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PubMed1996

Immune response to anaerobic bacteria in patients with peritonsillar cellulitis and abscess.

The role of four oral organisms (Fusobacterium nucleatum. Prevotella intermedia, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans) was investigated in 19 children with peritonsillar abscess, and 17 with peritonsillar cellulitis. Antibody titers to these organisms were measured by enzyme- linked immunosorbent assay in the patient, as well as in 32 control patients. Serum levels in the patients were determined at day 1 and 42-56 days later. Significantly higher antibody levels to F. nucleatum and P. intermedia were found in the second serum sample of patients with peritonsillar cellulitis or abscess, as compared to their first sample or the levels of antibodies in controls. A total of 136 bacterial isolates, 100 anaerobic and 36 aerobic were isolated from the 19 peritonsillar abscesses. Anaerobic bacteria were found in all abscesses, and they were mixed with aerobic bacteria in 5 (26%). F. nucleatum was recovered in 14 (74%) abscesses and P. intermedia was isolated in 13 (68%). The elevated antibody levels to F. nucleatum and P. intermedia, known oral pathogens, suggest a pathogenic role for these organisms in peritonsillar infections.

Abscess↗
PubMed2002

The association between periodontal disease and peritonsillar infection: a prospective study.

OBJECTIVE: To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis. STUDY DESIGN AND SETTING: A total of 158 patients presenting over a 3-year period with peritonsillar abscess (PTA) confirmed by needle aspiration and a control group of 112 patients booked for elective tonsillectomy for recurrent tonsillitis (RT) were examined in terms of their periodontal status using the WHO Community Periodontal Index of Treatment Needs (CPITN). RESULTS: The mean CPITN index was 2.81 (Standard Deviation [SD], 1.10) in patients with PTA and 1.41 (SD, 0.92) in patients with RT. One hundred seven of 158 patients with PTA had significant periodontal pathology (CPITN, 3 or 4) compared with 12 of 112 patients with RT. These differences were statistically significant. CONCLUSION: Patients with peritonsillar abscess had an increased prevalence of periodontal disease as compared with patients with recurrent tonsillitis. SIGNIFICANCE: There is a need to further explore this correlation and determine its nature, although it could be the result of common pathogenic factors, a causal relation cannot be excluded.

Adult↗
PubMed1982

[Clinical studies with cefmenoxime in the otorhinolaryngeal field (author's transl)].

We conducted a therapeutic trial with cefmenoxime in the field of otorhinolaryngology on a total of 14 subjects including 7 cases of otitis media, 5 cases of peritonsillar abscess, 1 case of chronic sinusitis and 1 case of congenital aural fistula. 1. The effective rate for peritonsillar abscess was extremely high being judged 'markedly effective' in 3 cases and 'effective' in 2 cases. 2. The effective rate for otitis media was also remarkably high; it was judged effective in 85.7% of the cases. It is thought that this is probably due to the fact that therapy and supervision were carried out on inhospital patients. 3. The 1 case of chronic sinusitis and the 1 case of congenital aural fistula were each judged 'effective' and 'markedly effective'. The only side effect observed was a slight case of skin eruption in 1 of the patients.

Adolescent↗
PubMed2000

[Hyperbaric oxygen as an adjunctive treatment for descending necrotizing mediastinitis: report of a case].

We report a case of 59-year-old man of descending necrotizing mediastinitis (DNM) secondary to peritonsillar abscess. A 59-year-old man with diabetes mellitus was admitted to a local hospital because of cervical swelling related to a peritonsillar abscess. Despite administration of antibiotics, swelling of the neck, dysphagia and dyspnea deteriorated. Therefore he was urgently undergone a tracheotomy and transferred to our hospital by an ambulance. The surgery consisted with neck and anterior mediastinal drainage through neck and cervical collar incision. Culture of drainage fluid showed clostridium difficile. On postoperative day 5, we started hyperbaric oxygen therapy (HBOT). After lavage and HBOT, the patient improved by degrees, and discharged on postoperative day 82. DNM is a rare but serious complication of otopharyngeal and deep neck infection that spreads down to the mediastinum through the cervical-facial planes. Its mortality rate remains high even with aggressive surgical drainage and appropriate antibiotics. Our patient was successfully treated with urgent surgical drainage, antibiotics and HBOT. HBOT might be of great value as an adjunctive management to control this fatal infection.

Anti-Bacterial Agents↗
PubMedDate not supplied

Bacteriology in peritonsillitis.

