[Tonsillectomy on the day following incision of a peritonsillar abscess].
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Abscess↗
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[Treatment of peritonsillar abscess].
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Abscess↗
Prevalence of penicillin allergy in adults with peritonsillar abscess.
We noticed a seemingly high prevalence of penicillin allergy in patients who had been diagnosed with peritonsillar abscess (PTA) at our institution. To formally investigate this observation, we reviewed the emergency room (ER) records of 118 patients who had presented between Jan. 1, 1995, and Dec. 31, 1999, with suspected PTA. A diagnosis of PTA was confirmed by the presence of pus on incision and drainage in 78 of these patients (66.1%). The remaining 40 patients (33.9%) were diagnosed with peritonsillar cellulitis (PTC). Of the 78 patients with confirmed PTA, 13 (16.7%) self-reported an allergy to an antibiotic, including 11 (14.1%) who claimed to be allergic to penicillin. In the 40 patients with PTC, the corresponding figures were only 3 (7.5%) and 1 (2.5%). The difference between the PTA and PTC groups with respect to the prevalence of self-reported penicillin allergy was statistically significant (p < 0.05). We also compared the prevalence of antibiotic allergies in our patients with that of 1,893 consecutively presenting patients whose records had been entered into a pharmacy database at our institution. We found that the overall prevalence of patient-reported penicillin allergy in our PTA group was similar to that of the database population, although penicillin allergy did account for a greater percentage of all antibiotic allergies (84.6%) in our PTA group than in the larger population (62.8%). In our series, patients with PTA were more likely to have reported an allergy to penicillin than were patients without an abscess. Additionally, the prevalence of patient-reported antibiotic allergy is high at our institution. Although self-reported penicillin allergy may not represent a true hypersensitivity reaction, it can influence antibiotic selection and/or compliance. Prospective studies are needed to determine what influence allergic status and antibiotic choice has on abscess development.
Adult↗
[Peritonsillar abscess treated with puncture and aspiration--a prospective 3-year follow-up].
Forty-one selected patients were treated with needle aspiration for peritonsillar abscess in our department in 1988. Two patients were treated with quinsy tonsillectomy secondary to needle aspiration, because of failure of treatment. The follow-up group consisted of 39 patients and the median follow-up time was 38 months (range 36-44 months). There were three recurrences of the abscess, and one patient had recurrent tonsillitis subsequent to discharge. The rate of recurrent tonsillitis/abscess among patients younger than 30 and 40 years was respectively 21% (4/19) and 14% (4/28). The rate in the corresponding older age groups was 0%. The overall recurrence rate was 10% (4/39). Needle aspiration is suggested as part of a selected strategy of treatment.
Adolescent↗
Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines.
Currently there is no agreement on the treatment of patients who develop a peritonsillar abscess (PTA). This lack of consensus results in highly variable and possibly expensive therapeutic regimens that may not provide optimum quality patient care at reasonable cost. The present study evaluates surgical, medical, diagnostic, and cost factors that affect the management of PTA based on the following: 1. a cohort study of 123 patients with PTA treated using needle aspiration as the initial surgical drainage; 2. a national survey of the PTA management practices of otolaryngologists; and 3. meta-analyses of various components of the treatment regimen for PTA. In the cohort study, patients diagnosed with PTA were treated by both otolaryngologists and emergency medicine specialists with needle aspiration as the primary surgical modality resulting in a 96% acute resolution rate for PTA. In the national survey, questionnaires were sent to 2000 randomly selected members of the American Academy of Otolaryngology-Head and Neck Surgery regarding their management of PTA. The return rate was 73%. Ninety-six percent of the physicians who returned survey forms treated an average of seven PTAs per year using either needle aspiration, incision and drainage, or abscess tonsillectomy to drain the abscess initially. The incidence of PTA in the United States and Puerto Rico among patients 5 to 59 years of age treated by survey practitioners is 30.1 per 100,000 person years, accounting for approximately 45,000 cases per year. Four meta-analyses were completed to quantify the success rate of needle aspiration in the treatment of PTA (94%), the recurrence rate of PTA (10% to 15%), the rate at which penicillin-resistant microorganisms are found in patients with PTA (0% to 56%), and the rate of prior oropharyngeal infections associated with PTA (11% to 56%). The recurrence rate for PTA in the United States is 10%, which is significantly different from the recurrence rate of 15% reported from the rest of the world (P < .002). A clinical intervention for PTA is proposed based on the clinical series, the national survey data, and the meta-analyses. These clinical guidelines recommend that needle aspiration be used as the initial surgical drainage procedure for all patients with a PTA other than those who have indications for abscess tonsillectomy. Patients should be treated in an outpatient setting, should receive penicillin if they are not allergic to it, and should receive adequate pain medication. The evidence does not suggest that there is any benefit in examining the abscess contents for microorganisms. Approximately 30% of patients with PTA can be expected to exhibit relative indications for a tonsillectomy.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Influence of antibiotic treatment on the isolation rate of group A streptococci from peritonsillar abscesses.
