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Bode S, Kostev K, Park JJH, Eichhorn S, Seidel DU. Diseases associated with subsequent peritonsillar abscess: a case-control-study from ENT practices in Germany. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08927-z. [PMID: 39242417 DOI: 10.1007/s00405-024-08927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Peritonsillar abscess (PTA) is the most common deep soft tissue infection necessitating surgical intervention in the head and neck region. Potential causes include infections of the palatine tonsils, palatine glands, or branchiogenic rudiments ("acute tonsillitis hypothesis" vs. "Weber's gland hypothesis"). Understanding the currently still unknown predominant cause is crucial for guiding therapeutic strategies, such as abscess tonsillectomy versus incision and drainage alone. This study aims to investigate the pre-diagnoses associated with subsequent PTA using a nationally representative practice database in Germany. METHODS Data were collected from 195 ENT practices across Germany utilizing the nationally representative practice database IQVIA™ Disease Analyzer. Included were patients aged 18 years and older with a first diagnosis of PTA (index date) between January 2005 and December 2022 and a minimum observation period of 12 months preceding the index date. These patients were matched (1:5) with controls without PTA, based on age, sex, and index year. Frequencies of prior diagnoses coded according to ICD-10 in the 12 months preceding the index date were computed. The association between prior diagnoses and PTA was evaluated using multivariable logistic regression (MLR) and sensitivity analysis (SA). RESULTS A total of 5,325 cases were compared with 26,725 controls in the multivariable logistic regression (MLR) analysis, and 16,251 cases were compared with 81,255 controls in the sensitivity analysis (SA). Mean age was 45.3 ± 18.3 years (MLR) and 41.9 ± 16.7 years (SA). The proportion of female patients was 51.8% (MLR) and 46.9% (SA), respectively. MLR showed the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (odds ratio, OR: 6.71; 95% CI: 5.81-7.74), "chronic tonsillitis" (OR: 2.00; 95% CI: 1.58-2.52), and "acute pharyngitis" (OR: 1.74; 95% CI: 1.50-2.03). SA similarly indicated the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (OR: 5.02; 95% CI: 4.60-5.47), "chronic tonsillitis" (OR: 1.87; 95% CI: 1.64-2.12), and "acute pharyngitis" (OR: 1.27; 95% CI: 1.14-1.41). CONCLUSION The most prevalent prior diagnosis associated with PTA was acute tonsillitis, followed by chronic tonsillitis and acute pharyngitis. The association with acute pharyngitis suggests possible non-tonsillogenic causes. Other specific causes of PTA, such as inflammation of the palatine gland or branchiogenic remnants, are not captured by the ICD system or the database utilized in this study.
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Affiliation(s)
- Simon Bode
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Oberberg, Gummersbach, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
| | - Jonas Jae-Hyun Park
- Department of Otorhinolaryngology, Head and Neck Surgery, Witten/Herdecke University, Katholisches Krankenhaus Hagen gGmbH, Hagen, Germany
| | - Sabine Eichhorn
- Department of Otorhinolaryngology, Head and Neck Surgery, Witten/Herdecke University, Katholisches Krankenhaus Hagen gGmbH, Hagen, Germany
| | - David Ulrich Seidel
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Oberberg, Gummersbach, Germany
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Gualtieri R, Verolet C, Mardegan C, Papis S, Loevy N, Asner S, Rohr M, Llor J, Heininger U, Lacroix L, Pittet LF, Posfay-Barbe KM. Amoxicillin vs. placebo to reduce symptoms in children with group A streptococcal pharyngitis: a randomized, multicenter, double-blind, non-inferiority trial. Eur J Pediatr 2024:10.1007/s00431-024-05705-1. [PMID: 39215861 DOI: 10.1007/s00431-024-05705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
The efficacy of antibiotic therapy for group A streptococcus (GAS) pharyngitis is debated. The role of antibiotics in preventing complications seems limited, with the main potential benefit being symptom duration reduction. Our study aimed to evaluate whether a placebo is non-inferior to amoxicillin in reducing fever duration. We randomized 88 children between 3 and 15 years of age presenting with acute symptoms of pharyngitis and a positive rapid antigen detection test for GAS to receive 6-day treatment with either placebo (n = 46) or amoxicillin (n = 42). The primary outcome was the difference in fever duration, with a non-inferiority threshold set at 12 h. The secondary outcomes included pain intensity and complications of streptococcal pharyngitis. The mean difference in fever duration between the amoxicillin and placebo groups was 2.0 h (95% CI, - 8.3 to 12.3) in the per-protocol analysis and 2.8 h (95% CI, - 6.5 to 12.2) in the intention-to-treat analysis. Treatment failure was observed in six participants in the placebo group and two in the amoxicillin group (relative risk, 2.15; 95% CI, 0.44-10.57). All patients were identified early and recovered well. There was no clinically relevant difference in pain intensity between groups over the 7 days following randomization, with the largest difference of 0.5 (95% CI, - 0.62-1.80) observed on day 3. CONCLUSION Placebo appears to be non-inferior to amoxicillin in reducing fever duration. Pain intensity and risk of complications were similar between the two groups. These findings support the restrictive antibiotic treatment for streptococcal pharyngitis. WHAT IS KNOWN • Group A streptococcus pharyngitis is a common reason for prescribing antibiotics in pediatric care. • In high-income countries, while antibiotic treatment has not been effective in preventing non-suppurative complications, the primary justification for their use remains the reduction of symptoms. WHAT IS NEW • Our results suggest that antibiotics have a limited impact on the duration of fever and the intensity of pain in children with streptococcal pharyngitis. • Considering that suppurative complications can be promptly treated if they arise, we recommend a more judicious approach to antibiotic prescriptions. TRIAL REGISTRATION The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03264911 on 15.08.2017.