Abscess material from 10 patients with peritonsillar abscesses was obtained by aspiration. Beside cultures and cultures in the laboratory, were performed 3-26 hours later, as well as routine nasopharyngeal and throat swab cultures. A total of 26 bacterial species were isolated from the abscess material; 19 of these were obligate anaerobes. In 4 patients a pure growth of anaerobes was found. In 3 patients a mixed aerobe/anaerobe flora was obtained. In 3 patients a pure growth of aerobes was found. Beta-hemolytic streptococci groups A and C respectively were isolated from 2 patients, but in pure culture from one patient only. The results of the nasopharyngeal and throat swab cultures showed a poor correlation to the results of cultures on aspirates. Comparison of the results of the bedside inoculation with the results of inoculation in the laboratory showed a moderate loss of bacterial species, viz. 3 of 26. All bacteria studied were susceptible to penicillin V, ampicillin and erythromycin when tested in vitro.

Adolescent↗
PubMed1999

Guideline of surgical management based on diffusion of descending necrotizing mediastinitis.

BACKGROUND: Descending necrotizing mediastinitis resulting from oropharyngeal abscess, is a serious, life-threatening infection. Exisiting strategies for surgical management, such as transcervical mediastinal drainage or aggressive thoracotomic drainage, remain controversial. METHODS: Four patients, (three males and one female) were treated for descending necrotizing mediastinitis resulting from oropharyngeal infection. Two had peritonsillar abscesses, while the others experienced dental abscess and submaxillaritis. Descending necrotizing mediastinitis received its classification according to the degree of diffusion of infection diagnosed by computed tomography. Mediastinitis in two cases, (Localized descending necrotizing mediastinitis-Type I), was localized to the upper mediastinal space above the carina. In the others, infection extended to the lower anterior mediastinum (Diffuse descending necrotizing mediastinitis-Type IIA), and to both anterior and posterior lower mediastinum (Diffuse descending necrotizing mediastinitis-Type IIB). The spread of infection to the pleural cavity occurred in three cases. RESULTS: The surgical outcome concerning each of the patients was successful. Radical cervicotomy (unilateral in three patients, bilateral in the other) in conjunction with mechanical ventilation with continuous postoperative positive airway pressure, was performed in all cases. Tracheostomy was established in three patients and pharyngostomy in two. The two descending necrotizing mediastinitis-Type I cases were successfully managed with transcervical mediastinal drainage. The descending necrotizing mediastinitis-Type IIA case received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphoidal incision. The patient with descending necrotizing mediastinitis-Type IIB required posterior mediastinal drainage through a right standard thoracotomy followed by left minimal thoracotomy. CONCLUSIONS: The mediastinal infection, the extent of which has been accurately determined by computed tomograms, necessitates radical cervicotomy followed by pleuromediastinal drainage. Situations where infection has spread to posterior medisatinum, particularly when it reaches in the level of the carina (descending necrotizing mediastinitis-type I), may not always require aggressive mediastinal drainage. In comparison, diffuse descending necrotizing mediastinitis-Type IIB demands complete mediastinal drainage with debridement via thoracotomy. Subxiphoidal mediastinal drainage without sternotomy may provide adequate drainage in diffuse descending necrotizing mediastinitis-Type IIA.

Abscess↗
PubMed1999

[Our experience in the management of peritonsillar phlegmon and abscess in children].

OBJECTIVE: Our objective was to evaluate the possible causes of the increased incidence of peritonsillar abscess in children during recent years, since up until now this condition has been unusual in children. PATIENTS AND METHODS: A retrospective study of all cases diagnosed in the Emergency Room between 1983 and 1998 detected nine children admitted to the hospital with painful swallowing, high fever and trismus. All of them underwent fine needle aspiration and transcutaneous ultrasound. RESULTS: The mean age was 9.8 years. Eight children suffered previous pharyngo-tonsillar infection, although emergency assistance was only confirmed in four cases. Six children were treated with macrolides, two with amoxicillin and one with cefuroxime. Exploration always diagnosed peritonsillar infection and needle aspiration detected an abscess in six cases. Ultrasound did not provide new information. In cases with abscess, drainage was performed and in three patients under general anesthesia. Bacteriologic cultures showed a lack of correlation between the isolates from the tonsillar surface and from pus from the abscess or tonsillar core. In the latter two there was a preponderance of Haemophilus influenzae and anaerobes. All children received intravenous antibiotic therapy and delayed tonsillectomy was done. There were no complications. CONCLUSIONS: Infant cases of peritonsillar abscess are increasing and there is no clear relationship with acute tonsillar infections, but probably with the use of inadequate antibiotics.

Adolescent↗
PubMed2001

Causes of tonsillar disease and frequency of tonsillectomy operations.

