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PubMed1994

Changing trends in deep neck abscess. A retrospective study of 110 patients.

We have conducted a retrospective study of 110 patients with the diagnosis of deep neck abscess who had been seen between 1981 and 1990. Etiologic factors, common pathogens, and antimicrobial therapy were reviewed with reference to diagnostic methods of choice and management principles. The findings were compared with the literature. We have identified trends of change in the following aspects of deep neck abscess: cause, presentation, diagnostic methods, and bacteriology. Management principles of airway protection, intravenous antibiotics, and drainage have not changed.

Abscess↗
PubMed1994

Clinical characteristics of acute uvulitis.

Previous literature has identified uvulitis as a condition with serious implications. This report details a series of 15 patients with uvulitis whose clinical features were remarkable for a relatively benign course. This is the largest series of patients with uvulitis in the literature. The predominant symptoms were related to sore throat and pain or difficulty on swallowing. No patient had significant airway or infectious complications attributable to the uvulitis. The only patient admitted to the hospital required management of an associated peritonsillar abscess. Of the 14 patients discharged, 13 (93%) were followed-up and none required further care. Seven (50%) of the discharged patients received symptomatic treatment only, whereas the others were treated with medications including antibiotics, corticosteroids, diphenhydramine, and B-agonists. Further research into the etiology and management of uvulitis is warranted.

Acute Disease↗
PubMed2005

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: a retrospective review.

INTRODUCTION: Tonsillar hyperplasia leading to dyspnea, dysphagia and other symptoms of obstruction represents a common problem especially in young children where tonsillectomy should be avoided in order to preserve the immunological function of the tonsils. Aim of the study was to assess carbon-dioxide-laser-tonsillotomy as a considered alternative procedure to reduce the tonsillar volume in these children. METHODS: Between 1993 and 2004, 109 children with tonsillar hyperplasia without former episodes of tonsillitis received laser-tonsillotomy mostly (n=98) combined with adenoidectomy. The protruding part of the tonsil was reduced by a CO2-laser. Seventy-five children were available for follow-up with a standard questionnaire. Five patients required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia. Histological investigations were performed. Twenty-two children were reevaluated by clinical examination. RESULTS: Most of the patients were relieved from obstructive symptoms. There was no occurrence of postoperative hemorrhage or peritonsillar abscesses. The histological investigations on the specimens from later performed tonsillectomy (n=5) showed no evidence of inflammation or scar formations, but open and deep crypts. The clinical examination did not reveal any signs of chronic infections. CONCLUSION: In this retrospective study tonsillotomy with CO2-laser in early childhood leads to a long-term elimination of obstructive symptoms due to tonsillar hyperplasia with minimal discomfort for the patient while preserving normally functioning immunocompetent tonsillar tissue. Further prospective studies are planned.

Child↗
PubMed2006

Thermal welding versus bipolar tonsillectomy: a comparative study.

OBJECTIVE: To compare thermal welding tonsillectomy (TWT) with bipolar electrocautery tonsillectomy (BET) procedure. STUDY DESIGN AND SETTING: A prospective randomized study was conducted on 150 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Exclusion criteria included peritonsillar abscess history, bleeding disorders, and any other procedure together with tonsillectomy. Patients were randomly assigned to TWT or BET groups. Intraoperative bleeding, operative time, postoperative pain, complication rates, and return to normal diet were evaluated. RESULTS: In the TWT group there was no measurable intraoperative bleeding, while mean bleeding for BET group was 16 mL. No significant difference regarding mean operative time was noticed. Mean postoperative pain score and mean time for return to normal diet were significantly lower in the TWT group. Primary hemorrhage occurred in 1 subject of the BET group. Secondary postoperative hemorrhage was noticed in 1 subject of the TWT group and 3 subjects of the BET group. CONCLUSION: Thermal welding tonsillectomy procedure provides sufficient hemostasis, lower postoperative pain, and quick return to normal diet. EBM RATING: A-1b.

Adolescent↗
PubMed2003

[Variations of salivary dismutase superoxide in tonsillar infection].

The antioxidant effect of superoxido dismutase in saliva was measured in children bearing of tonsillar hypertrophy, recidivant tonsillitis or peritonsillar abscess. These levels were compared to those detected on tonsillar tissue obtained from tonsillectomy (p < 0.001). Although salivary SOD concentration in children with tonsillar infection was higher than hypertrophy, there was not a significative correlation to tonsillar value of the enzyme (R2 = 0.2276), so we can not accept a predictive value for salivary SOD of tonsillar suffering and, eventually, of tonsillectomy.