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Affiliation(s)
- Renato Gualtieri
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Charlotte Verolet
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Chiara Mardegan
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Sébastien Papis
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Natasha Loevy
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Sandra Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Rohr
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
- Pediatric Infectious Diseases Unit, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Juan Llor
- Department of Pediatrics, Sion Hospital, Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University Children's Hospital Basel, Basel, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Laure F Pittet
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Division of General Pediatrics, Department of Pediatrics, Gynaecology and Obstetrics, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland.
- Pediatric Infectious Diseases Unit, Geneva University Children's Hospital and University of Geneva, Geneva, Switzerland.
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von Meyer F, Storck K. [Disproving the myth of "abscess weather" predisposing to peritonsillitis and peritonsillar abscess]. HNO 2024; 72:32-40. [PMID: 37932499 PMCID: PMC10781855 DOI: 10.1007/s00106-023-01384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Peritonsillar abscess (PTA) is often seen as a complication of acute tonsillitis and is defined as pus retention between the tonsillar capsule and the peritonsillar tissue. The etiology and pathogenesis have not yet been fully elucidated. A connection between certain weather conditions and temperature fluctuations and the occurrence of abscesses in the head and neck region has been discussed for years. The question here is whether higher temperature fluctuations are predisposing for the formation of abscesses. MATERIALS AND METHODS A retrospective evaluation of all patients hospitalized with peritonsillitis or PTA in the Department of Otorhinolaryngology of the Klinikum Rechts der Isar of the Technical University of Munich during a period of 10 years (2012-2021) was performed. Each patient was individually correlated with daily temperature data from the statistical meteorological office of the City of Munich. RESULTS A total of 1450 patients were included, 270 patients (18.62%) with peritonsillitis and 1180 patients (81.38%) with PTA. A correlation between the occurrence of peritonsillitis or PTA and major temperature fluctuations could be excluded in this large patient population. Moreover, a similar frequency of peritonsillitis and PTA was seen throughout the year. CONCLUSION The myth of a temperature dependence of the development of peritonsillitis or PTA and a so-called abscess weather could be negated in this study.
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Affiliation(s)
- Franziska von Meyer
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - Katharina Storck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
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Saar M, Vaikjärv R, Parm Ü, Kasenõmm P, Kõljalg S, Sepp E, Jaagura M, Salumets A, Štšepetova J, Mändar R. Unveiling the etiology of peritonsillar abscess using next generation sequencing. Ann Clin Microbiol Antimicrob 2023; 22:98. [PMID: 37940951 PMCID: PMC10633907 DOI: 10.1186/s12941-023-00649-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Peritonsillar abscess (PTA) is a severe deep neck space infection with an insufficiently characterized bacterial etiology. We aimed to reveal the bacteria associated with PTA applying next generation sequencing (NGS). Tonsil biopsies and pus samples of 91 PTA patients were analysed applying NGS method. RESULTS Over 400 genera and 800 species belonging to 34 phyla were revealed. The most abundant species in both sample types were Streptococcus pyogenes, Fusobacterium necrophorum and Fusobacterium nucleatum. When present, S. pyogenes was normally a predominant species, although it was recovered as a minor population in some samples dominated by F. nucleatum and occasionally F. necrophorum. S. pyogenes and F. necrophorum were the predominant species (> 10% in a community) in 28 (31%) pus samples, while F. nucleatum in 21 (23%) and S. anginosus in 8 (9%) pus samples. We observed no substantial differences between the microbial findings in pus and tonsil biopsies. CONCLUSIONS The most probable causative agents of PTA according to our NGS-study include Streptococcus pyogenes, Fusobacterium necrophorum and Fusobacterium nucleatum. Some other streptococci (S. anginosus) and anaerobes (Prevotella, Porphyromonas) may contribute to the infection as well. Pus of the peritonsillar abscess is more representative specimen for microbiological examination than the tonsillar tissue. Our results are important in the context of optimizing the handling of the PTA patients.
