (6.0%). BLNAR strains were frequently detected in pretreated patients. Of these 281 strains of H. influenzae, 214 had nontypable capsules. In conclusion, the major bacterial species showed resistance to beta-lactams, indicating that care should be taken when selecting an appropriate antimicrobial agent.

Adolescent↗

PubMed1995

Peritonsillar infection in Christchurch 1990-2: microbiology and management.

AIM: To review the management and microbiology of peritonsillar infection in Christchurch. METHOD: The hospital records of patients admitted acutely to Christchurch Hospital with peritonsillar infection between January 1990 and December 1992, were reviewed. RESULTS: 109 patients were admitted with peritonsillar infection, of which 74 (68%) were found to have a peritonsillar abscess. Of these 74, needle aspiration was performed in 22, incision and drainage in 15, both aspiration and drainage in 31, and acute tonsillectomy in 6. Interval tonsillectomy was performed in 35 patients. Sixteen pathogenic bacterial groups or species were cultured from 39 aspirates. Of the total number of bacteria isolates, obligate anaerobes were cultured in 48%, and group A beta-haemolytic streptococci in 29%, while aerobic beta-lactamase producing bacteria were cultured in only 6%. CONCLUSION: Central to the management of peritonsillar abscess is drainage. This was commonly achieved by needle aspiration and/or incision. As beta-lactamase producing organisms are infrequent, penicillin remains the antibiotic of choice. Metronidazole may be required in a non responding patient, particularly if resistant anaerobes are cultured.

Adult↗