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PubMed2000

Management of pain in peritonsillar abscess.

A prospective study was undertaken in 75 patients with peritonsillar abscess to determine the treatment that was most effective in relieving the excruciating pain associated with the condition. The patients were divided into three treatment groups: intravenous antibiotic, aspiration, and incision and drainage. The effect of treatment on pain was objectively assessed by serially measuring the upper to lower incisor distance and by giving the patient water to drink at regular intervals to determine the point at which swallowing was pain-free. The improvement of the mean upper to lower incisor distance 15 minutes after the initial treatment was five per cent in the intravenous antibiotic group, 38 per cent in the aspiration group, and 100 per cent in the incision and drainage group. None of the patients in the intravenous antibiotic group was able to swallow water two hours after the initial treatment. In the same time interval two patients (eight per cent) in the aspiration group and 23 patients (92 per cent) in the incision and drainage group were able to swallow water. The conclusion derived from this study is that incision and drainage is superior to intravenous antibiotic and aspiration in relieving the pain associated with peritonsillar abscess.

Adolescent↗
PubMed2004

[Peritonsillar abscess associated with infectious mononucleosis: retrospective study of three cases].

Three cases with infectious mononuculeosis associated with peritonsillar abscess were reviewed. The initial diagnoses in these three cases were tonsillitis or peritonsillitis. However, infectious mononucleosis was suspected because of an elevation in aminotransferases and was later confirmed by elevations in the titers of antibodies for Epstein-Barr virus. Peritonsillar abscesses developed and surgical drainage was performed in all three cases. The present study suggests a higher incidence of peritonsillar abscess in patients with infectious mononucleosis than previously expected.

Adult↗
PubMed1996

Immediate tonsillectomy for peritonsillar abscess.

The usual treatment for peritonsillar abscess (PTAs) in Japan is antibiotic therapy, drainage and incision followed by tonsillectomy several weeks later. This is a retrospective study of cases treated by immediate tonsillectomy (IT) for PTAs between January 1990 and February 1995 in our hospital. There were 119 cases, 94 male and 25 female, ranging in age from 14 to 76 years (average: 36.6). In all cases, we performed CT scan, which is the most reliable diagnostic method for PTAs. Five of the 119 cases were treated by IT under general anesthesia. All five were male and their ages ranged from 50 to 62 years (average: 56.2). Two patients had diabetes mellitus. Bacteriological study revealed alpha-Streptcoccus in 1 case, but the others showed no remarkable findings. Anaerobacteria were not found in any patient. IT under general anesthesia is preferable for advanced PTAs.

Abscess↗
PubMed1983

Unilateral immediate tonsillectomy as the treatment of peritonsillar abscess: results, with special attention to pharyngitis.

The results of unilateral immediate tonsillectomy, as the routine treatment of peritonsillar abscess, were studied in 47 patients with no previous history of serious tonsillitis. The follow-up was carried out between three and four years after operation. The incidence of tonsillitis in the contralateral tonsil remained unchanged and peritonsillar abscess did not occur in that tonsil. Symptoms of pharyngitis, periodic or chronic, were present in three patients only. This was found to be significantly lower than that found in the literature in a similar group of patients in whom bilateral immediate tonsillectomy had been performed. The results are discussed and the authors recommend unilateral immediate tonsillectomy in cases of peritonsillar abscess in all patients with no previous history of serious tonsillitis, as this apparently prevents the troublesome side-effects of chronic pharyngitis.

Adolescent↗
PubMed1996

[Pathogen spectrum and antibiotic resistance in peritonsillar abscess].

The study presented updates the spectrum of causative organisms in peritonsillar abscesses. Antibiotic treatment and surgery play important roles in this potentially life-threatening disease. A regular screening of the bacterial spectrum present and resistance remains important for optimizing a therapeutic regimen. Swabs of 122 peritonsillar abscesses were taken and investigated for the presence of causative organisms (bacteria and fungi) and potential antibiotic resistances. It was found that group A beta-hemolytic streptococci and Bacteroides spp. were the predominant isolates. It was also found that amoxicillin plus clavulinic acid or, alternatively, a third-generation cephalosporin (e.g., cefotaxime) represented the treatment of first choice to prevent antibiotic resistance.

Adolescent↗
PubMedDate not supplied

[Peritonsillar abscess with parotid and peripharyngeal extension. Report of a case].

Peritonsillar abscess is the most frequent complication of a tonsillar infection. The purulent material can spread from peritonsillar space to the fascial neck spaces. These deep neck infections may be a life threatening complication. The correct treatment of these infections is an appropriate antimicrobial therapy and abscess drainage, most of the times by surgery. We present a clinical case of a large perypharyngeal, and parotid abscess originated from a peritonsillar abscess. It was necessary surgical treatment to drain it.

Abscess↗
PubMed1990

[Peritonsillar abscess treated with puncture and aspiration].