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Affiliation(s)
- Merili Saar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- Competence Center on Health Technologies, Tartu, Estonia
| | | | - Ülle Parm
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- Tartu Health Care Colleges, Tartu, Estonia
| | - Priit Kasenõmm
- Ear Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Oto-Rhino-Laryngology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Siiri Kõljalg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- Competence Center on Health Technologies, Tartu, Estonia
- Laboratory of Clinical Microbiology, United Laboratories, Tartu University Hospital, Tartu, Estonia
| | - Epp Sepp
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- Competence Center on Health Technologies, Tartu, Estonia
| | - Madis Jaagura
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Center on Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Jelena Štšepetova
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- Competence Center on Health Technologies, Tartu, Estonia
| | - Reet Mändar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia.
- Competence Center on Health Technologies, Tartu, Estonia.
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Nesemeier R, Jones S, Jacob K, Cash E, Goldman J. Trends in Emergency Department Computed Tomography Usage for Diagnosis of Peritonsillar Abscess. EAR, NOSE & THROAT JOURNAL 2023; 102:NP35-NP39. [PMID: 33433233 DOI: 10.1177/0145561320984996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Peritonsillar abscess (PTA) is the most common deep neck space infection and a frequent cause for otolaryngology consultation. Patients often undergo computed tomography (CT) scan for confirmation in addition to physical examination. Our aims were to determine whether patients unnecessarily undergo CT scans in the emergency department (ED) when presenting with sore throat and identify physical examination characteristics that predict PTA. METHODS The electronic medical records of all patients (>18 years) presenting to an ED between June 2014 and June 2015 with a primary diagnosis of acute pharyngitis, acute tonsillitis, or PTA were reviewed for presenting symptoms and diagnostic imaging use. RESULTS Four hundred eight patients met inclusion criteria; 21 were diagnosed with PTA, including 13 based on history and physical alone. A total of 21 CT scans were ordered, 11 (52.3%) of which did not demonstrate abscess. Soft palatal fullness, uvular deviation, drooling, and muffled voice were all significantly associated with increased CT usage (all P values <.02). Rising subjective pain scores were associated with increased use of CT imaging (P = .029). Multivariable analyses revealed that soft palatal fullness, uvular deviation, and drooling were all significant predictors of PTA (all P values <.001). CONCLUSIONS Patients with severe symptoms of PTA, including uvular deviation, drooling, and soft palatal fullness, were most likely to undergo CT imaging. Given the high likelihood of PTA, patients presenting with these symptoms could forego CT imaging, reducing exposure to ionizing radiation.
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Affiliation(s)
- Ryan Nesemeier
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shawn Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin Jacob
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Julie Goldman
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Hathi K, Lees MX, Chandra K, Lewis D, McMullin B, Chin CJ. Seasonal Variation of Peritonsillar Abscess Presentation to an Emergency Department in an Atlantic Canadian Climate: A Retrospective Review. Ann Otol Rhinol Laryngol 2022:34894221127485. [PMID: 36217949 PMCID: PMC10359955 DOI: 10.1177/00034894221127485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Patients with a peritonsillar abscess (PTA) often present to emergency departments as the first point of medical contact. Upper respiratory tract infections (URTIs) are more frequent in the winter. Therefore, we hypothesize that the incidence of PTAs will be more frequent in colder winter months as well. This is the first study assessing the seasonal variation and epidemiology of PTA presentations to an emergency department in Atlantic Canada, home to a unique maritime climate. METHODS A retrospective cohort study was conducted through a chart review of all patients who presented to the Saint John Regional Hospital Emergency Department from January 1, 2015, to December 31, 2020. Patient characteristics, treatment, and microbiology were reported. A chi-square goodness-of-fit test assessed the seasonal variation of PTA. Pearson correlations assessed PTA incidence per mean monthly temperature and humidity. RESULTS A total of 75 patients were included. 57.3% were male and 42.7% were female, with a mean age (±SD) of 35.9 ± 14.0. Most patients presented afebrile (82.7%, cutoff ≥ 38.0°C). Approximately half of all patients had an elevated WBC count (49.3%, cutoff ≥ 10.9 × 109). The most common bacteria isolated were Streptococcus species followed by anaerobic bacteria (17.9%). No significant variation was found with respect to season (X2(3) = 1.0, P = .801), temperature (r(70) = 0.198, P = .096), or humidity, (r(70) = 0.063, P = .599). CONCLUSION This study did not find a seasonal variation of PTA in a maritime climate. These findings question the anecdotal hypothesis that PTA is associated with progression from acute URTIs and therefore would be more common in the winter months.