Humans↗
PubMed2005

[Intra cranial abscess and empyemas from E.N.T. origin].

OBJECTIVES: The purpose of this study was to evaluate the diagnosis criteria, the bacteriology and the evolution after adapted treatment of intracranial abscess of ENT origin. MATERIAL AND METHODS: It was a retrospective study from 1985 to 2003 concerning 22 patients who had brain abscesses secondary to an ENT infection. RESULTS: The infectious origin was sinusoid in 32% of cases, otologic in 32% of cases, pharyngeal or dental in 27% of cases and cutaneous in 9% of cases. The clinical symptoms were: fever in 55% of cases, headache in 73% of cases (Intra cranial hypertension syndrome in 23% of cases), epilepsy in 32% of cases and various other neurologic symptoms. Bacteria were identified in 82% of cases. In 50% of cases multibacterial associations were found. All the patients had bi antibiotherapy associated to surgical excision of the abscess (16 cases) or single (or more) punction (stereotaxic guided or not) of the abscess. 3 patients (14%) died and 50% are alive and well. CONCLUSION: The diagnosis of cerebral abscess is often difficult. The "classical" intracranial hypertension associated to high fever is usually incomplete and sometimes absent. There is no predominant bacteria involved and multibacterial infections are frequent. Despite abscesses are serious and potentially lethal, an early diagnosis, a medical (antibiotics) and surgical treatment (punction and/or surgical excision) may completely be cured in more than 50% of cases.

Adolescent↗
PubMed1994

Herpes simplex infection causing acute necrotizing tonsillitis.

OBJECTIVE: To describe the clinical and pathologic features of acute herpetic tonsillitis and to compare the histologic findings with those of herpetic lymphadenitis. DESIGN: We present a case report of a 22-year-old woman with bilateral cervical adenopathy, acute tonsillitis, and suspected peritonsillar abscess. MATERIAL AND METHODS: Histologic examination of the excised tonsils demonstrated discrete necrotic areas that contained cells with intranuclear viral inclusions. RESULTS: The diagnosis of herpetic tonsillitis was confirmed by demonstrating herpes simplex virus (HSV)-infected cells on paraffin section immunostains and by positive HSV cultures of the tonsillar tissue. CONCLUSION: HSV infection is an uncommon cause of acute tonsillitis; the histologic findings are similar to those seen in herpes simplex lymphadenitis.

Acute Disease↗
PubMed1997

Contemporary management of deep neck space infections.

Deep neck infections continue to be seen despite the wide use of antibiotics. These infections follow along fascial planes to create deep neck space abscesses. The clinical presentation often points to the space involved. Understanding the regional anatomy gives the surgeon the ability to treat these grave infections. The records of 24 patients with a diagnosis of deep neck space abscess admitted to Hermann Hospital between 1988 and 1993 were reviewed. Fifty percent of the patients had received antibiotics for an infection of the ear, nose, or throat before the development of a neck space abscess. Ten patients had parapharyngeal abscesses, seven had retropharyngeal abscesses, six had submandibular space abscesses, and one had parotid space abscess. Thirty-five organisms were isolated in 18 cases (1.9 isolates per patient). The most common organism cultured was Streptococcus (13 of 18), followed by Staphylococcus (6 of 18), Bacteroides (5 of 18), Micrococcus (2 of 18), and Neisseria (2 of 18). One case each of Candida, Enterobacter, Enterococcus, Peptostreptococcus, Proteus, Proprionobacter, and Pseudomonas was cultured. Six patients had no growth on culture but did have organisms found on Gram's stain. The operative techniques and antibiotics used are discussed. The main complications of jugular vein thrombosis, carotid artery rupture, and mediastinitis are described, as well as an unusual case of meningitis from a large retropharyngeal-parapharyngeal abscess.

Adolescent↗
PubMed1993

Dexamethasone as adjuvant therapy for severe acute pharyngitis.

