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PubMed1988

A clinical prospective study of peritonsillar abscess in children.

Distinguishing peritonsillar abscess from cellulitis is an important clinical problem, particularly in children, who may require a general anesthetic for drainage of these abscesses. In order to identify those clinical factors most significant for peritonsillar abscess, we did a prospective study of 21 patients who presented with sore throat, fever, trismus, and tonsillar bulge; all symptoms that are consistent with the diagnosis of peritonsillar abscess. On admission, the following parameters were recorded: patient age, duration of sore throat, fever, white blood cell count, drooling, the degree of trismus (measured exactly as incisor-incisor distance), the degree of pharyngotonsillar bulge, and change in voice. After 24 to 48 hours of parenteral antibiotics, 12 patients (57%) had improved sufficiently and were continued on antibiotics until resolution (cellulitis group). Nine patients (43%) had no improvement and underwent surgery for drainage of the peritonsillar abscess (abscess group). At the end of the 18-month study period, the cellulitis and abscess groups were compared. On admission, no significant difference was found in age, duration of sore throat, fever, or white blood cell count. The pharyngotonsillar bulge was mild in 58% and moderate in 42% of the cellulitis group, while in the abscess group, the pharyngotonsillar bulge was mild in only 33% and moderate in 67%. After 24 to 48 hours of parenteral antibiotics, all patients in the cellulitis group had improvement of at least one symptom; whereas, all patients in the abscess group had no change or worsening of at least one symptom, including trismus, dysphagia, voice change, drooling, or pharyngotonsillar bulge. On admission, the precise measurement of trismus was not significantly different in the two groups (24.7 mm in cellulitis group vs. 22.5 mm in abscess group). However, after 24 hours of antibiotics, trismus averaged 7 mm more in the abscess group versus the cellulitis group (p less than 0.05).

Adolescent↗

PubMed1999

Selection of antibiotics after incision and drainage of peritonsillar abscesses.

Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial. One element of controversy is the choice of antibiotics after drainage of the abscess. In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage. Our review identified 103 patients, comprising two groups: 58 patients treated with broad-spectrum intravenous antibiotics and 45 patients treated with intravenous penicillin alone. These patients were hospitalized after incision and drainage, and therefore their clinical courses and responses to therapy could be rigorously assessed. Characterization of illness based on patient age, temperature, and white blood cell count revealed similar severity of illness between the two groups. Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients. The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature. These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.

Adolescent↗

PubMed1995

Computed tomographic findings in peritonsillar abscess and cellulitis.

The differentiation of a peritonsillar abscess from peritonsillar cellulitis, although difficult on physical examination, is required in order to determine the appropriate treatment. Peritonsillar cellulitis can be treated with antibiotics alone, while a peritonsillar abscess should be drained. Computed tomography (CT) of the neck is often performed to identify the formation of a deep abscess in the neck, but is rarely used to diagnose peritonsillar infections. We report a patient in whom CT was a useful diagnostic tool for distinguishing peritonsillar abscess from peritonsillar cellulitis.

Adult↗

PubMed1999

[Therapeutic approach to peritonsillar abscesses].

The treatment of peritonsillar abscesses is debated. A retrospective study was made of 19 patients diagnosed as peritonsillar abscess who were treated by incision, drainage, and intravenous antibiotics. The surgical, medical and diagnosis factors that affect the management of peritonsillar abscesses are discussed.

Abscess↗

PubMed1994

The role of ultrasound in the management of peritonsillar abscess.

A distinction between a peritonsillar abscess and peritonsillitis is useful clinically, as the former requires surgical drainage while the latter merely requires treatment with antibiotics. To evaluate the diagnostic implications of performing ultrasonography of the tonsils in patients with clinically diagnosed peritonsillar abscess, 27 patients underwent ultrasound examination before needle aspiration of the abscess was performed. Ultrasound was able to detect peritonsillar abscess in 91 per cent of the cases (sensitivity rate), with a false negative rate of nine per cent and a false positive rate of 20 per cent. The specificity of the test was 80 per cent, and was able to differentiate abscess from peritonsillitis in 88.9 per cent. On the basis of these results we conclude that ultrasonography of the tonsils in patients thought to have peritonsillar abscess is a useful adjunct, enhancing diagnostic accuracy and reducing unnecessary surgical drainage.

Adult↗

PubMed1981

Bilateral peritonsillar abscesses.

A case of bilateral peritonsillar abscesses is reported. The patient was a 31-year-old male presenting with a severe sore throat, dysphagia, trismus and bilateral swelling of the soft palate causing no displacement of the uvula. Incision and drainage (I and D) and an interval tonsillectomy cured this condition. On review of the literature, it was noted that bilateral peritonsillar abscesses are not uncommon. Peritonsillar abscesses possibly occur bilaterally, but as the developmental stages of the abscesses are not simultaneous, immediate tonsillectomy or intensive antibiotic treatment following I and D controls the formation of the opposite side abscess in most cases.