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Affiliation(s)
- Kalpesh Hathi
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Miranda X Lees
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Kavish Chandra
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Department of Emergency Medicine, Horizon Health Network, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - David Lewis
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Department of Emergency Medicine, Horizon Health Network, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Ben McMullin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Christopher J Chin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Mizuno K, Takeuchi M, Kishimoto Y, Omori K, Kawakami K. Risk Factors for Recurrence of Peritonsillar Abscess. Laryngoscope 2022. [DOI: 10.1002/lary.30367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/11/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health Kyoto University Kyoto Japan
- Department of Otolaryngology—Head and Neck Surgery, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health Kyoto University Kyoto Japan
| | - Yo Kishimoto
- Department of Otolaryngology—Head and Neck Surgery, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Koichi Omori
- Department of Otolaryngology—Head and Neck Surgery, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health Kyoto University Kyoto Japan
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Fauck V, Schinz K, Alexiou C, Mantsopoulos K, Iro H, Mueller SK. [Abscesstonsillectomy: Uni- or bilateral?]. Laryngorhinootologie 2022; 101:896-901. [PMID: 35605964 DOI: 10.1055/a-1841-6419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative bleeding after abscesstonsillectomy (ABTE) is this surgery's most feared complication which can rarely lead to patients' deaths. The objective of this study was to compare bleeding complications of ABTE with and without contralateral tonsillectomy (TE) and to analyze the occurrence of a metachronous PTA at the contralateral side. METHODS Retrospective study of n= 655 patients undergoing ABTE with and without TE of the contralateral side from January 2004 to February 2019. Bleeding complications needing surgical hemostasis were analyzed regarding demographic and surgical parameters. In addition, occurrence of PTA and need for ABTE of the contralateral side after unilateral ABTE were evaluated. RESULTS Overall, 10/655 (1.5 %) patients presented with postoperative bleeding after ABTE. In 404/655 an ABTE with contralateral TE was performed. Here, 8/404 (1.98 %) patients showed contra- or bilateral bleeding. Only in 2/251 (0.7 %) patients occurred a bleeding complication after unilateral ABTE. Therefore, bleeding after unilateral ABTE was significantly lower than ABTE with contralateral TE (1.98 % vs. 0.7 %, p= 0.001). In 0.8 % of the patients a contralateral ABTE was necessary due to a metachronous PTA. CONCLUSION Overall, the rate of postoperative bleeding after ABTE (1.5 %) was low. Unilateral ABTE showed significantly lower postoperative bleeding rates compared to ABTE with contralateral TE. Consequently, the indication of a contralateral TE must be very strict.
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Affiliation(s)
- Vanessa Fauck
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Schinz
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Alexiou
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarina K Mueller
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Clark C, Santarelli A, Merrill S, Ashurst J. Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience. Cureus 2022; 14:e23300. [PMID: 35464569 PMCID: PMC9013514 DOI: 10.7759/cureus.23300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background Peritonsillar abscesses (PTA) are the most common deep space infection of the head and neck. They appear to have an association with a patient’s smoking history but data showing this relationship is sparse and controversial. Currently, no data on this association exists for those who seek care at a rural community emergency department (ED). Based upon the lack of data in this setting, the authors sought to determine the incidence, treatments, and outcomes between smokers and non-smokers with a PTA at a rural community ED. Methods A retrospective chart review of all patients undergoing a soft tissue neck computed tomography (CT) scan with or without intravenous contrast was completed from September 25th, 2019 through October 4th, 2021. Patients with a previously diagnosed PTA and those diagnosed via another means (clinical, needle aspiration, etc.), or outside of the ED were excluded from the dataset. Abstracted data included demographics, treatments, and outcomes of each patient. The data were analyzed using the Mann-Whitney test for continuous data and the chi-square test for categorical data. Results During the study period, a total of 50 patients were diagnosed with a PTA via soft tissue neck CT. Of those diagnosed, the median age was 40.5 (25.5 - 53.3) years, 15 were female, 38 self-identified as white, and 27 noted a current smoking history. Smokers presented to ED earlier than non-smokers (2.0 vs 4.0 days; p=0.03), but no difference was noted in the size of PTA identified via CT (2.0 vs 1.5 cm; p=0.13). No difference among smokers and non-smokers was noted in corticosteroid therapy either administered in the ED (p = 0.53) or prescribed as an outpatient (p = 0.75), incision and drainage (p = 0.19), outpatient follow-up (p = 0.53), or resolution of the symptoms (p = 0.86). However, more patients in the non-smoking group had an unplanned return to the ED as compared to those who smoked (p=0.02). In those patients who were not discharged from the ED after initial presentation, four were admitted to the hospital and 11 were transferred to a higher level of care. Conclusion Although drawn from a limited sample from a single rural community ED, a positive smoking history was more common among patients with a PTA. While there was no statistically significant difference in the overall treatment, a difference was noted for unscheduled return visits to the ED in those without a history of smoking.
