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PubMed1990

Peritonsillar abscess in Kawasaki disease.

Mucocutaneous lymph node syndrome, Kawasaki disease, is a potentially fatal pediatric disease characterized by prolonged high fever, conjunctivitis, stomatitis. myocarditis, aseptic meningitis and coronary artery vasculitis. We present peritonsillar abscess as a previously unreported otolaryngologic symptom and presentation of Kawasaki disease. A previously healthy 7-year-old boy required hospitalization for a peritonsillar abscess. Despite adequate surgical drainage and appropriate intravenous antibiotics, the patients' systemic symptoms persisted. After the week of hospitalization, the child was transferred to the intensive care unit with acute myocarditis, heart failure and severe arthritis. The diagnosis of Kawasaki disease was confirmed with echocardiographic evidence of coronary artery aneurysms and the development of the characteristic hand and foot desquamation. The patient's symptoms resolved with salicylates and intravenous gamma globulin therapy. He was discharged in good condition after 3 weeks of hospitalization. This is the first report of Kawasaki syndrome presenting with peritonsillar abscess. Although we discuss a unique presentation of this disease. Kawasaki syndrome often exhibits other otolaryngologic findings early in its course. A literature review of the clinical characteristics, pathogenesis and therapy of this disease is presented.

Child↗
PubMed2004

Role of screening for infectious mononucleosis in patients admitted with isolated, unilateral peritonsillar abscess.

Two hundred and four cases of in-patient admission with isolated, unilateral peritonsillar abscess over the three-year period 1999-2001 were reviewed retrospectively. One hundred and fifty-one patients had been screened for infectious mononucleosis (IM) using the heterophile antibody screening test. Of these 142 (94 per cent) tested negative and nine (six per cent) positive. There were no IM-typical clinical or haematological signs in any of the IM positive patients to facilitate the prediction of the diagnosis. Due to the comparatively high prevalence of positives, the low cost of screening, the lack of predictive signs and the diversity of potential complications of IM, routine screening in all patients presenting with peritonsillar abscess is recommended.

Adult↗
PubMed1997

Direct microscopy of effusions obtained from peritonsillar abscesses as a complement to bacterial culturing.

Effusion material was aspirated from 51 consecutive peritonsillar abscesses (34 male, 17 female; age range eight to 46 years) and subjected to direct microscopy after staining with acridine orange. Bacteria were counted per ml effusion material and their morphology was analyzed. In addition, aerobic and anaerobic bacterial culturing was performed. Effusions containing beta-haemolytic streptococci Group A, which appeared as a single species contained fewer bacteria (8 x 10(6) per ml, median value) than effusions harbouring a mixed flora (7 x 10(8) bacteria per ml, median value). Direct microscopy of effusions obtained from peritonsillar abscesses makes possible rapid identification of a single or mixed flora, which is of importance for the antibiotic treatment of the disease.

Acridine Orange↗
PubMedDate not supplied

Peritonsillar abscess in the pediatric population.

This paper reports on 115 pediatric patients who were treated for peritonsillar abscess at The Columbus Children's Hospital. Its purpose is to document the threefold increase of peritonsillar abscess between 1959 and 1978, relating this to the simultaneous decrease in the number of tonsillectomies by about one third. The paper further shows that 55 of 115 patients underwent successful treatment by immediate tonsillectomy with lower morbidity and shorter hospital stay when compared with 60 patients treated medically. The timing of the operation will also be discussed. We believe that immediate tonsillectomy is the treatment of choice.

Adolescent↗
PubMed1998

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses.

The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.

Adult↗
PubMedDate not supplied

Bilateral peritonsillar abscesses: case report and literature review.

Although unilateral peritonsillar abscesses (PTA) are a common complication of acute bacterial tonsillitis, bilateral PTA are quite rare. We present the case of a 14-year-old female teenager with a 1-week history of acute tonsillitis. Physical examination revealed significant trismus, symmetrically inflamed tonsils and soft palate, and a midline uvula. A contrast-enhanced CT scan of the neck demonstrated bilateral PTA. After bilateral needle aspiration and administration of antibiotics, complete disease resolution was rapidly achieved. Patients with bilateral PTA present a diagnostic dilemma because they do not demonstrate the classic asymmetric signs and symptoms seen in the more prevalent unilateral PTA. Contrast-enhanced CT imaging can help diagnose bilateral PTA and should be considered in the presence of marked trismus but with the absence of unilateral inflammatory findings.