OBJECTIVE: To characterize the factors that influence the frequency of tonsillectomy and adenoidectomy operations. DESIGN AND SETTING: Nationwide questionnaire. Analysis of patients undergoing tonsillectomy or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland. PARTICIPANTS: Four hundred eighty-three of 819 individuals randomly selected from the Finnish National Public Registry. Two thousand two hundred thirty-one individuals younger than 30 years who underwent tonsillectomy (888 patients), adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki University Central Hospital from January 1, 1997, through December 31, 1998. MAIN OUTCOME MEASURES: Age of the individual at the time of operation. Indication for the operation. RESULTS: The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies 8% (39 persons) among the 483 individuals who returned the questionnaire. The frequency of tonsillectomy operations by age was multimodal; the frequency of tonsillectomies increased in preschool-aged children, declined thereafter, and increased again in teenagers. Tonsillar hyperplasia was the most frequent among children younger than 10 years, peritonsillar abscesses among teenagers, and chronic tonsillitis among individuals older than 20 years. The proportion of females was higher than males among teenaged patients. However, the cause and sex distribution could not explain the multimodality in the age-specific frequency. The age-specific frequency of tonsillectomies performed because of peritonsillar abscesses still followed a multimodal distribution. CONCLUSIONS: Factors relating to respiratory tract infections, maturation of the immune system, and the onset of puberty contribute to the cause of tonsillar disease. Distinct indications for tonsillectomy should be defined for preschool-aged children, teenagers, and individuals older than 20 years.

Adenoidectomy↗
PubMedDate not supplied

Impact on peritonsillar infections and microflora of phenoxymethylpenicillin alone versus phenoxymethylpenicillin in combination with metronidazole.

In a double-blind study, 20 patients with peritonsillar abscesses were treated with 2 g phenoxymethylpenicillin b.i.d. for ten days together with needle aspiration, incision and daily drainage, and 20 patients were treated with 2 g phenoxymethylpenicillin b.i.d. and 0.8 g metronidazole b.i.d. for ten days together with needle aspiration, incision and daily drainage. Group A beta-hemolytic streptococci were isolated from pus in 20 of the patients with peritonsillar abscesses, in five of these together with indigenous oropharyngeal aerobic and anaerobic microorganisms. Pure anaerobic bacteria were found in nine abscesses, together with indigenous aerobic microorganisms in eight, and together with group A, C and G streptococci in five. In one patient heavily colonized with beta-lactamase-producing Staphylococcus aureus, Haemophilus parainfluenzae and Bacteroides, group A beta-streptococci failed to be eradicated. In the penicillin group, nine of 18 patients harboured beta-lactamase producing Bacteroides strains in the tonsils on the day of admission. On the third and tenth days of treatment all patients harboured beta-lactamase producing Bacteroides strains in the tonsils, while in the penicillin + metronidazole group, only one out of 17 patients still harboured beta-lactamase producing Bacteroides strains. None of the patients harboured beta-lactamase producing fusobacteria on the day of admission. In the penicillin group, however, beta-lactamase producing fusobacteria were recovered from three patients on the tenth day of treatment. No beta-lactamase producing fusobacteria were recovered from the penicillin + metronidazole group.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed2005

[Indications for tonsillectomy in 2005].

Tonsillectomy is one of the most frequent ENT operations but yet a very disputed one. The majority of children and adults are treated for recurrent angina, which is validated by several clinical trials. For an adult a peritonsillar abscess is best treated by immediate tonsillectomy. Incision and drainage is a validated method as well, as long as there is no indication to a delayed tonsillectomy. The tonsillectomy alone is not a validated treatment for adult upper airway obstruction. On the other hand it is a recommended procedure for children upper airway obstruction. Partial tonsillectomy (tonsillotomy) is also a validated procedure for this indication. Finally the peritonsillar abscess in a child should first be treated by one or two days of intravenous antibiotics.

Abscess↗
PubMed2006

Airway infectious disease emergencies.

Upper and lower respiratory infections are encountered commonly in the emergency department. Visits resulting from occurrences of respiratory disease account for 10% of all pediatric emergency department visits and 20% of all pediatric hospital admissions. Causes of upper airway infections include croup, epiglottitis, retropharyngeal abscess, cellulitis, pharyngitis, and peritonsillar abscesses. Lower airway viral and bacterial infections cause illnesses such as pneumonia and bronchiolitis. Signs and symptoms of upper and lower airway infections overlap, but the differentiation is important for appropriate treatment of these conditions. This article reviews the varied clinical characteristics of upper and lower airway infections.

Child↗
PubMed2001

Descending necrotizing mediastinitis: surgical management.

OBJECTIVE: Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces. METHODS: Between April 1994 and April 2000, 13 patients, mean age 39.23+/-18.47 (median 38, range 16-67) years, with DNM were submitted to surgical treatment. Primary odontogenic abscess occurred in six, peritonsillar abscess in five and post-traumatic cervical abscess in two patients. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of the cervico-mediastinal regions by a bilateral collar incision associated with right thoracotomy in ten cases. RESULTS: Six patients out of 13 required reoperation. Two patients previously submitted only to cervical drainage required thoracotomy; four patients, which have been submitted to cervico-thoracic drainage, underwent contralateral thoracotomy in two cases and ipsilateral reoperation in two cases. Ten patients evolved well and were discharged without major sequelae; three patients died of multiorgan failure related to septic shock. Mortality rate was 23%. CONCLUSION: Early diagnosis by CT of the neck and chest suggest a rapid indication of surgical approach to DNM. Ample cervicotomy associated with mediastinal drainage via large thoracotomic incision is essential in managing these critically ill patients and can significantly reduce the mortality rate for this condition, often affecting young people, to acceptable values.