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Vanhapiha N, Sanmark E, Blomgren K, Wikstén J. Minor salivary gland infection as origin of peritonsillitis - novel theory and preliminary results. Acta Otolaryngol 2022; 142:182-186. [PMID: 35073502 DOI: 10.1080/00016489.2022.2026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Peritonsillitis (PT) is defined as cellulitis in peritonsillar tissue without pus. The pathogenesis of peritonsillar infections is controversial. OBJECTIVE To explore whether minor salivary glands are involved in the development of PT and to identify clinical findings that predict the evolution of PT to peritonsillar abscess (PTA). MATERIAL AND METHODS We included 146 adult patients treated for acute tonsillitis (AT; n = 54), PT (n = 34), or PTA (n = 58) at the Helsinki University Hospital. The treating physician recorded tonsillar, oropharyngeal, and dental findings. We analysed serum C-reactive protein (S-CRP) and amylase (S-Amyl). For PTA, pus samples were analysed; for AT and PT, throat cultures were collected. Patients with PT or PTA (PT/PTA; n = 92) were classified into groups with or without tonsillar exudate or hyperaemia (tonsillar findings). RESULTS The PT group without tonsillar findings had lower S-CRP than the PT group with tonsillar findings (p=.0275). The PT/PTA group without tonsillar findings had higher S-Amyl than the PT/PTA group with tonsillar findings (p=.0278). Three out of 34 (8.8%) patients with PT returned to the emergency department; 1 (2.9%) developed PTA. CONCLUSIONS Elevated S-Amyl in the PT/PTA group without tonsillar findings suggests that minor salivary glands are sometimes involved in the development of peritonsillar infections.
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Affiliation(s)
- Nelli Vanhapiha
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Enni Sanmark
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Karin Blomgren
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Wikstén
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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Sideris G, Malamas V, Tyrellis G, Maragkoudakis P, Delides A, Nikolopoulos T. Ubi pus, ibi evacua: a review of 601 peritonsillar abscess adult cases. Ir J Med Sci 2021; 191:1849-1853. [PMID: 34617243 PMCID: PMC8494509 DOI: 10.1007/s11845-021-02796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Background Peritonsillar abscess (PTA) is the most common deep neck infection, occurring as a consequence of bacterial acute tonsillitis or as a result of infection of the Weber glands, with frequent and life-threatening complications. Aim To investigate several factors associated with complications and worse prognosis, such as defining the method of surgical drainage and treatment of a PTA which remains an area of controversy in the literature Methods The purpose of this retrospective study is to examine the epidemiological, clinical, and laboratory findings of 601 adult patients and to discuss them along with their treatment plan. Results Pharyngalgia was the most common reported symptom, followed by trismus, odynophagia, fever, hot potato voice, malaise, and cervical lymphadenopathy. Sixty-eight patients developed complications. Streptococcus species were the most common pathogens. A statistically significant difference was found in days of hospitalization, WBC and CRP levels, age, and the pre-existing systemic diseases between patients with and without complications. A comparison of patients treated with intravenous and oral antibiotics revealed no statistically significant difference. Conclusion Οver 10% of PTA cases may develop complications, the most common of which is extension into deep neck spaces. Comorbid conditions increase the risk of complications. Despite the wide range of treatment strategies, incision and drainage remain the cornerstone of surgical treatment. In patients with no comorbidities, intravenous antibiotics appear to have no advantage over oral antibiotics.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece.
| | - Vangelis Malamas
- Department of Infomatics, University of Peiraeus, Peiraeus, Greece
| | - George Tyrellis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
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13
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Kim AS, Boyko NV, Stagnieva IV, Panchenko SN. [Small salivary glands in the paratonsillar space in children]. Vestn Otorinolaringol 2021; 86:41-45. [PMID: 33720650 DOI: 10.17116/otorino20218601141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Was to study the changes in the small salivary glands in chronic tonsillitis and paratonsillar abscess in children. A histological examination of the palatine tonsils of 22 children aged 5 to 14 years old who had a paratonsillar abscess and 18 children suffering from chronic tonsillitis was carried out. Fragments of small salivary glands, located both superficially, in the mucous membrane between the stratified squamous non-keratinizing epithelium and the lymphoid tissue of the palatine tonsils, and between the muscles of the amygdala were found in 42 of the 80 (52.5%) tonsils studied. Along with the unchanged glandular structure, 26 (61.9%) samples revealed areas of destruction foci in small salivary glands with signs of inflammatory and compensatory regenerative activity. The presence of separate interlobular ducts of the salivary glands with pronounced periductal lymph - macrophage infiltration was noted. The subepithelial lymph-macrophage infiltrates found in the lamina propria are associated with the exit of the excretory ducts of the salivary glands to the surface of the mucous membrane. Many thin-walled veins are surrounded by perivascular lymphocellular infiltrates. The inflammatory and post-inflammatory changes in the small salivary glands revealed by us in children with chronic tonsillitis do not exclude their participation in the pathogenesis of paratonsillitis. At the same time, inflammation in the salivary gland can be both primary, as a result of its infection with live microorganisms from the tissues of the tonsil, and secondary, due to the compression of the excretory ducts by the edematous tissue of the tonsil in acute tonsillitis.