In a prospective one-year study, group A streptococci were cultured from pus specimens from 13 of 71 patients (18%) with peritonsillar abscesses. The isolation rate was significantly lower (7/57 = 12%) in patients who had received antibiotic treatment before specimen collection than in patients who had not received such treatment (6/12 = 50%). Group A streptococcus antigen detection tests on pus, using a commercially available diagnostic kit, had a low sensitivity (5/13 = 38%). It was concluded that in patients treated with antibiotics prior to collection of specimens, the absence of group A streptococcus on culture does not rule out that this organism could have been the principal etiologic agent.
Adolescent↗
Conscious sedation: a new approach for peritonsillar abscess drainage in the pediatric population.
OBJECTIVE: To assess the safety and efficacy of conscious sedation (CS) in children undergoing emergency department incision and drainage (I&D) of peritonsillar abscesses (PTAs). DESIGN: A 33-month retrospective chart review of all children presenting to the emergency department with the diagnosis of a PTA or peritonsillar cellulitis. Children who underwent CS prior to I&D were compared with children without CS for complications and efficacy. SETTING: St Louis Children's Hospital, an academic tertiary care pediatric hospital. PATIENTS: Fifty-two children were enrolled; 30 PTAs were drained with CS in 27 children (3 underwent I&D twice), and 25 PTAs were drained in 25 children without CS. INTERVENTIONS: The CS team included an otolaryngologist, a pediatric emergency department physician, and a registered nurse. A standardized CS protocol assessing vital signs and level of consciousness was employed during each procedure. A combination of midazolam, ketamine hydrochloride, and glycopyrrolate was used in appropriately weighted calculated doses. Patients were assessed for major and minor airway complications. MAIN OUTCOME MEASURES: Airway complications related to CS were reviewed. Patients who underwent I&D with and without CS were compared with regard to purulent drainage. RESULTS: There were no major airway complications in patients undergoing I&D with CS. There was 1 minor complication in this group, oxygen desaturation to 88%, which resolved with stimulation. Of the 55 procedures, 45 (82%) yielded purulence: 29 (97%) of 30 in the CS group and 16 (64%) of 25 in the non-CS group (chi2 = 9.8; P = .002). Of those children undergoing CS, 3 (10%) of 30 were admitted to the hospital from the emergency department as compared with 6 (24%) of 25 without CS (chi2 = 1.95; P = .16). In the CS group, PTAs had a low recurrence rate of 1 (3.3%) of 30 compared with 2 (8%) of 25 in the non-CS group (chi2 = 0.57; P = .45). No one in the CS group required a secondary procedure under general anesthesia. CONCLUSIONS: This preliminary study demonstrates CS to be a potentially safe and efficacious approach to drainage of PTAs in children. Given its efficacy and its associated lower levels of anxiety and pain for the patient, CS seems to be a promising new approach to caring for children with PTAs.
Adolescent↗
Characterization of clinical tonsil stages by their T-cell count. Immunopathological description of tonsils after a peritonsillar abscess.
The T-cell counts in five different clinical tonsil stages are compared. No particularities were observed, with the exception of the condition after a peritonsillar abscess. The differences existing between the individual groups are discussed as age-dependent. A considerable increase in T-cells is found in the abscess tonsil compared with other tonsils and the T-cell count in blood. Its pathomechanism is discussed.
Adolescent↗
[Fatal necrotizing mediastinitis as a complication of peritonsillar abscess].
In the paper showed the case of fatal necrotizing phlegmon of the neck and descending mediastinitis in 48 year old male patient with primary peritonsillar abscess. On the base of literature it was showed the etiology, pathomechanism of the evolution of this heavy complication and surgical and pharmacological methods of its treatment. In spite of prompt wide incision and drainage of phlegmon of the neck and mediastinum and intensive treatment in intensive care unit conditions patient died in the image of septic shock and pus changes in the mediastinum, heart and lungs, what was showed on the base of post-mortum examination.
Drainage↗
[Giant tonsillolith simulating peritonsillar abscess].
The authors describe a tonsillolith detected by a 70-year-old man with odynophagy and a history of often tonsillar infections. A diagnosis of peritonsillar abscess was first made. The large concrement was yellowish-gray, measured 41 x 21 x 19 mm, which was one of the largest reported case in the world.
Aged↗
Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy.
Lemierre's syndrome is characterized by acute oropharyngeal infection complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and metastatic abscesses. We report a case of Lemierre's syndrome in an 18-year-old Caucasian woman presenting with a peritonsillar abscess and ipsilateral VIth cranial nerve palsy.
Abducens Nerve Diseases↗
Large tonsillolith mimicking peritonsillar abscess: a case report.
