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Jacob T, Leshno M, Carmel-Neidermann NN, Kampel L, Warshavsky A, Mansour J, Assadi N, Muhanna N, Horowitz G. Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils. Laryngoscope 2024; 134:2153-2161. [PMID: 37937815 DOI: 10.1002/lary.31139] [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] [Received: 06/14/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT). METHODS A Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment. RESULTS Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD. CONCLUSION Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges. LEVEL OF EVIDENCE NA Laryngoscope, 134:2153-2161, 2024.
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Affiliation(s)
- Tommy Jacob
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Leshno
- The 'Coller' School of Management, Tel-Aviv University, Both Affiliated to the Tel-Aviv Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neidermann
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liyona Kampel
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anton Warshavsky
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joubran Mansour
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Assadi
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Muhanna
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Wilson JA, Fouweather T, Stocken DD, Homer T, Haighton C, Rousseau N, O'Hara J, Vale L, Wilson R, Carnell S, Wilkes S, Morrison J, Ah-See K, Carrie S, Hopkins C, Howe N, Hussain M, Lindley L, MacKenzie K, McSweeney L, Mehanna H, Raine C, Whelan RS, Sullivan F, von Wilamowitz-Moellendorff A, Teare D. Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation. Health Technol Assess 2023; 27:1-195. [PMID: 38204203 PMCID: PMC11017150 DOI: 10.3310/ykur3660] [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: 01/12/2024] Open
Abstract
Background The place of tonsillectomy in the management of sore throat in adults remains uncertain. Objectives To establish the clinical effectiveness and cost-effectiveness of tonsillectomy, compared with conservative management, for tonsillitis in adults, and to evaluate the impact of alternative sore throat patient pathways. Design This was a multicentre, randomised controlled trial comparing tonsillectomy with conservative management. The trial included a qualitative process evaluation and an economic evaluation. Setting The study took place at 27 NHS secondary care hospitals in Great Britain. Participants A total of 453 eligible participants with recurrent sore throats were recruited to the main trial. Interventions Patients were randomised on a 1 : 1 basis between tonsil dissection and conservative management (i.e. deferred surgery) using a variable block-stratified design, stratified by (1) centre and (2) severity. Main outcome measures The primary outcome measure was the total number of sore throat days over 24 months following randomisation. The secondary outcome measures were the number of sore throat episodes and five characteristics from Sore Throat Alert Return, describing severity of the sore throat, use of medications, time away from usual activities and the Short Form questionnaire-12 items. Additional secondary outcomes were the Tonsil Outcome Inventory-14 total and subscales and Short Form questionnaire-12 items 6 monthly. Evaluation of the impact of alternative sore throat patient pathways by observation and statistical modelling of outcomes against baseline severity, as assessed by Tonsil Outcome Inventory-14 score at recruitment. The incremental cost per sore throat day avoided, the incremental cost per quality-adjusted life-year gained based on responses to the Short Form questionnaire-12 items and the incremental net benefit based on costs and responses to a contingent valuation exercise. A qualitative process evaluation examined acceptability of trial processes and ramdomised arms. Results There was a median of 27 (interquartile range 12-52) sore throats over the 24-month follow-up. A smaller number of sore throats was reported in the tonsillectomy arm [median 23 (interquartile range 11-46)] than in the conservative management arm [median 30 (interquartile range 14-65)]. On an intention-to-treat basis, there were fewer sore throats in the tonsillectomy arm (incident rate ratio 0.53, 95% confidence interval 0.43 to 0.65). Sensitivity analyses confirmed this, as did the secondary outcomes. There were 52 episodes of post-operative haemorrhage reported in 231 participants undergoing tonsillectomy (22.5%). There were 47 re-admissions following tonsillectomy (20.3%), 35 relating to haemorrhage. On average, tonsillectomy was more costly and more effective in terms of both sore throat days avoided and quality-adjusted life-years gained. Tonsillectomy had a 100% probability of being considered cost-effective if the threshold for an additional quality-adjusted life year was £20,000. Tonsillectomy had a 69% probability of having a higher net benefit than conservative management. Trial processes were deemed to be acceptable. Patients who received surgery were unanimous in reporting to be happy to have received it. Limitations The decliners who provided data tended to have higher Tonsillectomy Outcome Inventory-14 scores than those willing to be randomised implying that patients with a higher burden of tonsillitis symptoms may have declined entry into the trial. Conclusions The tonsillectomy arm had fewer sore throat days over 24 months than the conservative management arm, and had a high probability of being considered cost-effective over the ranges considered. Further work should focus on when tonsillectomy should be offered. National Trial of Tonsillectomy IN Adults has assessed the effectiveness of tonsillectomy when offered for the current UK threshold of disease burden. Further research is required to define the minimum disease burden at which tonsillectomy becomes clinically effective and cost-effective. Trial registration This trial is registered as ISRCTN55284102. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/146/06) and is published in full in Health Technology Assessment; Vol. 27, No. 31. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Wilson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Sonya Carnell
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Kim Ah-See
- Department of Otolaryngology Head and Neck Surgery, NHS Grampian, Aberdeen, UK
| | - Sean Carrie
- Ear, Nose and Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Hopkins
- Ear, Nose and Throat and Head and Neck Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Kenneth MacKenzie
- Department of Ear, Nose and Throat Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lorraine McSweeney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Christopher Raine
- Ear, Nose and Throat Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ruby Smith Whelan
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Sullivan
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Ahmed Abdelmaksoud A, Nafady A, Ezzeldin Sayed Bazeed S, Khalefa M, Elsamman MK, Abdelrhman Sayed MA, Qubaisy HM, Ghweil AA, Aref ZF. Lactoferrin versus Long-Acting Penicillin in Reducing Elevated Anti-Streptolysin O Titer in Cases of Tonsillopharyngitis. Infect Drug Resist 2022; 15:5257-5263. [PMID: 36097531 PMCID: PMC9464002 DOI: 10.2147/idr.s376401] [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: 05/30/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Beta-Hemolytic streptococci are the most frequent bacteria causing tonsillitis. Lactoferrin may play a role in the treatment of chronic tonsillitis due to its direct antimicrobial activity. Objective To assess the possible role of lactoferrin in reduction of raised serum Anti-Streptolysin O Titer (ASOT) in cases of chronic tonsillopharyngitis in comparison to long acting penicillin. Methods This study included 117 children with tonsillopharyngitis with high ASOT randomly divided into three groups; group 1 treated with lactoferrin, group 2 treated with long acting penicillin and group 3 treated with both drugs. For all patients ASOT was measured after three and six months of starting treatment. Results This study included 60 males and 57 females with the mean age (8.5 ± 2.4). There is statistically significant reduction in ASOT in all groups after three months of treatment. ASOT after 3 months was significantly lower in group1 (370±440) and group 3 (350±450) in comparison to group 2 (420±560) with p value 0.02, 0.004, respectively, with no significant difference in comparing group 1 to group 3 p value 0.4. Also, ASO titre after 6 months was significantly lower in group1 (350±420) and group 3 (340±440) in comparison to group 2 (420±550) with p value 0.02, 0.007, respectively, with no significant difference in comparing group 1 to group 3 p value 0.5. In comparing ASOT at three months and six months of treatment in the three studied groups; it decreased by 2% in group 1, and 1.6% in group 3 and no change in group 2. Conclusion Lactoferrin alone or in combination with long acting penicillin is safe and more effective than long acting penicillin alone in reducing ASOT. Treatment for six months with lactoferrin alone or in combination with long acting penicillin could offer a better response.
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Affiliation(s)
| | - Asmaa Nafady
- Clinical and Chemical Pathology, South Valley University, Qena, Egypt
| | | | | | | | | | | | - Ali A Ghweil
- Tropical Medicine and Gastroenterology, South Valley University, Qena, Egypt
| | - Zaki F Aref
- ENT, South Valley University, Qena, Egypt.,Department and Institution, ENT Department, Clinical and Chemical Chemistry Department Faculty of Medicine, South Valley University, Qena, Egypt
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Houborg HI, Klug TE. Quality of life after tonsillectomy in adult patients with recurrent acute tonsillitis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:2753-2764. [DOI: 10.1007/s00405-022-07260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
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Liu W, Gu W, Jin X, Wang J. Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China. Infect Drug Resist 2021; 14:4091-4096. [PMID: 34675554 PMCID: PMC8502109 DOI: 10.2147/idr.s334203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Surgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs. Patients and Methods Medical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed. Results No differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4–18) and 22 (8–35), 21 (4–39) and 50 (9–86), one (1–2) and two (1–4), and 31.5 (11–49) and 56 (19–98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1–2) and two (1–4), respectively, with no statistically significant difference (P = 0.336). Conclusion Simultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.