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Affiliation(s)
- A S Kim
- Rostov State Medical University, Rostov-on-Don, Russia
| | - N V Boyko
- Rostov State Medical University, Rostov-on-Don, Russia
| | - I V Stagnieva
- Rostov State Medical University, Rostov-on-Don, Russia
| | - S N Panchenko
- Rostov State Medical University, Rostov-on-Don, Russia
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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study. PLoS One 2020; 15:e0228122. [PMID: 32243441 PMCID: PMC7122714 DOI: 10.1371/journal.pone.0228122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to specify diagnostics for peritonsillar abscesses (PTAs) and to clarify the role of minor salivary glands. This prospective cohort study included 112 patients with acute tonsillitis (AT) and PTA recruited at a tertiary hospital emergency department between February and October 2017. All patients completed a questionnaire concerning their current disease. Serum amylase (S-Amyl) and C-reactive protein (S-CRP) levels, tonsillar findings, and pus aspirate samples and throat cultures were analyzed. Eight of 58 PTA patients (13.8%) had no signs of tonsillar infection. The absence of tonsillar erythema and exudate was associated with low S-CRP (p<0.001) and older age (p<0.001). We also observed an inverse correlation between S-Amyl and S-CRP levels (AT, r = -0.519; PTA, r = -0.353). Therefore, we observed a group of PTA patients without signs of tonsillar infection who had significantly lower S-CRP levels than other PTA patients. These findings support that PTA may be caused by an etiology other than AT. Variations in the S-Amyl levels and a negative correlation between S-Amyl and S-CRP levels may indicate that minor salivary glands are involved in PTA development.
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Chao WC, Lin CH, Chen YM, Jiang RS, Chen HH. Association between tonsillitis and newly diagnosed ankylosing spondylitis: A nationwide, population-based, case-control study. PLoS One 2019; 14:e0220721. [PMID: 31369625 PMCID: PMC6675079 DOI: 10.1371/journal.pone.0220721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives To investigate the association between tonsillitis and the risk of newly diagnosed ankylosing spondylitis (AS). Methods We used 2003–2012 data from Taiwan’s National Health Insurance Research Database to conduct this nationwide, population-based, case-control study. We identified AS patients newly diagnosed between 2005 to 2012 as the study group and selected age, sex and index-year matched (1:6) non-AS individuals as controls. The association between tonsillitis and risk of newly diagnosed AS was determined by calculating odds ratios (ORs) with 95% confidence intervals (CIs) using conditional logistic regression analysis. Results We identified 37,002 newly diagnosed AS cases and 222,012 matched non-AS controls. Patients with AS were more likely to have tonsillitis (aOR 1.46, 95% CI 1.43–1.50), appendicitis (aOR 1.29, 95% CI 1.13–1.48) and periodontitis (aOR 1.35, 95% CI 1.31–1.38) than non-AS control subjects. The association between tonsillitis and AS was consistent using varying definitions for tonsillitis, and we further found that a high frequency of visits for tonsillitis, a high medical cost for tonsillitis and a long interval between diagnosis were associated with newly diagnosed AS in a dose-response manner. Furthermore, the association between tonsillitis and AS appeared to be stronger in females (aOR 1.59, 95% CI 1.53–1.65) than those in males (aOR 1.39, 95% CI 1.35–1.44). Conclusions The present study revealed an association between AS risk and prior tonsillitis and indicates the need for vigilance of AS-associated symptoms in patients who had been diagnosed with tonsillitis, particularly in females.
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Affiliation(s)
- Wen-Cheng Chao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, College of Medicine & Nursing, Hung Kuang University, Taichung, Taiwan
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- * E-mail:
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The presence of minor salivary glands in the peritonsillar space. Eur Arch Otorhinolaryngol 2017; 274:3997-4001. [PMID: 28900734 DOI: 10.1007/s00405-017-4738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Abstract
Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.
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Wetmore RF. Surgical management of the tonsillectomy and adenoidectomy patient. World J Otorhinolaryngol Head Neck Surg 2017; 3:176-182. [PMID: 29516064 PMCID: PMC5829294 DOI: 10.1016/j.wjorl.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ralph F. Wetmore
- E. Mortimer Newlin Professor of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Dept. of Otorhinolaryngology, Civic Center Boulevard, Philadelphia, PA 19104, USA
- Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Peritonsillar abscess: epidemiology and relationship with climate variations. The Journal of Laryngology & Otology 2017; 131:627-630. [DOI: 10.1017/s0022215117000895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractBackground:Peritonsillar abscess is the most common deep infection of the head and neck in young adults. It is considered a purulent complication of acute tonsillitis, but other mechanisms have been proposed. There is no consensus as to whether seasonality affects peritonsillar abscess incidence.Methods:This observational, descriptive, retrospective study explored the epidemiology of peritonsillar abscess and its relationship with seasonality. The cases were selected from the emergency otolaryngology service of a tertiary hospital.Results:The sample comprised 528 patients (42.61 per cent males, mean age = 26.63 years). A moderate positive correlation was found between peritonsillar abscess incidence and monthly average temperature. No associations were found with insolation, precipitation or humidity.Conclusion:In this sample, peritonsillar abscess was more likely to occur in warmer months. The findings corroborate the theory that peritonsillar abscess is not a direct complication of acute tonsillitis and may improve understanding of peritonsillar abscess aetiology.