Acute Disease↗
PubMed1995

Peritonsillar abscess in children. Is incision and drainage an effective management?

Debate continues concerning proper management of peritonsillar abscess (PA). We studied 189 children (mean age, 9 years) admitted in our department during the last 7 years with the diagnosis of PA. Management consisted of incision and drainage (performed in 92.5% of the children without general anaesthesia) and antibiotic therapy intravenously. There was resolution without complications in the overwhelming majority of the cases. After the initial episode, we further followed up 101 children. The recurrence rate was 15.8%. Forty-seven percent of the recurrences occurred 1 month after the children had been discharged. Probably some of these second PA should be considered as persistent and not as recurrent. Therefore, we propose that after their discharge, the children must take oral antibiotics (resistant to beta-lactamase) for more than 10 days. Cultures were taken from 58 cases. The predominant bacterial isolates were Streptococcus spp. (55%), anaerobes spp. (12%) and Staphylococcus aureus (6%). To our knowledge, this is the first survey that addresses exclusively a pediatric population and suggests that incision and drainage without general anaesthesia is an applicable and effective management in children with PA. Moreover, we believe that peritonsillar abscess is no longer a strong indication for tonsillectomy due to the relatively low rate of recurrence. We recommend close follow-up, mainly for the first months after the initial episode.

Adolescent↗
PubMed1992

[The His duct as a cause of peritonsillar abscess before and after tonsillectomy].

The role of the duct of His in the aetiology and development of peritonsillar abscess before and after tonsillectomy is evaluated. This duct, lying between the palatine tonsil and the superior pharyngeal constrictor muscle, is the only remnant of the second pharyngeal pouch. If not properly identified and marsupialized, it can be responsible for recurrent peritonsillar abscess.

Adult↗
PubMed1997

Peritonsillar abscess in early childhood. Presentation and management.

OBJECTIVE: To highlight the modes of presentation and management of a peritonsillar abscess in children younger than 5 years. DESIGN: Retrospective case series. SETTING: Tertiary referral pediatric otolaryngology practice. PATIENTS: Seven children younger than 5 years. RESULTS: The mean age of the children studied was 27 months (age range, 7-41 months). Five (71%) of the 7 patients underwent computed tomographic scanning to confirm the diagnosis. Pus was cultured at surgery in every case. The most common organism detected was Streptococcus viridans. The average hospital stay was 72 hours (range, 22 hours to 12 days). After diagnosis of an abscess, all patients underwent an electrocautery tonsillectomy and had an uneventful recovery. CONCLUSIONS: Children younger than 5 years who present with poor oral intake, high fever, drooling, and trismus should be suspected of having a peritonsillar abscess. A computed tomographic scan of the neck is usually required to confirm a suspected diagnosis. Prompt diagnosis and treatment will lead to a considerable decrease in morbidity. Immediate tonsillectomy is a safe and effective means of abscess drainage.

Child, Preschool↗
PubMed2002

Peritonsillar abscess: a study of 724 cases in Japan.

We reviewed the records of 724 patients diagnosed with peritonsillar abscess who had been admitted to our hospital between January 1988 and December 1999. We analyzed their clinical features, disease course, and treatment. The male:female ratio was 3:1, and approximately two-thirds of these patients were between 20 and 39 years of age. The most common aerobic bacteria cultured from patients' pus were alpha-hemolytic streptococci. Severe complications---including deep neck infections and mediastinitis--were seen in 13 patients (1.8%). This complication rate suggests that patients with peritonsillar abscess should undergo immediate incision and drainage rather than needle aspiration.

Adult↗
PubMed2005

[Smoking promotes the formation of peritonsillar abscesses].

INTRODUCTION: Smoking has not properly been investigated as a predisposing factor for the development of a peritonsillar abscess. METHODS: In a retrospective study a group of 541 abscess tonsillectomies--performed in the department of Otorhinolaryngology (University of Duisburg/Essen) between 1994-2003--was retrospectively analysed for smoking habits of the patients. Further on we investigated the influence of smoking on the risk for a postoperative haemorrhage. RESULTS: Smoking habits of 519/541 were known, 296/519 (57%) were smokers, which is much more than expected with regard to the prevalence of smokers in the German population. Beneath the 2.2% of patients with a postoperative haemorrhage that had to be arrested under general anaesthesia no statistical relation between the occurrence of a postoperative haemorrhage and smoking was found. CONCLUSION: Smoking could be an important predisposing factor for the development of peritonsillar abscess e. g. due to alteration of the mucosa and microbiological changes. We could not identify a statistical relation between smoking and the risk of a postoperative haemorrhage after tonsillectomy à chaud.