STUDY OBJECTIVE: To determine the efficacy of dexamethasone as adjuvant therapy to improve pain relief in patients with severe, acute exudative pharyngitis. DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical trial. SETTING: Large, urban community hospital emergency department with an emergency medicine residency program. TYPE OF PARTICIPANTS: Patients aged 12 to 65 years old with exudative pharyngitis and severe dysphagia/odynophagia. Patients with cancer, AIDS, diabetes mellitus, recent steroid use, pregnancy, or suspicion of peritonsillar abscess were excluded. INTERVENTIONS: All patients received oral penicillin (500 mg Pen VK) or erythromycin (333 mg base) three times daily for ten days in addition to either 10 mg single-dose dexamethasone or saline placebo IM injection. MEASUREMENTS AND RESULTS: Fifty-eight patients graded their initial degree of throat pain on a visual-analog scale that was 15 cm long and scored from 0 to 3.0 in 0.5-cm increments. Follow-up was obtained on 51 patients to determine their condition at 24 hours. At entry, there was no difference in age, weight, antibiotic assignment, or initial pain score between groups. Improvement in pain score (initial versus 24 hours) was 1.8 +/- 0.8 in the 26 patients of the dexamethasone group and 1.2 +/- 0.9 in the 25 patients of the placebo group (P < .05). Time to onset of pain relief was also faster in steroid-treated patients who demonstrated relief beginning at 6.3 +/- 5.3 hours, compared with 12.4 +/- 8.5 hours in the placebo group (P < .01). Of the 26 patients evaluated at seven days (13 in each group), time to complete lack of pain averaged 15.0 +/- 11.4 hours in the dexamethasone group and 35.4 +/- 17.9 hours in the placebo group (P < .02). Complications attributable to dexamethasone were not observed. CONCLUSION: In patients with severe, acute exudative pharyngitis, single-injection dexamethasone adjuvant compared with placebo resulted in statistically and clinically significant improvement, as evidenced by more rapid onset and greater degree of pain relief.

Acute Disease↗
PubMed2001

Pediatric otolaryngologic emergencies.

Anesthesiologists are often consulted to help in the management of pediatric otolaryngologic emergencies. These include airway obstruction in children suffering from acute epiglottitis and croup. Surgical otolaryngologic emergencies such as foreign body aspiration, post-tonsillectomy bleeding, obstructive laryngeal papillomatosis, peritonsillar abscess, and laryngeal trauma can be life threatening. The pathophysiology, clinical course, and anesthetic management of these conditions are addressed with special emphasis on the details of airway management in each case.

Anesthesia↗
PubMed1999

Descending necrotizing mediastinitis: a retrospective surgical experience.

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. We reviewed the last 10 years of our surgical experience in DNM and commented on early diagnosis and aggressive surgical treatment in these patients. METHODS: Five males (71%) and two females (29%), mean age 34 years, with DNM, were surgically treated. Primary oropharyngeal infection occurred in three (43%) and odontogenic abscess in four (57%) patients. All had serious cervical and mediastinal infections with severe respiratory and hemodynamic repercussions, i.e. bacteremia, systemic arterial hypotension and obnubilation. Diagnosis was confirmed by computerized chest tomography. RESULTS: All patients underwent surgical drainage of the cervical region by bilateral transverse cervicotomy with debridement of the necrotic and infected tissues, associating ample mediastinal drainage with or without thoracotomy. Six patients (86%) evolved well and were discharged after a mean of 35 days. Two patients (29%) required reoperation due to local surgical complications: empyema and dehiscence of the sternum. One patient (14%) died on the second postoperative (p.o.) day due to renal and respiratory insufficiency. Cultures of DNM showed the development of associated aerobic and anaerobic flora in 71% of the operated patients and only aerobic in 29%. CONCLUSION: Early diagnosis by CAT scan of the neck and thorax aids in rapid indication of a surgical approach of DNM. Performing ample cervicotomy with mediastinal drainage generally associated with thoracotomy can significantly reduce the mortality rate for this condition to 14%.

Adolescent↗
PubMed2006

Acute epiglottitis in adults: a recent experience with 10 cases.

OBJECTIVES: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients. METHOD: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy. RESULTS: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used. CONCLUSION: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

Acute Disease↗
PubMed2006

Blood splash from different diathermy instruments during tonsillectomy.