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Windfuhr JP. Specified data for tonsil surgery in Germany. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc08. [PMID: 28025608 PMCID: PMC5169081 DOI: 10.3205/cto000135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Tonsillectomy rates vary considerably among different states, regions, and times. This study was conducted to identify the prevalence of “chronic” tonsillitis, peritonsillar abscess, hypertrophy of the tonsils with and without adenoids in absolute and relative numbers in an 80 million people nation. Moreover, the number and rates of different surgical procedures to resolve either “chronic” tonsillitis, peritonsillar abscess, or upper airway obstruction due to (adeno)tonsillar hypertrophy over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy, abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was calculated and analyzed in relation to age and gender. Material and methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013. Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142,574 (in 2000) to 87,624 in 2013 (38.5%). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833,896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120,993 in 2006 to 84,332 procedures in 2013 (30.3%). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10,000 in 2010 to 58.68 per 10,000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10,000 to 10.90 per 10,000. In contrast, an increasing number of tonsillotomies was observed between 2007 (4,659 procedures) and 2013 (11,493). The cumulated number of procedures was 59,049. A constant number of 15,000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100,000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to the transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced in 5.98% of all patients after 245,721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06% vs. 7.02%). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only. Conclusion: Chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continually, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance in insurance companies and authorities in the national health system of an 80 million people nation. (Tab. 1)
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Affiliation(s)
- Jochen P Windfuhr
- Department of Otolaryngology, Head & Neck Surgery, Allergology, Kliniken Maria Hilf, Mönchengladbach, Germany
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Klug TE, Rusan M, Fuursted K, Ovesen T, Jorgensen AW. A systematic review of Fusobacterium necrophorum-positive acute tonsillitis: prevalence, methods of detection, patient characteristics, and the usefulness of the Centor score. Eur J Clin Microbiol Infect Dis 2016; 35:1903-1912. [DOI: 10.1007/s10096-016-2757-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/11/2016] [Indexed: 01/01/2023]
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Klug TE, Rusan M, Fuursted K, Ovesen T. Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection? Otolaryngol Head Neck Surg 2016; 155:199-207. [PMID: 27026737 DOI: 10.1177/0194599816639551] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the literature concerning the 2 primary hypotheses put forth to explain the pathogenesis of peritonsillar abscess: "the acute tonsillitis hypothesis" (peritonsillar abscess is a complication of acute tonsillitis) and "the Weber gland hypothesis" (peritonsillar abscess is an infection of Weber's glands). DATA SOURCES PubMed, EMBASE. REVIEW METHODS Data supporting or negating one hypothesis or the other were elicited from the literature. CONCLUSIONS Several findings support the acute tonsillitis hypothesis. First, the 2 main pathogens in peritonsillar abscess have been recovered from pus aspirates and bilateral tonsillar tissues with high concordance rates, suggesting that both tonsils are infected in patients with peritonsillar abscess. Second, studies report signs of acute tonsillitis in the days prior to and at the time of peritonsillar abscess. Third, antibiotic treatment reduces the risk of abscess development in patients with acute tonsillitis. However, some findings suggest involvement of the Weber's glands in peritonsillar abscess pathogenesis. First, high amylase levels have been found in peritonsillar pus. Second, the majority of peritonsillar abscesses are located at the superior tonsillar pole in proximity of the Weber's glands. We propose a unified hypothesis whereby bacteria initially infect the tonsillar mucosa and spread via the salivary duct system to the peritonsillar space, where an abscess is formed. IMPLICATIONS FOR PRACTICE Our findings support the rationale for antibiotic treatment of patients with severe acute tonsillitis to reduce the risk of abscess development. Improved understanding of peritonsillar abscess pathogenesis is important for the development of efficient prevention strategies.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Rusan
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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El-Saied S, Kaplan DM, Zlotnik A, Abu Tailakh M, Kordeluk S, Joshua BZ. A comparison between amylase levels from peritonsillar, dental and neck abscesses. Clin Otolaryngol 2015; 39:359-61. [PMID: 25117975 DOI: 10.1111/coa.12298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pus of peritonsillar abscess (PTA) contains very high amylase levels in some patients. The objective of this study was to further test this finding and to check whether high amylase levels in peritonsillar abscess originate from contamination by saliva during aspiration. STUDY DESIGN Prospective study. SETTING Tertiary care university hospital. PARTICIPANTS The study includes 64 patients with PTA, 8 patients with a neck abscess and 12 patients with a dental abscess. MAIN OUTCOME MEASURE Amylase levels of pus and serum were compared between the groups. Clinical data regarding hospitalisation length, recurrence rate and previous antibiotic treatment were also collected. RESULTS Mean amylase levels in the pus of the PTA group were 3045 U/L (median 59 U/L), 13 U/L in the neck abscess group (P = 0.001) and 22 U/L in the dental abscess group (P = 0.001). Mean serum amylase was higher in the PTA group; PTA - 50 U/L, neck abscess - 37 U/L (P = 0.002) and dental abscess - 26 U/L (P < 0.002). All of the patients with amylase levels above 65 U/L had a first episode of PTA. In contrast, 40% of patients with amylase lower than 65 U/L had recurrent PTA (P = 0.003). CONCLUSION A clear association is seen between minor salivary glands and peritonsillar abscess. The high amylase level in peritonsillar pus is not from contamination with saliva.