Out of 48 patients treated for peritonsillar abscess in our department in 1988, 45 were treated with needle aspiration. In 43 of these the aspiration was positive. More than one aspiration was only required in seven patients, no patient was needle aspirated more than twice. Five patients were treated with abscess tonsillectomy secondary to needle aspiration. In two cases the indication may have been failure of treatment. No complications were recorded in relation to aspiration. Followup time was seven months (median). There were two cases of recurrence of the abscess and five patients subsequently had one episode of tonsillitis after discharge. Needle aspiration is suggested as part of a selected strategy of treatment for peritonsillar abscess.

Adolescent↗
PubMed1984

Permucosal needle drainage of peritonsillar abscesses. A five-year experience.

Forty-one patients with proved peritonsillar abscesses were treated during a five-year period with needle aspiration as the sole initial surgical treatment. Ninety percent (37/41) of the patients' abscesses resolved without further invasive therapy. All but two of the patients were treated as outpatients. Fifty percent (21/41) of the patients were treated by nonotolaryngologists. These data indicate that outpatient needle aspiration is the simplest, most cost-effective therapy for peritonsillar abscess.

Administration, Oral↗
PubMed1987

Peritonsillar abscess with parapharyngeal involvement: incidence and treatment.

In 2.3% of 217 patients with peritonsillar abscess, the clinical picture was atypical, with inflammatory swelling of the pharyngeal wall below and behind the tonsil, oedema of the epiglottis and a diffuse swelling on the side of the neck. The typical signs of peritonsillar abscess, i.e. trismus, a medially displaced tonsil and displacement of the uvula toward the opposite side, were either completely lacking or less pronounced than usual. The abscesses were all located in the peritonsillar space at the lower pole or behind the tonsil. To ensure rapid, uncomplicated recovery in such cases with parapharyngeal involvement, it is essential that abscess tonsillectomy under antibiotic cover with penicillin is not postponed.

Adult↗
PubMed1993

[Peritonsillar abscess--a comparison of treatment by needle aspiration and incision].

To compare the efficacy of permucosal needle aspiration with that of incision and drainage in the management of peritonsillar abscess, we reviewed the charts of 32 patients, diagnosed as having peritonsillar abscess, who had been admitted to the Central Hospital of Social Health Insurance from June 1987 to December 1991. Twelve patients, 9 males and 3 females, were managed with incision and drainage. Their average age was 34 years, with a range of 23 to 69 years. Permucosal needle aspirations were performed in 20 patients, including 14 males and 6 females. Their age ranged from 16 to 65 with a mean of 36 years. All patients received parenteral antibiotics. The duration of fever over 37.0 degrees C averaged 2.0 hospital days (range, 0 to 8 days) in patients treated with incision and drainage, and 2.1 hospital days (range, 0 to 4 days) in patients treated with needle aspiration. The average postoperative time elapsed until the patient could eat solid food with ease was 3.8 hospital days with a range of 1 to 9 days in patients treated with incision and drainage, and 3.2 hospital days with a range of 1 to 7 days in patients treated with needle aspiration. The hospital stay ranged from 3 to 9 days with an average of 5.4 days in patients treated with incision and drainage, and from 4 to 10 days with an average of 5.5 days in patients treated with needle aspiration. These data indicate that permucosal needle aspiration of peritonsillar abscess provides symptomatic relief and cure which are as rapid as those of incision and drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Clinical findings in needle aspiration of peritonsillar abscess.

A retrospective study was undertaken of all patients admitted through the casualty department of St Mary's Hospital, London W2, with the diagnosis of peritonsillar abscess over a period of 4 years. Patients were divided into those in whom pus was aspirated from the peritonsillar swelling, and those in whom no pus was aspirated from the peritonsillar swelling. These two groups may be described clinically as peritonsillar abscess, and peritonsillar cellulitis respectively (Shoemaker et al., 1986). Relevant details from the history, examination, and investigations were recorded. The results were compared in order to determine whether there was any difference in the details recorded between those patients with pus aspirated, and those with no pus found. Of the 70 patients admitted with this diagnosis over the last 4 years, full data was available in 55 cases. Pus was found on routine needle aspiration of the peritonsillar swelling in 35(63%) cases. There was no pus found in 20(37%). There was no significant information recorded that would have predicted the presence or absence of pus in the peritonsillar space.

Adult↗
PubMed2001

The safety of conscious sedation in peritonsillar abscess drainage.