Adolescent↗
PubMed1992

Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis.

Infection around the tonsillar region does not always mean the presence of a peritonsillar abscess although the condition of peritonsillitis without abscess formation may clinically present similarly. It is, however, of therapeutic importance to distinguish between the two conditions. Treatment for abscess is surgical: aspiration, incision and drainage or immediate tonsillectomy. In contrast, phlegmonous peritonsillitis only requires antibiotics. In order to evaluate the diagnostic implications of preoperative ultrasonography in patients referred for treatment of peritonsillar abscess, 27 consecutive patients were subjected to bilateral ultrasound examination to visualize the tonsillar region. The transducer used was placed just below the mandibular angle, pointing posteriorly and cranially. The results of this study showed that it was possible to verify the presence of an abscess in approximately 90% of the cases. We suggest that this examination be performed whenever the normal clinical examination is insufficient due to trismus, lack of patient cooperation, etc.

Adolescent↗
PubMed1996

Mediastinitis-a rare complication of a peritonsillar abscess.

We report a case of mediastinitis, in an otherwise healthy 25-year-old man, resulting from a peritonsillar abscess with extension through the parapharyngeal and retropharyngeal spaces. In our case the patient was primarily treated with needle aspiration, a method described in many publications as a safe alternative to incision and drainage. We emphasize that for peritonsillar abscesses a tonsillectomy or wide incision and drainage, instead of needle aspiration, might prevent the extension of the condition, thus preventing serious complications.

Adult↗
PubMed1982

Microorganisms isolated from peritonsillar abscess and indicated chemotherapy.

A bacteriologic study was made of 30 patients with peritonsillar abscesses with the use of both aerobic and anaerobic culture procedures. The abscess was punctured and the pus was aspirated by a syringe with an 18-gauge needle. Aerobes and anaerobes were detected in a frequency rate of approximately 1:2. Peptostreptococcus (30.2%), group a streptococci (27.9%), Peptococcus (16.3%), and Fusobacterium (9.3%) were preponderant pathogens. Anaerobic organisms were isolated in 75% of 30 cases. Aside from group A streptococci, anaerobes play a major etiologic role in peritonsillar abscess. Penicillins or cephalosporins will provide maximum chemotherapeutic benefit.

Abscess↗
PubMed2003

Ultrasound-guided drainage of peritonsillar abscess by the emergency physician.

The diagnosis of peritonsillar abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. However, this bedside emergency application of ultrasonography has the potential to be of considerable use in EM practice, and could allow EPs who previously deferred blind needle aspiration of a potential abscess to perform the procedure themselves. We report the cases of 6 patients who presented with probable PTA and were evaluated with intraoral ultrasound at the bedside by an EP. All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish abscess drainage after multiple failures with the blind approach.

Adult↗
PubMed1990

[Peritonsillar abscess in the ultrasonic image].

A prospective study was carried out to evaluate the sensitivity of ultrasonography in diagnosis of peritonsillar abscess (Quinsy). In 1986 through 1989 all cases of doubtful peritonsillitis were subjected to B-mode ultrasonography of tonsils before tonsillectomy was carried out. 36 patients were included in this clinical study. In cases of clinically uncertain peritonsillar abscesses the sensitivity of the method was 82%. However, only four false positive cases ("abscess in the scan but no pus during surgery") occurred.

Adolescent↗
PubMed1997

[Investigation of the infectious route of peritonsillar abscess].

One hundred and thirty-one cases of peritonsillar abscess were studied to investigate the pathogenesis and the infectious route. The involved tonsils were resected in 83 patients. The surface of the resected tonsils was smooth and intact, neither ulceration nor pustular sinus was found on the surface of the upper part of these tonsils. There were some inflammatory and/or fibrotic minor salivary glands (Weber's glands) on the top of the quinsy tonsils. The glands adjacent to the tonsils of non-quinsy patients had normal appearance. It suggests that the origin of peritonsillar infection might be the Weber's glands rather than extension from acutely inflamed tonsil.

Adolescent↗