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Affiliation(s)
- S El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Clinical Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Peritonsillar abscess: remember to always think twice. Eur Arch Otorhinolaryngol 2015; 273:1269-81. [DOI: 10.1007/s00405-015-3582-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/24/2015] [Indexed: 01/12/2023]
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Bovo R, Barillari MR, Martini A. Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy? Eur Arch Otorhinolaryngol 2015; 273:225-30. [DOI: 10.1007/s00405-014-3454-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 12/28/2022]
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Tachibana T, Orita Y, Abe-Fujisawa I, Ogawara Y, Matsuyama Y, Shimizu A, Nakada M, Sato Y, Nishizaki K. Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess. J Infect Chemother 2014; 20:722-5. [DOI: 10.1016/j.jiac.2014.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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Klug TE. Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis 2014; 33:1163-7. [PMID: 24474247 DOI: 10.1007/s10096-014-2052-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
To explore the correlations among the incidence, microbiology, season, gender, and age in patients with peritonsillar abscess (PTA) in order to identify risk factors for PTA development. All patients with PTA treated at private ENT practices in Aarhus County and in the Ear-Nose-Throat Departments at Aarhus University Hospital and Randers Hospital from January 2001 to December 2006 were included in the study. Age- and gender-stratified population data for Aarhus County for the same 6 years were obtained. The incidence rate of PTA increased from childhood to peak in teenage life and declined afterward gradually until old age. Girls predominated over boys until the age of 14 years. Subsequently, men were more frequently affected than women. Fusobacterium necrophorum (FN) was significantly more prevalent than group A Streptococcus (GAS) among patients aged 15-24 years (P < 0.001). In contrast, GAS was significantly more frequently recovered among children aged 0-9 years and adults aged 30-39 years compared with FN (P < 0.001 and P = 0.017 respectively). The seasonal variation of PTA was statistically insignificant (P = 0.437). However, GAS was significantly more frequently recovered in the winter and spring than in the summer (P = 0.002 and P = 0.036 respectively). There was a trend toward a higher incidence of FN infection during the summer than the winter (P = 0.165). Although the collected PTA incidence was stable throughout the year, the microbiology fluctuated with seasons. Patients aged 15-24 years are at an increased risk of PTA due to FN, which may have clinical implications for the diagnostic work-up and treatment of patients with acute tonsillitis.
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Affiliation(s)
- T E Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, NBG, Building 10, Noerrebrogade 44, Aarhus C, 8000, Denmark,
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Powell EL, Powell J, Samuel JR, Wilson JA. A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother 2013; 68:1941-50. [PMID: 23612569 DOI: 10.1093/jac/dkt128] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To perform a multifactorial exploration of the aetiology of peritonsillar abscess (PTA) in adults, in order to develop greater clinical understanding of the condition and improve management. DESIGN A literature review exploring key pathogens, predisposing host factors and current pathogenic hypotheses. METHODS A PubMed search for articles published between January 1980 and January 2012 using the terms 'peritonsillar abscess AND microbiology', 'peritonsillar abscess AND pathophysiology' and 'peritonsillar abscess AND etiology'. RESULTS Major pathogens in PTA are opportunistic microflora. Group A streptococcal PTA infections present differently from polymicrobial PTA. A number of host factors influence the conditions required for the pathogenesis of PTA. CONCLUSIONS PTA is clinically distinct from acute tonsillitis and occurs in people with a chronic underlying susceptibility. Targeting host factors, including oral hygiene, antibiotic use and smoking, may prevent PTA. Re-education of clinicians concerning the aetiology of PTA is necessary for appropriate disease management.
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Affiliation(s)
- Emily L Powell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Álvarez Marcos C, Llorente-Pendás JL. Peritonsillar Infections: Prospective Study of 100 Consecutive Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2012.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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El-Saied S, Puterman M, Kaplan DM, Cohen-Lahav M, Joshua BZ. Involvement of minor salivary glands in the pathogenesis of peritonsillar abscess. Otolaryngol Head Neck Surg 2012; 147:472-4. [PMID: 22547556 DOI: 10.1177/0194599812445552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. STUDY DESIGN Prospective population-based study. SETTINGS Tertiary care university hospital. SUBJECTS AND METHOD Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. RESULTS Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group (P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L (P = .01). CONCLUSION High amylase in the pus lends further support for involvement of minor salivary glands. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection. It is possible that both minor salivary glands as well as tonsillar infection play a role in the pathogenesis of peritonsillar infections.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Alvarez Marcos C, Llorente-Pendás JL. [Peritonsillar infections: prospective study of 100 consecutive cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:212-7. [PMID: 22425204 DOI: 10.1016/j.otorri.2012.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/23/2011] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.
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Affiliation(s)
- María Costales-Marcos
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Principado de Asturias, España.
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