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[Clinical, histologic and bacteriologic findings in peritonsillar abscess].

Peritonsillar abscesses are the main complication of chronic inflammation of the tonsils. They should be considered as emergency cases and require quick and adequate treatment. Although abscess tonsillectomy has been reported since 1932, there is still a vivid discussion about this method of choice. We report on our experiences and findings in 284 cases of peritonsillar abscess. Our experiences show that theoretical considerations against this method of surgical treatment are smaller than the advantages for the patient. The authors recommend abscess tonsillectomy at one time and on both tonsils as treatment of choice in peritonsillar abscess without restriction.

Adolescent↗

Use of steroids in the treatment of peritonsillar abscess.

Peritonsillar abscess is the most common deep infection of the head and neck that occurs in adults; the treatment of the disease remains controversial. A prospective study using a single high dose steroid treatment for peritonsillar abscess, was undertaken in 62 patients to determine the treatment's effectiveness in relieving symptoms such as fever, throat pain, dysphagia and trismus. All patients were randomly assigned to two groups: 28 patients received intravenous antibiotic therapy and a single dose placebo and 34 patients were treated with single use of high dose steroid in addition to intravenous antibiotic. Patients were hospitalized after needle aspiration and therefore their clinical courses and responses to therapy could be rigorously assessed. Comparison of clinical outcomes with respect to hours hospitalized, throat pain, fever, trismus were assessed between the two groups. Clinical outcomes revealed a statistically significant difference between the two groups (p < 0.01), indicating that single use of high dose steroid prior to antibiotic therapy is more effective than the use of an antibiotic alone. These results suggest that single intravenous use of steroid in addition to antibiotic therapy is an excellent choice for the management of peritonsillar abscess.

Adolescent↗

Synergistic necrotizing cellulitis as a complication of peritonsillar abscess.

Peritonsillar abscess, a complication of tonsillitis, is not uncommon. The usual treatment consists of needle aspiration or surgical drainage and antibiotic treatment. Tonsillectomy may be used in the management of this condition, either at the time of diagnosis or after an interval period. Severe complications of peritonsillar abscess are rare. Synergistic necrotizing cellulitis is a fulminant infection associated with spread along fascial plains, necrosis of connective tissue and muscle, and high mortality. It is usually otondogenic in origin in the cervicofacial area and occurs in debilitated or immune compromised patients. We discuss cervicofacial-necrotizing soft tissue disease and report an unusual case of extensive synergistic necrotizing cellulitis of the neck, chest, and shoulder as a result of a peritonsillar abscess.

Cellulitis↗

Intraoral ultrasound evaluation of peritonsillar abscess.

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment. This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating abscess from cellulitis. Sixteen consecutive patients suspected of having peritonsillar abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage. Correct diagnoses were made in 9 (90%) of 10 abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate abscess from cellulitis. We believe that this will be a clinically useful technique in the future.

Adolescent↗

New trends in the management of peritonsillar abscess.

Peritonsillar abscess is the most common complication of acute tonsillitis. Signs and symptoms include fever, unilateral sore throat, odynophagia and trismus. Optimal management consists of antibiotic therapy and drainage of the abscess. Controversy exists about the drainage procedure, which includes needle aspiration, incision and drainage, or acute tonsillectomy. Data indicate that outpatient needle aspiration, antibiotics and pain medication are effective treatment in 85 to 90 percent of patients with uncomplicated peritonsillar abscesses.

Anti-Bacterial Agents↗

The use of ultrasound evaluation in the diagnosis of peritonsillar abscess.