OBJECTIVE: To demonstrate the safety of conscious sedation in draining peritonsillar abscesses (PTAs). DESIGN: Children diagnosed as having a PTA in the pediatric emergency department were identified, and their medical records were retrospectively reviewed. Results of the present study were compared with those of a previous report. SETTING: A tertiary referral children's hospital pediatric emergency department. PARTICIPANTS: Ninety-one consecutive children initially evaluated in the emergency department and managed for a PTA. INTERVENTIONS: Peritonsillar abscess incision and drainage with or without sedation. A team of physicians whose activities were documented on a formal conscious-sedation record was present. Patients were monitored for major and minor complications. OUTCOME MEASURES: The primary outcome measures were major and minor complications. Secondary outcome measures were recurrence of PTA and the need for admission. RESULTS: There were 62 episodes of conscious sedation for drainage of a PTA. Among the 91 patients, 3 had a recurrence and 24 were admitted after the procedure. A previous study evaluated 30 episodes of conscious sedation for drainage of a PTA. No major complications occurred in either series. Combining the previous data with the present data produced 92 episodes of conscious sedation for drainage of a PTA. The 1-sided upper 95% confidence limit for the rate of major complications is 3.2%. CONCLUSION: Our series, when combined with previously published data, demonstrates that conscious sedation can be safely used when draining a PTA in pediatric patients.

Adolescent↗
PubMed1987

Peritonsillar abscess: a comparison of a conservative and a more aggressive management protocol.

A two-year prospective study was undertaken to compare acute treatment modalities for peritonsillar abscesses. The most widely used modality, incision and drainage, with subsequent hospitalization for intravenous antibiotics and hydration, was compared with incision and drainage, with subsequent oral antibiotics and oral hydration. The results in 27 randomized patients showed no difference in morbidity, recovery time, or recurrence rate between the two groups. The authors conclude that initial incision and drainage, and oral antibiotics, is an effective, safe and less expensive treatment modality for peritonsillar abscesses. These results suggest that with a compliant patient population, peritonsillar abscesses may be effectively treated in an outpatient setting.

Administration, Oral↗
PubMed1990

Peritonsillar abscess in spite of adequately performed tonsillectomy.

We describe a rare case of peritonsillar abscess in a woman, in spite of an adequately performed tonsillectomy 35 years earlier. Cultures from aspirated pus yielded a heavy growth of Streptococcus milleri and Bacteroides species. No remaining tonsillar tissue could be seen. We conclude that a peritonsillar abscess might develop in spite of adequately performed tonsillectomy.

Female↗
PubMed1977

Immediate tonsillectomy for the treatment of peritonsillar abscess.

Our experience with 119 cases of peritonsillar abscess supports the experience of others, that immediate tonsillectomy is a safe treatment which provides prompt, complete drainage of the abscess. There was one episode of immediate postoperative hemorrhage and one of delayed bleeding, but there were no anesthetic complications. If one believes that the abscess is an indication for tonsillectomy and plans to perform the procedure at some time, we recommend that it be performed as the drainage procedure. The total hospitalization time will as a rule be shortened and a second convalescent period avoided. Its major drawback is the inconvenience of inserting a relative emergency into the schedule.

Adolescent↗
PubMed2000

Peritonsillar abscess: the rationale for interval tonsillectomy.

Although peritonsillar abscess (quinsy) and peritonsillitis are common ENT emergencies, management strategies in the United Kingdom still vary among otolaryngologists. In order to obtain data on the success of the various strategies, we conducted two surveys--one concerned itself with patient outcomes, while the other sought information on physician preferences. The survey of 571 practicing ENT surgeons revealed that 83% advise interval tonsillectomy only for patients who have a history of tonsillitis; they prefer to take a wait-and-see approach for a single attack of quinsy. Conversely, 15% advise a routine interval tonsillectomy following even a single isolated attack of quinsy/peritonsillitis. Only 6.8% still perform a quinsy tonsillectomy in selected cases. Survey responses from 192 adults and 15 children who had been hospitalized for the treatment of quinsy/peritonsillitis revealed that the vast majority of patients who did not undergo an interval tonsillectomy were still asymptomatic 2 to 8 years later. These results indicate that a wait-and-see policy is indeed suitable for most patients who present with an isolated attack of quinsy/peritonsillitis without a history of tonsillitis. We recommend that tonsillectomy be performed as a definitive treatment for quinsy/peritonsillitis in patients who have a history of tonsillitis. Such a history is a reliable indicator of recurrent quinsy or tonsillitis following an attack of quinsy/peritonsillitis in both children and adults. Quinsy tonsillectomy should be reserved for those few patients who do not respond to conservative measures.

Adolescent↗
PubMed1991

Management of peritonsillar abscess.

A prospective, randomized clinical trial was conducted on 60 patients with confirmed peritonsillar abscess to: (1) compare the safety and efficacy of permucosal needle aspiration with that of incision and drainage; (2) assess whether admission to hospital and treatment with intravenous antibiotics is necessary; (3) culture the pus obtained, in order to decide on a rational antibiotic regime. Of the 60 patients, 30 were randomized to the needle aspiration group, and 30 to the incision and drainage group. The initial success rate was 87 per cent (26 of 30 patients) with needle aspiration, and 90 per cent (27 of 30 patients) with incision and drainage. Two patients required hospital admission, for rehydration and intravenous antibiotics. The commonest organisms cultured were streptococci (62 per cent); 97 per cent of all patients responded to penicillin. This study indicates that most patients with peritonsillar abscess may successfully and safely be treated by permucosal needle aspiration, and oral penicillin, on an out-patient basis.

Adolescent↗