Adult↗

PubMed2001

[Clinical significance of the Streptococcus milleri group in peritonsillar abscesses].

Few researchers have microbiologically studied peritonsillar abscesses in detail, and their results have been conflicting. Although Streptococcus pyogenes (Group A beta-streptococcus) is commonly considered an important pathogen in this infection, recent studies have demonstrated the recovery of many other streptococci mainly consisting of alpha-streptococci. Few studies have identified these streptococci at the species level, however. We studied details of bacteriology in 31 cases of peritonsillar abscess treated between 1991 and 2000. The Streptococcus milleri group was most frequently isolated (25.8%), followed by Eikenella corrodens (9.7%), Staphylococcus aureus (6.5%), and S. pyogenes (3.2%). The S. milleri group, consisting of 3 species of Streptococcus constellatus, S. intermedius, and S. anginosus, forms part of the normal flora most commonly found in the mouth, throat, gastrointestinal tract, and genital tract. These species have become known as an important pathogen in abscess disease but little attention has been paid to their role in peritonsillar abscesses. To adequately culture the S. milleri group, incubation in air containing carbon dioxide or in an anaerobic condition is required, and then the differentiation of the 3 species requires the biochemical reactivity tests. Since hemolytic patterns of the S. milleri group vary, we studied the population of alpha-, beta-, and gamma-hemolytic strains among 36 strains of this group. We found 32 (88.8%) to be alpha-hemolytic. Although not all alpha-hemolytic strains belong to the S. milleri group, a considerable number of this group could be missed among alpha-streptococci isolated from the peritonsillar abscess. As antibiotics began being used widely, normal flora such as the S. milleri group may have become an important pathogen in peritonsillar abscesses due to an imbalance between organisms and host defense.

Adolescent↗

PubMed2002

Peritonsillar abscess: diagnosis and treatment.

Peritonsillar abscess, the most common deep infection of the head and neck that occurs in adults, is typically formed by a combination of aerobic and anaerobic bacteria. The presenting symptoms include fever, throat pain, and trismus. Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. After performing aspiration, appropriate antibiotic therapy (including penicillin, clindamycin, cephalosporins, or metronidazole) must be initiated. In advanced cases, incision and drainage or immediate tonsillectomy may be required.

Adult↗

PubMed1995

The microbiology and antibiotic treatment of peritonsillar abscesses.

Pus from 53 peritonsillar abscesses was cultured and associations between the microbiological results and clinical data were investigated with the aim of developing a clinical protocol for treatment. A positive culture grew in 85% of quinsies and of these 16% produced aerobes and 84% anaerobes. Penicillin-resistant organisms were grown from 32% of patients and all but one of these organisms (Haemophilus influenzae) was sensitive to metronidazole. There was no association between clinical presentation and cultured organism which could guide treatment, hence we recommend penicillin and metronidazole as the antibiotic regimen of choice in the treatment of peritonsillar abscesses because of its effectiveness in 98% of patients.

Adolescent↗

PubMed1995

[A case of deep neck abscess and acute mediastinitis, secondary to peritonsillar abscess].

A 60-year-old female visited a hospital complaining of fever and pharyngeal pain. She was diagnosed as peritonsillar abscess. Initial conservative treatment was not curative, and deep neck and mediastinal abscess developed. After cervical drainage, she was referred to our hospital. Drainage tube was inserted via epigastrium into anterior mediastinum upwardly under local anesthesia. Postoperative course was uneventful, and she was cured and discharged after about 1 month of hospitalization. We stressed the importance of recognition of the mediastinitis as a complication of cervical infections. And immediate drainage procedure is required as soon as the diagnosis is established.

Abscess↗

PubMed1981

Peritonsillar abscess.

In 161 patients treated for a peritonsillar abscess by stab incision as the only surgical procedure, a follow-up study was conducted after 3 1/2 to eight years. Of all the patients examined, 51% had experienced no throat symptoms, 22% had had recurrent peritonsillar abscesses, 20% had had recurrent episodes of tonsillitis with fever, and 7% had had symptoms resembling episodic pharyngitis in varying degrees. The age of the patient and the patient's history of previous throat infections were found to have prognostic value. Older patients (older than 40 years) had a lower incidence of new throat infections (peritonsillar abscess, tonsillitis, or both) than younger patients. Patients without previous throat symptoms had a lower incidence of new throat infections than patients with a history of throat infection before the peritonsillar abscess, which in itself might indicate the need for tonsillectomy.

Adolescent↗

PubMed1981

Bilateral peritonsillar abscess: an unusual presentation.