Peritonsillar Abscess (PTA) and Peritonsillar Cellulitis (PTC) are very similar clinical conditions. The differential diagnosis between them is made by needle aspiration, a very painful and invasive method. This study was performed at the Department of Otolaryngology at the Clinical Hospital of São Paulo University Medical School. It's aim was to evaluate the use of ultrasound as a noninvasive and inexpensive method of diagnosis, differentiating abscess from cellulitis. Twenty-one consecutive patients with a clinical diagnosis of peritonsillar infection were evaluated in the emergency service with a probable diagnosis of PTA. These patients were evaluated with intraoral and percutaneous ultrasound. Needle aspiration was used to compare and confirm the diagnosis. The sensitivity was 92.3% and specificity was 62.3%. The authors conclude that ultrasound is a good method to evaluate the differences between PTA and PTC.

Adolescent↗

Cannula aspiration of peritonsillar abscesses.

Peritonsillar abscesses may be treated by needle aspiration, incision and drainage, or abscess tonsillectomy. A modification of the technique of needle aspiration is described. This technique minimizes the risk of vascular damage during needle aspiration and is more reassuring to the patient.

Catheterization↗

Role of quinsy tonsillectomy in the management of peritonsillar abscess.

Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis requiring surgical intervention. Debate continues concerning optimal therapy in terms of patient morbidity and cost-effectiveness. A retrospective study was performed on 45 tonsillectomies for PTA in military personnel from December 1986 through December 1988. Twenty-three quinsy (abscess) tonsillectomies and 22 interval tonsillectomies were identified. Parameters studied were age, sex, abscess location, interval prior to operation, blood loss, operative time, operative experience, and combined hospital and convalescent days for the two groups. Significant differences were noted between the quinsy and interval tonsillectomy groups concerning the average number of days hospitalized (3.0 versus 4.5) and their respective convalescent periods (10.3 versus 17.3). We conclude that quinsy tonsillectomy is the best management for PTA in a young work force when the optimal treatment choice is between interval or acute tonsillectomy.

Adolescent↗

Abscess tonsillectomy for acute peritonsillar abscess.

Peritonsillar abscess (PTA) is a common but potentially serious complication of acute exudative tonsillitis. Several treatment guidelines have been described including needle aspiration, incision and drainage or abscess tonsillectomy. From January 1996 to September 2000 145 patients (53 female and 92 male, age range 3-95 years) were treated for PTA at the Department of Otorhinolaryngology, Head and Neck Surgery of the MLU Halle-Wittenberg, Germany. The highest incidence of PTA was observed in the second and third decades of life. Immediate abscess tonsillectomy was performed in 105 cases. This procedure, considered as safe and easy, has a lot of advantages. Compared with other treatments, it removes the abscess with amelioration of the trismus and dysphagia. Needle aspiration as the initial and only treatment was performed in 13 patients. In 20 patients without clinical improvement after aspiration, abscess tonsillectomy was undertaken. We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for peritonsillar abscess.

Abscess↗

[Successfully treated neck abscess secondary to peritonsillar abscess].

The complications of peritonsillar abscess are potentially life-threatening conditions. The acute tonsillar infections frequently extend in the peritonsillar tissues from which the rare form of neck and mediastinal abscess can develop. The authors review the case of 17 years old boy, at whom the infection spread from peritonsillar space to the neck space. Complications of the peritonsillar abscess today are potentially life-threatening conditions. The wide incision performed at appropriate time resulted in complete healing and prevented the progress into the mediastinal space. The authors have not met similar case neither in their administrative area, nor in the Hungarian literature, however the number of reports in English is abundant.

Abscess↗

[Parapharyngeal abscess secondary to peritonsillar abscess in childhood].

We report a case of parapharyngeal abscess in a five-years-old girl, secondary to a local extension of a peritonsillar abscess. The typical signs of peritonsillar abscess, medially displaced tonsil and displacement of the uvula toward the opposite side, were either less pronounced than usual. In this case, with parapharyngeal involvement, the treatment was abscess tonsillectomy under intravenous anti-.

Abscess↗

Clinical advantage of abscess tonsillectomy in peritonsillar abscess.

