[Indications for tonsillectomy].
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Acute Disease↗
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Results for “Peritonsillar Abscess”
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Recognition and emergency management of infectious causes of upper airway obstruction in children.
Infections represent one of the most common causes of upper airway obstruction in the pediatric age group. Because obstructive processes may lead to respiratory failure and subsequent cardiopulmonary arrest, prompt recognition is crucial. This discussion provides a brief review of the unique anatomic and physiological characteristics of the child's airway, which may contribute to obstructive processes, followed by basic principles of pediatric airway management. Finally, we review many of the infectious causes of upper respiratory obstruction, with emphasis on early recognition and acute management.
Adolescent↗
Comparison of penicillin and trimethoprim-sulfamethoxazole in the treatment of ear, nose and throat infections.
A double-blind trial of penicillin and the combination trimethoprim-sulfamethoxazole was undertaken in adult patients with active infection of the ears, nose or throat. The results indicated that the drug trimethoprim-sulfamethoxazole was as effective as penicillin in achieving clinical improvement and showed a broader spectrum than penicillin the the elimination of pathogenic organisms. The difficulties in obtaining positive cultures that were reflective of the clinical condition are described.
Adolescent↗
[Oropharyngeal origin of septic thrombophlebitis of the internal jugular vein. Apropos of 3 cases].
While before antibiotics cases of septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection were frequent and had a poor prognosis, today they are exceptional and often have a favourable course under antibiotic therapy. The clinical features are often limited to fever and a painful tumefaction of the anterior border of the sterno-cleido-mastoidian muscle, symptoms may be more pronounced in the Lemierre syndrome in which the anaerobic septicaemia is associated with secondary, especially pleuro-pulmonary, localizations. The diagnosis can be confirmed with a cervical CT-scan showing an enlarged, thrombosed vein which does not opacify and has a hyperdense periphery. Treatment is based on parenteral antibiotics adapted to anaerobic germs.
Adult↗
Use of a size 2 LMA to relieve life-threatening hypoxia in an adult with quinsy.
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Adult↗
[Basic features of diphtheria (author's transl)].
The basic features of diphtheria, especially clinical aspects, differential diagnosis and therapy are set out insofar as they are important for the general practitioner. The doctor, not the bacteriologist, must make the diagnosis. Serotherapy must be begun as rapidly as possible, and in adequate dosage. The patients must be carefully watched over in the interests of early detection of possible complications. Rest in bed is required in every case for at least 3 to 4 weeks, longer if possible. Even mild "localized" forms can lead to toxic damage during the course or subsequently. In infants, diphtheria may run its course as the well-defined clinical picture of "diphtheria intoxication" of infants.
Adolescent↗
[A case report: jatrogenic damage of the internal carotid artery].
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Carotid Artery Injuries↗
[Characteristics of clinico-biochemical indicators in obese children with chronic tonsillitis].
Chronic tonsillitis (CT) was found in 63.1% of 190 obese children aged 3-15 years, 15% of them had no quinsy in the past. Onset of obesity was attributed to frequent quinsy in 18.3% of the examinees. Marked CT exacerbations were more typical for the children aged 6-7 years (10%). In 12-15-year-olds the disease tended to a sluggish course with scarce symptoms (25.8%). Pharyngoscopy discovered edema and hypertrophy of the tonsils in 74.1% of the patients. 35 patients underwent tonsillectomy. Examination of the removed tonsil tissue for phospholipids revealed pathological phospholipids lysophosphatidylcholine and phosphatidylinosite the quantities of which rose with growing obesity. It may be the result of negative action of obesity on tonsil structure.
Adolescent↗
Peregrine Wroth, M.D., and cynanche tonsillaris.
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Bloodletting↗
[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases].
OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. MATERIALS AND METHODS: Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived. DISCUSSION: Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.
Adult↗
The role of anaerobic bacteria in tonsillitis.