Bilateral peritonsillar abscess is uncommon. We have described a patient in whom it was misdiagnosed as bilateral hypertrophy of the tonsils. Direct palpation of the tonsils, which helped in the diagnosis in our patient, should be done routinely in patients with suspected peritonsillar abscess.

Child↗

PubMed1982

Changing face of treatment of peritonsillar abscess.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.

Adolescent↗

PubMed1993

Peritonsillar abscess, retropharyngeal abscess, mediastinitis, and nonclostridial anaerobic myonecrosis: a case report.

Peritonsillar abscess is a potentially life-threatening complication of acute tonsillitis. On occasion, peritonsillar abscess can extend to neck spaces and/or to the mediastinum. We describe a case of a patient with a peritonsillar abscess that extended to the neck, producing bilateral retropharyngeal abscesses and myonecrosis of the strap muscles. Culture of a specimen of the necrotic muscle yielded Prevotella intermedia, Prevotella buccae, Lactobacillus catenaforme, another Lactobacillus species, Peptostreptococcus anaerobius, and some nonanaerobes. Culture of the peritonsillar abscess yielded P. intermedia and P. buccae plus P. anaerobius, Peptostreptococcus asaccharolyticus, Bifidobacterium dentium, viridans and group F streptococci, and Citrobacter diversus. Culture of the retropharyngeal abscess yielded Fusobacterium nucleatum and Actinomyces odontolyticus in addition to most of the aforementioned organisms. The patient underwent repeated drainage and debridement procedures and was treated with various antimicrobial agents and ultimately recovered. This case highlights the polymicrobial nature of peritonsillar abscess and the serious complications that this infection may lead to.

Abscess↗

PubMed1981

Aerobic and anaerobic bacteriology of peritonsillar abscess in children.

Aspiration of peritonsillar abscess (quinsy) was aseptically performed in 16 children. Patients' median age was 10 years (range 6 to 17 years), and 12 were males. Unilateral abscess was present in all but one child. All aspirates were cultured for aerobes and anaerobes and yielded bacterial growth in all patients. Anaerobes were isolated in all patients; in 3 patients (19%), they were the only organism isolated, and in 13 (81%), they were mixed with aerobes. There were 91 anaerobic isolates (5.7 per specimen): 42 Bacteroides sp. (including 23 B. melaninogenicus, 5 B. oralis and 4 B. ruminicola ss. brevis); 18 anaerobic Gram-positive cocci (including 10 Peptostreptococcus sp., 4 Peptococcus sp. and 4 microaerophilic streptococci); 15 Fusobacterium sp.; and 3 Clostridium sp. There were 32 aerobic isolates (2.0 per specimen): 11 gamma-hemolytic streptococci, 8 alpha-hemolytic streptococci, 4 Group A beta-hemolytic streptococci, 4 Haemophilus sp. and 3 S. aureus. Beta-lactamase production was noted in 13 isolates recovered from 11 patients (68%). These were all isolates of S. aureus (3), 8 of 23 B. melaninogenicus (35%), and 2 of 5 B. oralis (40%). Our findings indicate the major role of anaerobic organisms in the polymicrobial etiology of peritonsillar abscesses in children, and demonstrate the presence of many beta-lactamase-producing organisms in two thirds of the patients.

Adolescent↗

PubMed1990

Peritonsillar abscess: the treatment options.

Peritonsillar abscess is the second most common ENT emergency admission at our hospital. The optimal management has been a subject of discussion for years. This paper reviews 51 patients and the literature to question the traditional medical/surgical managements.

Adolescent↗

PubMed1983

Septic necrosis of the internal carotid artery: a complication of peritonsillar abscess.

Septic necrosis of the internal carotid artery is a major complication of peritonsillar abscess. Although once a common complication, its occurrence is rare since the introduction of antibiotics. A 12-year-old girl was referred to our institution after a false aneurysm of the internal carotid artery had been entered during routine tonsillectomy for a peritonsillar abscess. Review of the literature and features of the present case demonstrate the following findings suggestive of erosion of the internal carotid artery as a result of peritonsillar abscess: (1) spontaneous hemorrhage from a peritonsillar abscess, (2) persistent peritonsillar swelling after resolution of symptoms of peritonsillar abscess, (3) ipsilateral Horner's syndrome, and (4) otherwise unexplained cranial nerve palsies (nerves IX, X, XI, and XII).

Carotid Artery Diseases↗

PubMed1984

Necrotizing fasciitis as a lethal complication of peritonsillar abscess.

Abscesses of the peritonsillar region rarely lead to serious complications. Incision and drainage, antibiotic therapy, and subsequent tonsillectomy is the accepted method of treatment. Two cases of fatal necrotizing fasciitis following peritonsillar abscess are presented. The entity of necrotizing fasciitis in the head and neck is discussed with respect to its presentation, diagnosis, and treatment.

Anti-Bacterial Agents↗