OBJECTIVE: To compare the potential risk of blood contamination of the surgeon's conjunctiva during tonsillectomy using disposable bipolar diathermy and reusable monopolar diathermy. DESIGN: A prospective, single-blind, randomized, controlled trial. METHODS: Elective tonsillectomy was performed using either disposable bipolar diathermy or reusable monopolar diathermy. The operating surgeon wore a ViewsafeTM protective eyeshield which was later examined under an operating microscope by a blinded observer and the number of blood spots counted. RESULTS: One hundred and sixty-eight patients were enrolled. The relative risk of conjunctival contamination of the surgeon using disposable bipolar diathermy was 2.8 times that with reusable monopolar diathermy (chi-squared test, p < 0.0005). A previous history of peritonsillar abscess and additional adenoidectomy were associated with increased blood splatter. CONCLUSION: The use of disposable bipolar diathermy for haemostasis during tonsillectomy poses a greater risk of conjunctival contamination for the surgeon than using reusable monopolar diathermy.

Adolescent↗
PubMed2003

Pulsed mode radiofrequency lesioning to treat chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia).

Glossopharyngeal neuralgia (GPN) is an uncommon orofacial pain syndrome. Primary GPN is idiopathic, whereas secondary GPN has identifiable causes: tonsillectomy, peritonsillar abscesses, invasive cancer, and trauma. Despite these differences, both types of GPN present similarly and can recur. Pulsed mode radiofrequency lesioning is a safe, non-destructive treatment method and hence, useful in neuropathic pain conditions. We present the first case of chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia), that was successfully managed with pulsed radiofrequency lesioning.

Journal Article↗
PubMed2004

[Long-term results of laser-tonsillotomy in obstructive tonsillar hyperplasia].

BACKGROUND: Carbon-dioxide-laser-tonsillotomy is reconsidered as a procedure to relieve patients in early childhood from obstructive symptoms caused by tonsillar hyperplasia such as snoring or sleep apnea without influencing the immunological function. METHODS AND PATIENTS: The protruding part of the tonsils was removed by a CO (2)-laser delivering 10 - 15 W. During 1993 to 2003, 83 children received laser-tonsillotomy, combined with adenoidectomy 51 children were available for follow-up with a standard questionnaire. The parents were surveyed in average 39 months postoperatively. 5 patients required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia. Histological investigations were done. 15 children were reevaluated by clinical examination. RESULTS: Most of the patients were relieved from obstructive symptoms. There was no occurrence of postoperative hemorrhage or peritonsillar abscesses. The histological investigations on the specimens from later performed tonsillectomy (n = 5) showed no evidence of scarring opened crypts. The clinical examination did not reveal any signs of chronic infections. CONCLUSION: The tonsillotomy by carbon-dioxide-laser appears as a suitable and safe technique for the treatment of tonsillar hyperplasia without severe throat infection in early childhood.

Airway Obstruction↗
PubMed2006

[Lethal end of a group C streptococcal necrotizing fasciitis in a healthy female].

The necrotizing fasciitis (NF) is a life threatening, quickly progressive soft-tissue infection characterized by necrosis of the superficial fascia. It is very rare in the head and neck region. Usually this infection attacks weak patients with chronic diseases, such as diabetes or cancer. In adults the most common organisms implicated in craniocervical NF are Streptococcus pyogenes, Staphylococcus aureus, Streptococcus viridans and Peptostreptococci. The typical infectious entrance is a deep wound, after surgery or a peritonsillar abscess. We describe a very unusual case of a craniocervical NF with a deadly outcome in a sixty year old female. The patient had no chronic diseases and went to an ENT doctor with an acute tonsillitis for 3 days. Within the next three hours the general condition became dangerous to life. Therefore she was brought to us for immediate therapy. But despite fast and aggressive surgery of the neck, throat and thorax the patient died of a toxic schock syndrome on the intensive care unit within a few hours. The microbiology showed just group C Streptococcus. The postmortem examination confirmed the NF with starting point in the left tonsil after acute tonsillitis. Such a foudroyant course of a craniocervical NF with group C streptococci in a healthy patient is not published yet.

Acute Disease↗
PubMed1982

Acute upper airway obstruction in the adult. 1. Causative disease processes.

Infectious processes that can cause acute upper airway obstruction in adults include Ludwig's angina, retropharyngeal infection, acute epiglottis, diphtheria, tetanus, and peritonsillar abscess. They are uncommon but potentially lethal. Ludwig's angina in particular quickly progresses to airway obstruction. In most cases, the mainstays of management are antibiotics, surgical drainage, and if necessary, airway maintenance by tracheostomy, cricothyrotomy, or nasotracheal or endotracheal intubation. Hereditary angioneurotic edema causes episodes of laryngeal edema that may lead to suffocation. In an acute episode the airway must be maintained by endotracheal intubation.

Adult↗