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Affiliation(s)
- Weijiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, People's Republic of China
| | - Wei Gu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaofeng Jin
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Long-term impact of paediatric tonsillectomy and adenotonsillectomy on the Paediatric Throat Disorders Outcome Test (T-14): a prospective observational study. The Journal of Laryngology & Otology 2021; 136:1066-1070. [PMID: 34593062 DOI: 10.1017/s0022215121002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Balai E, Bhamra N, Gupta K, Jolly K, Barraclough J. Implementation of an acute tonsillitis management protocol within a clinical decisions unit. Ann R Coll Surg Engl 2021; 103:690-693. [PMID: 34436947 DOI: 10.1308/rcsann.2021.0060] [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: 11/22/2022] Open
Abstract
INTRODUCTION With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department. METHODS Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy. RESULTS The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304-1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380-0.972; p = 0.038). CONCLUSIONS Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.
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Affiliation(s)
- E Balai
- The Royal Wolverhampton NHS Trust, UK
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, UK
| | - K Gupta
- The Royal Wolverhampton NHS Trust, UK
| | - K Jolly
- The Royal Wolverhampton NHS Trust, UK
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Sheikh Z, Tan ET, Ifedayo S, Quraishi MS. The role of sepsis screening, SIRS and qSOFA in head and neck infections: An audit of 104 patients. Clin Otolaryngol 2021; 46:1273-1277. [PMID: 34174167 DOI: 10.1111/coa.13828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Zain Sheikh
- Department of Otolaryngology, Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK.,University of Sheffield, Sheffield, UK
| | - E Tian Tan
- Department of Otolaryngology, Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Sunday Ifedayo
- Primary Care, West End Lane Clinic, Doncaster Royal Infirmary, Doncaster, UK
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Pankhania M, Rees J, Thompson A, Richards S. Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management. Ann R Coll Surg Engl 2021; 103:208-217. [PMID: 33645267 DOI: 10.1308/rcsann.2020.7030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits. MATERIALS AND METHODS A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance. RESULTS Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1-2%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period. DISCUSSION The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around £73 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is £56 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at £71 million with tonsillitis and its complications accounting for a further £8 million.
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Affiliation(s)
- M Pankhania
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
| | - J Rees
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
| | - A Thompson
- Sheffield Teaching Hospitals, Glossop Road, Sheffield
| | - S Richards
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
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A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031049. [PMID: 33504039 PMCID: PMC7908373 DOI: 10.3390/ijerph18031049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.
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Sanders O, Bolton L, Nemeth Z, Hardy A, Meghji S. A 4-year retrospective study of tonsillectomy rate and admission rate of tonsillitis and complications in the East of England and nationally. Eur Arch Otorhinolaryngol 2021; 278:2613-2618. [PMID: 33420839 DOI: 10.1007/s00405-020-06591-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Guidance set out by Scottish Intercollegiate Guidelines Network (SIGN) sought to restrict the frequency of elective tonsillectomy in reaction to the recognised and substantial risks of the procedure, namely pain and bleeding. With stricter criteria in place before a patient can undergo tonsillectomy, patients must endure more episodes of tonsillitis than was previously the case. The cost of managing tonsillitis and its complications as an inpatient is substantial to the NHS and also to the economy as a whole in missed work days. The authors sought to establish if the reduced rate of tonsillectomy performed had any effect on the rate of acute hospital admission for tonsillitis or the associated abscesses-peritonsillar, parapharyngeal and retropharyngeal. METHODS A retrospective multi-centre study reviewed admission data across a 4-year period. The rate of tonsillectomies performed for recurrent tonsillitis across four trusts in Mid-Essex was compared with the number of admissions for tonsillitis, peritonsillar, parapharyngeal and retropharyngeal abscesses. National hospital episode statistics data over a 5-year period was also analysed. RESULTS For the regional data in 2015, 979 tonsillectomies were performed across the four centres, reducing to 875 in 2018. There was no trend in the rates of acute tonsillitis requiring admission but the rates of peritonsillar abscess increased from 156 to 192 cases per year in the same period. This correlation was found not to be statistically significant in the measured sample size. The National hospital episode statistics data showed a significant correlation between tonsillectomy rates and admissions from complications of tonsillitis as well as the associated abscesses. CONCLUSION This study shows that the reduced tonsillectomy rate was correlated with an increased number of admissions with peritonsillar abscess regionally. Nationally reduced tonsillectomy rate is significantly associated with increased admissions with tonsillitis and all its complications. A decreased rate of tonsillectomy may be increasing the rate of serious tonsillitis. This has an impact on patient morbidity, an increasing financial burden on the NHS and the UK economy.