At the moment, regardless of the prevalence of the peritonsillar abscess (PTA), a definite protocol concerning the treatment of PTA has not yet been established and the treatment remains controversial. In the treatment of PTA the two most used therapeutic approaches are compared in this short study carried out on 16 patients. A group of patients presenting PTA received an abscess tonsillectomy (AT) is compared with another group treated with aspiration and subsequently operated on with interval tonsillectomy (IT). The results show obviously that the abscess tonsillectomy is better than the interval tonsillectomy in every aspect of treatment. The hospitalization time and global costs are also reduced. So when a young person has PTA and once the indication of tonsillectomy is posed, the operation has to be carried out "à chaud".

Adult↗

Immediate tonsillectomy for peritonsillar abscess.

OBJECTIVE: Peritonsillar abscess (PTA) is one of the most common infectious diseases of the head and neck region requiring surgical intervention to relieve symptoms such as severe throat pain, fever, dysphagia, and trismus. However, the appropriate management of PTA is still controversial. In Europe and the US, immediate tonsillectomy under general anesthesia has been accepted as the treatment for PTA. But in Japan, immediate tonsillectomy has been regarded as contraindicated for PTA because of difficulties encountered in the operation during the acute stage, as well as possible postoperative complications. METHODS: A total of 103 cases of PTA treated at our clinic during the past 16 years were reviewed; immediate tonsillectomies had been performed in 99 of them. Surgical findings, postoperative course, and bacteriological examination were surveyed. RESULTS: The results showed that immediate tonsillectomy under general anesthesia was carried out safely without complications. Dramatic relief of the symptoms was obtained within a few days following each operation. A high incidence of anaerobes was observed by bacteriological examination, suggesting that sufficient drainage is required to treat this disease. CONCLUSION: We conclude that immediate tonsillectomy should be performed for peritonsillar abscess.

Acute Disease↗

[Does antibiotic therapy hinder the course of peritonsillar abscesses?].

INTRODUCTION: Peritonsillar abscess (quinsy) is a complication of acute bacterial tonsillitis. In a prospective study, the influence of antibiotic therapy on the clinical course in patients with quinsy was analysed. METHOD: History and clinical signs in patients with quinsy referred to our hospital were assessed by a structured questionnaire. Pus was cultured under aerobic and anaerobic conditions. RESULTS: 40 patients were enrolled in the study, 18 of whom (45%) were treated with antibiotics prior to admission. There was no significant difference in history and clinical signs between the patients with antibiotics and the group without. The microbiological results showed a dominant role of anaerobic bacteria without significant difference between the two groups of patients. DISCUSSION: Antibiotic therapy did not prevent the occurrence of peritonsillar abscess in 45% of our patients and had no influence on the clinical course of the disease. A possible reason for these findings is that the onset of antibiotic therapy was too late in the disease process, or, in some cases, that an antibiotic drug with an inadequate antimicrobiological spectrum was chosen.

Adolescent↗

Bilateral peritonsillar abscess revisited.

Bilateral peritonsillar abscess is uncommon. When it does occur; patients usually present with sore throat; other clinical signs and symptoms may differ from those usually associated with unilateral peritonsillar abscess. We describe 2 cases of bilateral peritonsillar abscess that were successfully treated with needle aspiration of both sides with a 14-gauge intravenous cannula. Needle aspiration is an accepted form of treatment for unilateral peritonsillar abscess, but to the best of our knowledge, its use as a sole treatment modality (with observation under intravenous antibiotic coverage) for bilateral peritonsillar abscess has not been previously reported in the literature. We also believe that the incidence of acute bilateral peritonsillar abscess may be higher than the rates that have been reported in the literature. Finally, we recommend that the threshold for imaging be low for any patient who is suspected of having acute bilateral peritonsillar abscess to avoid any delay in diagnosis and treatment.

Adult↗

[Unusual complications of a bilateral peritonsillar abscess].

Bilateral peritonsillar abscesses with complications in the region of the neck are extremely rare. The case of a 60 year old women with an additional abscess of the right parotid gland/neck is reported. Diagnostic and therapeutic problems are discussed.

Female↗