Abscess↗
PubMed2004

Peritonsillar infections: local experience.

INTRODUCTION: The disease pattern and management of peritonsillar infections in Singapore General Hospital are studied. Other objectives are to determine if a seasonal variation exists and to examine the role of routine bacterial cultures and interval tonsillectomy. METHODS: This is a retrospective review of the management and outcome of patients with peritonsillar infections who were admitted acutely to Singapore General Hospital over a three-year period. RESULTS: Of 185 patients studied, 151 (81.6 percent) had peritonsillar abscess or quinsy and 34 (18.4 percent) had peritonsillar cellulitis. There were 139 males and 46 females, with a racial predisposition among Malays (p value is less than 0.0005). There may be a seasonal variation with a bi-annual trend, though no correlation with upper respiration tract infections was noted. Treatment consisted mainly of incision and drainage (66 percent) or needle aspiration (34 percent). No significant difference in the length of stay was noted in patients receiving penicillin alone, penicillin with metronidazole, or broad-spectrum antibiotics (p value is equal to 0.062). Fourteen (7.6 percent) patients had recurrences, all of which occurred after the first month. Two patients (1 percent) had bilateral quinsy. CONCLUSION: Peritonsillar infections remain a common admitting diagnosis to the Otolaryngology department. A single episode of infection should no longer be an indication for tonsillectomy as the incidence of recurrence is low.

Acute Disease↗
PubMed2005

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy.

CONCLUSION: There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. OBJECTIVE: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. MATERIAL AND METHODS: All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years). RESULTS: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of "selected" elective tonsillectomies. The difference between these two rates was not significant (p = 0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.

Adolescent↗
PubMed1992

Infection of the neck spaces: a present day complication.

Although advances in antibiotic therapy have made adult neck space infections an uncommon event, it is essential to bear them in mind when treating oro-dental and oro-pharyngeal sepsis, as they can often progress with life threatening sequelae. Three cases of neck space infection as a consequence of dental infection, pharyngitis and peritonsillar abscess are presented. The management of a potentially compromised airway is of paramount importance in the immediate treatment of neck space sepsis.

Abscess↗
PubMed2003

[Descending necrotic mediastinitis--course and methods of surgical treatment].

UNLABELLED: Between 1995-2002 12 patients, (6 M and 6 F) aged 20-87, (mean 47 years), were treated surgically in our Clinic for descending necrotizing mediastinitis (DNM). The disease was caused by peridental abscess in 7 (54.5%) patients, by peritonsillar abscess in 4 (36.4%), and by retropharyngeal abscess in 1 (9.1%). Septic shock and acute respiratory failure were diagnosed in 11 (91.7%) patients on admission to the Clinic. Complains and clinical symptoms of various intensity appeared during 3-11 days, prior to admission. Extensive cervicotomy and mediastinal drainage were made in 6 patients, whereas cervicotomy and posterolateral thoracotomy in the other 6. Of the 12 patients, 2 (16.7%) survived. Postmortem eximinastions revealed in all patients gangrenous mediastinitis, pericarditis and empyema of both pleural cavities. CONCLUSIONS: 1. No characteristic symptoms and low prevalence are essential causes of problems with proper diagnosis of DNM and related high death rate. 2. Early drainage of neck and mediastinum during thoracotomy should be considered as management of choice in patients with DNM. 3. Symptoms of septic shock, pneumonia, pericarditis or empyema diagnosed on admission to hospital are unfavourable prognostic factors.

Abscess↗
PubMedDate not supplied

Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses.

AIMS: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. STUDY DESIGN: Clinical-Prospective. MATERIAL AND METHODS: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. RESULTS: Intraoral US was performed on 35 cases and its sensitivity was of 95.2%, the specificity was of 78.5% and the accuracy was of 86.9%. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8%. There were 5 false-negatives and 1 false-positive result, sensitivity was 80%, specificity was 92.8% and accuracy was 84.5%. CONCLUSION: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Adolescent↗
PubMed1978

Anesthetic and operative management of potential upper airway obstruction.

Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. In carcinoma of the supraglottic larynx and in pharyngeal abscess, the unobstructed airway in the conscious patient became impossible to secure once general anesthesia was begun. Unappreciated pathological deformity prohibited endotracheal intubation, and anesthesia precipitated obstruction. In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia.

Adolescent↗