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Affiliation(s)
- O Sanders
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK.
| | - L Bolton
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Z Nemeth
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - A Hardy
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
| | - S Meghji
- Mid and South Essex Hospital Services NHS Trust, Chelmsford, UK
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Selwyn D, Yang D, Heward E, Kerai A, Thompson E, Shommakhi A, Faulkner S, Siau R, Walijee H, Hampton T, Chudek D, Singhera S, Din W, Lau AS. A prospective multicentre external validation study of the Liverpool Peritonsillar abscess Score (LPS) with a no-examination COVID-19 modification. Clin Otolaryngol 2020; 46:229-233. [PMID: 32997893 PMCID: PMC7646663 DOI: 10.1111/coa.13652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022]
Abstract
Objectives Our primary aim was to validate the Liverpool Peritonsillar abscess Score (LPS) externally in a new patient cohort. Our secondary aim was to modify the LPS in the light of the COVID‐19 pandemic to produce a no‐examination variant for use in this instance. Design Prospective multicentre external validation study. Setting Six different secondary care institutions across the United Kingdom. Participants Patients over 16 years old who were referred to ENT with any uncomplicated sore throat such a tonsillitis or peritonsillar abscess (PTA). Main outcome measures Sensitivity, specificity, positive predictive value and negative predictive value for both the original LPS model and the modified model for COVID‐19. Results The LPS model had sensitivity and specificity calculated at 98% and 79%, respectively. The LPS has a high negative predictive value (NPV) of 99%. The positive predictive value (PPV) was slightly lower at 63%. Receiver operating characteristic (ROC) curve, including the area under the curve (AUROC), was 0.888 which indicates very good accuracy. Conclusions External validation of the LPS against an independent geographically diverse population yields high NPV. This may support non‐specialist colleagues who may have concerns about mis‐diagnosing a PTA. The COVID‐19 modification of the LPS has a similar NPV, which may be of use where routine oral examination is to be avoided during the COVID‐19 pandemic.
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Affiliation(s)
| | - Ding Yang
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | | | | | | | | | | | | | - Tom Hampton
- Mersey ENT Research Collaborative (MERC), Merseyside, UK
| | | | | | - Waqas Din
- Bradford Royal Infirmary, Bradford, UK
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Alicja Chudek D, Wilson I, Hogg E, Emerson H, Heward E, Yang D, Selwyn D, Lau AS. A low fidelity Peritonsillar Abscess Drainage Simulator-Our experience of feedback from 117 trainees. Clin Otolaryngol 2020; 46:79-83. [PMID: 32920925 DOI: 10.1111/coa.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Imogen Wilson
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - Emma Hogg
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - Hannah Emerson
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - Elliot Heward
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - Ding Yang
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - David Selwyn
- ENT Department, University Hospital Aintree, Liverpool, UK
| | - Andrew S Lau
- ENT Department, University Hospital Aintree, Liverpool, UK
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Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation. The Journal of Laryngology & Otology 2019; 133:775-781. [DOI: 10.1017/s0022215119001610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractObjectiveThis study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.MethodsA prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.ResultsIn total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.ConclusionIntracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.
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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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A NEW TREATMENT MODALITY TO REDUCE ACUTE TONSILLITIS HEALING TIME. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e14-e19. [PMID: 31577081 DOI: 10.15586/jptcp.v26i2.616] [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: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute tonsillitis is one of the most common reasons for application to otorhinolaryngology clinics. In the treatment of acute tonsillitis, supportive therapies are mostly used. As antibiotic therapy, penicillin or erythromycin can be used. The aim of this study is to decrease the clinical recovery time of acute tonsillitis by providing parenteral treatment and daily cleaning of tonsillar lesions. MATERIAL AND METHODS Patients with an age range of 15-60 years were included in the study. The patients were divided into two groups. The first group used an i.v. combination of ampicillin + sulbactam and the tonsillar membranes of patients were cleaned daily. The second group used only the i.v. combination of ampicillin + sulbactam. RESULTS Patients who received antibiotherapy and debridement had a clinical improvement of 90% on the 2nd treatment day and 95% on the 5th treatment day. The patients receiving only antibiotics had a clinical improvement of 65% on the 5th treatment day and 75% on the 7th treatment day. The recovery time of both groups was significantly different (p < 0.05). CONCLUSION The solution and technique used in this clinical study showed that patients with acute tonsillitis could recover in a very short time without any complications.