This review summarizes the information that supports the potential importance of anaerobic bacteria in tonsillitis. Some anaerobic bacteria possess interfering capability with Group A beta-hemolytic streptococci (GABHS) and other pathogens. The possible role of anaerobes in the acute inflammatory process in the tonsils is supported by several observations: anaerobes have been isolated from the cores of tonsils of patients with recurrent GABHS and non-GABHS tonsillitis (NST); the recovery of anaerobes as predominant pathogens in abscesses of tonsils, in many cases without any aerobic bacteria; their recovery as pathogens in well-established anaerobic infections of the tonsils (Vincent's angina); the increased recovery rate of encapsulated pigmented Prevotella and Porphyromonas spp. in acutely inflamed tonsils; their isolation from the cores of recurrently inflamed NST; and the response to antibiotics in patients with NST. Furthermore, immune response against Prevotella intermedia is present in patients with recurrent NST, and an immune response can also be detected against P. intermedia and Fusobacterium nucleatum in patients who recovered from peritonsillar cellulitis or abscesses, infectious mononucleosis and acute non-streptococcal and GABHS tonsillitis. Although more studies are needed, these findings support the possible pathogenicity of Gram-negative anaerobic bacilli in tonsillitis.
Antibodies, Bacterial↗
"Hot potato voice" in peritonsillitis: a misnomer.
The "hot potato voice" is widely recognized as a symptom of peritonsillar cellulitis or abscess; yet there have been no studies assessing the resonance characteristics of the vocal tract in peritonsillitis. Analysis was undertaken of formant frequencies in the articulation of the vowels /i:/. /a:/ and /u:/ in six subjects with peritonsillitis and compared with articulation once the peritonsillitis had settled. Significant variation was found in F1 when articulating /i:/ and in F2 when articulating /a:/, which are explainable by dyskinesis of the peritonsillar musculature. These findings were compared with six subjects articulating the same vowels with and without a hot potato in their mouth. Variation was found in both F1 and F2 when articulating /i:/, which can be related to interference of the potato with movement of the anterior tongue. The changes in the vocal tract differ in these two cases and the title "hot potato voice" in peritonsillitis is a misnomer.
Adolescent↗
Clindamycin in the upper respiratory tract infections.
Bacterial infections of the upper respiratory airways are common. Some of these infections are caused by anaerobic bacteria and Staphylococcus aureus and may constitute considerable therapeutical problems. Chronic suppurative otitis media may sometimes give rise to serious osteitis of surrounding bone structures, sigmoid sinus thrombosis and intracranial abscesses. The causative microorganisms are mostly anaerobes. Many paranasal sinus infections are also due to anaerobic bacteria. These infections can rapidly cause irreversible damage of the sinus mucosa and eventually spread intracranially. Purulent parotitis is mostly seen in elderly and seriously ill patients. In the majority of the cases bacterial cultures reveal beta-lactamase-producing S. aureus. Infections of the teeth in the mandible sometimes spread into the floor of the mouth and may extend down into the throat and mediastinum. If not properly treated these anaerobic infections will prove fatal. Chronic osteomyelitis of the mandible is increasing in frequency and constitute serious therapeutical problems. Many patients cannot be protected against painful and disabling relapses. Anaerobic bacteria, emanating from the normal oropharyngeal flora, play an important part in the pathogenesis of this disorder. Retropharyngeal, parapharyngeal as well as peritonsillar infections and abscesses are mostly caused by anaerobes and demand adequate surgical and antibacterial therapy. In malignant tumors of the ear, nose or throat, anaerobic infections often deteriorate the conditions as inflammatory oedema increases the volume of the tumor and the pain of the patients. Cutaneous infections of the face and auricles caused by S. aureus may constitute therapeutical problems.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Socioeconomic aspects in the therapy of peritonsillar absscess].