A case of large tonsillolith is described. A 26-year-old male presented with a history of recurrent throat infections. A diagnosis of peritonsillar abscess was made. A tonsillolith was spontaneously expelled on admission. A tonsillectomy was subsequently performed. The tonsillolith was yellowish-gray, measured 30 x 26 x 16 mm, and weighed 8.5 g, which was the largest reported case in Japan. Chemical analysis revealed the stone to consist of calcium phosphate.
Adult↗
Peritonsillar abscess: a comparison of outpatient i.m. clindamycin and inpatient i.v. ampicillin/sulbactam following needle aspiration.
In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we compared the clinical efficacy of empiric intramuscular clindamycin and intravenous ampicillin/sulbactam (following needle aspiration of the abscess) in a prospective, randomized study of 58 patients. Patients in the clindamycin group were treated on an outpatient basis, whereas those in the ampicillin/sulbactam group were hospitalized for the duration of their treatment (minimum: 7 days). Comparison of clinical outcomes with respect to the posttherapeutic duration of fever and throat pain and the time to resumption of eating revealed no statistically significant difference between the two groups. These results suggest that intramuscular clindamycin is an excellent choice and can be safely prescribed on an outpatient basis following needle aspiration, thereby reducing both antibiotic and hospital costs.
Adolescent↗
[A fatal outcome of false croup in lacunar angina complicated by peritonsillar abscess].
The paper reports a lethal outcome of false croup in a 62-year-old man. In pathogenetic chain of the disease the leading role belonged to purulent tonsillitis with peritonsillar abscess and epiglottitis with phlegmone of the adjacent soft tissues including the vocal cords. A severe edema of the latter provoked a complete obstruction in the larynx and asphyxia with all its macro- and microscopic morphological features. Chronic alcoholic intoxication seemed to cause immunodeficiency and slow progression of the disease. Tonsillitis, chronic with exacerbation, was alleviated by chronic alcoholic intoxication leading to weak symptoms, delayed reactions and "strange" outcome. Hyperergia could be due to intake of alcohol surrogate.
Croup↗
Intraoral ultrasonography in the diagnosis of peritonsillar abscess.
The diagnosis of quinsy is traditionally established on the basis of clinical observations and sometimes several diagnostic punctures. The present study has focused on the possible usefulness of intraoral ultrasonography (IOU) as a diagnostic tool when a peritonsillar abscess is suspected. The results show that it is possible to demonstrate, with a high degree of accuracy, the presence of an abscess, its volume, location, and its relation to the carotid artery. With this information an exact and safe diagnostic puncture can be performed when necessary and avoided in cases with clinical signs of quinsy with no abscess.
Adult↗
Spontaneous rupture of an internal carotid artery aneurysm diagnosed as a peritonsillar abscess, a tonsillar and epipharyngeal carcinoma with metastasis.
The author observed a spontaneous rupture of an internal carotid artery aneurysm with initial manifestations of throat pain and subfebrillity. The condition was diagnosed as peritonsillar abscess. Two days later, a swelling appeared on the same side of the neck, which necessitated a revision of the primary diagnosis and acceptance of another one--a carcinoma of the palatine tonsil with metastasis. A third diagnosis was made on hospitalization--epipharyngeal carcinoma with metastasis. Physical examination disclosed an intact skin of the neck with a right-side tumefaction of a walnut size. The right tonsil was displaced anteriorly and medially. The epi- and hypopharynx were restricted. Simultaneous palpation of the displaced tonsil and the neck tumefaction showed that the lesion was single and pulsated. The pulsations were synchronous with the pulse. Contrast angiography showed an internal carotid artery aneurysm reaching the cranial base. The manifestation of the aneurysm by pains at the throat, subfebrillity, the displacement of the palatine tonsil and the appearance of a neck tumefaction were related to a spontaneous rupture. The absence of a skin lividity was most probably due to the barrier function of the neck fasciae concerning the haematoma.
Aged↗
Alveolar rhabdomyosarcoma presenting as a peritonsillar abscess.
A rhabdomyosarcoma of the head and neck region is a rare childhood neoplasm often presenting with vague symptoms that can easily mimic other diseases. We present an unusual case of an alveolar rhabdomyosarcoma of the soft palate in a three-year-old child, that presented as a peritonsillar abscess.
Child, Preschool↗
Peritonsillar abscess in an infant.
Although a common enough condition in the general population, quinsy is rare in children and even rarer in infants. In most cases the diagnosis is easy on the basis of the suggestive clinical picture. A case is presented of a peritonsillar abscess in a 7-month-old baby. Here, the diagnosis was somewhat doubtful, due to the uncharacteristic clinical appearance and the young age of the patient. Some of the dangers of an inadequate antibiotic treatment are briefly discussed.
Ampicillin↗