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At least 19 recordsLinked to original sources

PubMed1990

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↗

PubMed1991

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↗

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↗

PubMed1975

Influence of the collection and transport of specimens on the recovery of bacteria from peritonsillar abscesses.

In 30 patients with peritonsillar abscesses, pus was obtained by aspiration and by taking a swab after incision; bacterial recovery was compared. Although processed in the laboratory within 2 h, swab speciments gave results comparable to syringe specimens in only 9 of 13 patients with beta-hemolytic streptococci and 7 of 25 patients with anaerobic bacteria. Both kinds of microorganisms were lost in some cases but appeared as additional flora in others. The poor results from the swab technique was ascribed to overgrowth of respiratory flora contaminating the sample after incision. In aspirated pus kept in the syringe, or transferred to anaerobic transporters, the microbial flora was unchanged for 24 to 48 h. Some anaerobes also survived on agar slants for 24 h, but specially designed anaerobic transporters are recommended.

Anaerobiosis↗

PubMed1991

Aerobic and anaerobic microbiology of peritonsillar abscess.

Thirty-four aspirates of pus from peritonsillar abscesses that were studied for aerobic and anaerobic bacteria showed bacterial growth. A total 107 bacterial isolates (58 anaerobic and 49 aerobic and facultative) were recovered, accounting for 3.1 isolates per specimen (1.7 anaerobic and 1.4 aerobic and facultatives). Anaerobic bacteria only were present in 6 (18%) patients, aerobic and facultatives in 2 (6%), and mixed aerobic and anaerobic flora in 26 (76%). Single bacterial isolates were recovered in 4 infections, 2 of which were Streptococcus pyogenes and 2 were anaerobic bacteria. The predominant bacterial isolates were Staphylococcus aureus (6 isolates), Bacteroides sp (21 isolates, including 15 Bacteroides melaninogenicus group), and Peptostreptococcus sp (16) and S. pyogenes (10). beta-Lactamase-producing organisms were recovered from 13 (52%) of 25 specimens tested. This retrospective study highlights the polymicrobial nature and importance of anaerobic bacteria in peritonsillar abscess.

Adolescent↗

PubMed1990

Peritonsillar abscess. Why aggressive management is appropriate.

Peritonsillar abscess is the most common deep neck infection in adults. Infections develop from purulent material collecting in the fascial spaces lateral to the capsule of the palatine tonsil. Infections are usually polymicrobial, and a significant number of anaerobes are isolated. The cornerstone of therapy is drainage of the abscess. With cooperative patients, careful permucosal needle aspiration is an accepted method of primary therapy. Large or recurrent abscesses require otolaryngologic consultation for adequate incision and drainage. Tonsillectomy may be necessary to prevent re-formation of abscess in patients with a history of recurrent tonsillitis.

Adult↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

PubMed1992

Intrathoracic infections with bacteraemia due to Eikenella corrodens as a complication of peritonsillar abscesses: report of a case and review of the literature.

A 52-year-old man, without previous disease, presented with dysphagia, dyspnoea, high fever and sore throat after peritonsillar abscesses drainage. Physical and complementary examinations were consistent with pericarditis, mediastinitis, pneumonia and pleuritis. Blood cultures grew Eikenella corrodens resistant to clindamycin and amikacin. We emphasize the pathogenic potential of Eikenella corrodens. To the best of our knowledge, this is the first reported case of this organism as a pathogen in intrathoracic infections after peritonsillar abscesses drainage.

Bacteremia↗

PubMed1991

Peritonsillar abscess: risk of disease in the remaining tonsil after unilateral tonsillectomy à chaud.

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.

Adolescent↗

PubMed1991

[Peritonsillar abscess. Occurrence of disease requiring surgery in the remaining tonsil after unilateral tonsillectomy à chaud].

The occurrence of disease requiring surgery of the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess was studied in 536 patients. None of the patients histories of previous severe tonsillitis at the time of the unilateral had tonsillectomy. 9.3% of the patients under 30 years of age were readmitted for surgery on the remaining tonsil during the follow up period. Only 0.5% of the patients over 30 years were readmitted. Previous investigations have shown increasing frequency of pharyngitis after bilateral tonsillectomy. The present authors suggest bilateral tonsillectomy in all patients under 30 years of age who suffer from peritonsillar abscess irrespectively of previous tonsillar disease. In patients over 30 years, unilateral ablation is recommended unless clear indication for bilateral tonsillectomy are present.

Adolescent↗