OBJECTIVE: To determine which treatment for quinsy is the most cost-effective option. MATERIAL AND METHOD: 277 quinsies were diagnosed in 262 patients in our institution between 1.1.1991 and 31.12.1998. Median age was 29 years (1-89 years), and sex ratio was 3 males:2 females. 82 quinsy tonsillectomies (AC), 91 drainages with interval tonsillectomy (DAF) and 104 drainages of the abscess without tonsillectomy (D) were carried out. RESULTS: Median hospital stay was 3 (1-7) days for quinsy tonsillectomy, and 10 (4-18) days for drainages with interval tonsillectomy (hospital stay after drainage added to hospital stay after tonsillectomy). If interval tonsillectomy is performed as an outpatient procedure, median hospital stay decreases to 5 (2-8) days. For patients who refused tonsillectomy, median hospital stay was 3 (0-14) days. Median disability after treatment was 15 (7-30) days for quinsy tonsillectomy. For drainages with interval tonsillectomy (disability succeeding the drainage added to that following interval tonsillectomy), the median is 20 (15-52) days. For patients who refused tonsillectomy it is 6 (0-15) days. In the AC group we counted 9 late haemorrhages (11%). In the DAF group 14 patients (15%) presented a late haemorrhage; 6 patients (6%) presented a postoperative superinfection of the tonsillar fossae. DISCUSSION: On the basis of the tariffs of our institution (CHUV), and of statistical data obtained from the National Institute for Social Insurance (SUVA) with regard to the economic impact of each day of disability, the cost of the various treatment options is presented. CONCLUSION: It results from our study that in the absence of a significant difference in the rate of complications, and even considering the possibility of carrying out interval amygdalectomy on an outpatient basis, the most cost-effective treatment of peritonsillar abscess is quinsy tonsillectomy.
Adolescent↗
Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis.
OBJECTIVE: Descending necrotizing mediastinitis (DNM) is a severe infection spreading from the cervical region to the mediastinal connective tissue. The mortality rate was reported as 40% until the 1980s. Since DNM is uncommon, few reports of large series of patients with DNM (i.e. more than 10 cases) have been published. The present aim was to evaluate our treatment strategy for DNM by retrospective chart review. METHODS: Retrospective chart review was performed in 10 patients with DNM between 1991 and 2003. The mean age was 53.8+/-23.3 years (median 58, range 16-82). The causes of DNM were primary peritonsillar or parapharyngeal abscess in 5 patients, post-extraction odontogenic abscess in 3, cervical abscess of post-tracheostomy in 1, and unknown in 1 patient. In nine cases, the abscess extended from the cervical region to the lower mediastinum. Immediately after the diagnosis of DNM, broad-spectrum antibiotics were administered empirically, and surgical treatments consisting of cervical drainage, thoracotomy with radical surgical debridement of the mediastinum and excision of necrotic tissue, decortication, and irrigation were performed in all cases. Post-operatively, mediastinopleural irrigation with saline was performed once or twice a day until a culture of pleural effusion became negative. RESULTS: The mean duration of chest tube retention was 26.7+/-17.0 days, and the mean hospital stay was 62.3+/-33.9 days. Five patients suffered from severe complications including septic shock, acute respiratory distress syndrome, disseminated intravascular coagulation, and pan-peritonitis due to duodenal perforation. The outcome was favorable in 8 patients. Of those with severe complications, two patients, who were older than 75 and had diabetes, died of multiple organ failure due to septic shock. Therefore, the mortality rate was 20%. CONCLUSION: Our treatment strategy for severe DNM was efficacious for early treatment and reduced the mortality rate. Early detection of DNM, and immediate thoracotomy and irrigation of the mediastinum and thoracic cavity, are recommended.
Abscess↗
Complications of the 'treatment' of tonsillar infection by traditional healers in Nigeria.
Traditional healers in Nigeria attempt to treat tonsillar infections either by performing uvulectomy with a sickle knife or by digital rupture of the tonsil. These procedures result in various complications, including haemorrhage, septicaemia, cellulitis of the neck, peritonsillar and parapharyngeal abscess, upper airway obstruction, and pharyngo-laryngocele with pneumothorax. These complications are illustrated with case reports. The danger of encouraging traditional healers to practise unsupervised and unscientific medicine is stressed.
Adolescent↗
[Pseudoaneurysm of the lingual artery after tonsillectomy. A rare complication].
BACKGROUND: Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology; however, life-threatening complications can occur in rare cases. PATIENTS: We report about a seven-year-old girl who developed a pseudoaneurysm of the lingual artery following elective routine tonsillectomy. RESULTS AND CONCLUSION: Initial ENT examination will reveal a painful cervical mass or unilateral palatal swelling that can easily be misinterpreted as a peritonsillar (or parapharyngeal) abscess. Computed tomography and angiography are indicated to confirm the diagnosis. Bleeding from a pseudoaneurysm of any branch of the external carotid artery represents a serious and life-threatening complication. Surgery is the treatment of choice.
Aneurysm, False↗