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Windfuhr JP, Chen YS. Hospital admissions for acute throat and deep neck infections versus tonsillectomy rates in Germany. Eur Arch Otorhinolaryngol 2019; 276:2519-2530. [PMID: 31214826 DOI: 10.1007/s00405-019-05509-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate trends in hospital admissions in Germany for acute infections of the upper airway and deep neck in the context of the number of tonsil-related surgical procedures between 2005 and 2017. METHODS A retrospective longitudinal population-based cohort study was performed including all unplanned admissions for acute pharyngitis/tonsillitis, abscess formation of the peritonsillar or retropharyngeal/parapharyngeal space. Elective procedures included tonsillectomy (with or without adenoidectomy), secondary tonsillectomy, and tonsillotomy. Emergency operations encompassed abscess-tonsillectomy and transoral drainage procedures of the peritonsillar/parapharyngeal/retropharyngeal space. RESULTS 553.600 admissions were registered in total with a significant, stepwise increase between 2005 and 2017, including retropharyngeal/parapharyngeal abscess (47.0%), acute tonsillitis (30.8%), acute pharyngitis (26.5%) and peritonsillar abscess (7.9%). There were 1.323.984 elective operations with a significant decrease during the study period. A total of 188.316 emergency operations were done, a significant decrease in the number of abscess-tonsillectomies was compensated by the increased number of transoral peritonsillar abscess drainages. The number of transoral parapharyngeal and retropharygeal abscess drainage procedures did not change significantly (p = 0.846; p = 0.846). Negative correlation was significant between admissions for chronic tonsillitis and emergency admissions (Pearson correlation coefficient = - 0.879, p < 0.001) and also between elective and emergency operations (r = - 0.667; p = 0.013). CONCLUSIONS Concerning infections of the upper airway and deep neck spaces, German Hospitals have to prepare strategies for the increasing challenge by unplanned admissions and emergency operations. Further research is required to clarify whether this phenomenon is caused by the significant decrease in the number of elective operations.
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Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany.
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18
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Implementing a guideline for acute tonsillitis using an ambulatory medical unit. The Journal of Laryngology & Otology 2019; 133:386-389. [PMID: 30967160 DOI: 10.1017/s0022215119000380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission. METHODS A retrospective review of 48 patients' notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions. RESULTS The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase. CONCLUSION The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.
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Abstract
BACKGROUND The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise. METHOD In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted. RESULTS Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019). CONCLUSION The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.
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20
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Wilkie MD, De S, Krishnan M. Defining the role of surgical drainage in paediatric deep neck space infections. Clin Otolaryngol 2019; 44:366-371. [PMID: 30784193 DOI: 10.1111/coa.13315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/05/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Surgical drainage is the traditional mainstay of treatment of paediatric deep neck space infection (DNSI), but recently non-operative management in selected cases has been advocated. We sought to identify any characteristics predictive of requirement for surgical intervention. DESIGN Retrospective cohort study using receiver operating characteristics analyses. SETTING Tertiary referral paediatric hospital. PARTICIPANTS Children (≤16 years) with a radiologically confirmed diagnosis of retro- or parapharyngeal abscess over a ten-year period. MAIN OUTCOME MEASURES Predictive value of clinical and radiological variables in determining the requirement for surgical intervention. Length of hospital stay (LoS) was also examined. RESULTS Ninety-three children were studied, 15 (16.1%) of whom underwent immediate surgery, 42 (45.2%) of whom underwent delayed surgery following an initial period of conservative management, and 36 (38.7%) of whom were managed conservatively. Age, WCC and CRP were not predictive of the need for surgical drainage. Radiological abscess diameter, however, was predictive of requirement surgery (AUC = 0.85 [95% CI ± 0.09] P = 0.02), with a cut-off value of 2.5 cm determined assuming equal weight to sensitivity and specificity. All DNSIs were successfully treated with no adverse outcomes, and there was no significant difference in LoS between groups. In those managed surgically, outcome and LoS did not depend on yield of pus. CONCLUSIONS Selected paediatric DNSIs can be successfully managed conservatively, with abscess diameter >2.5 cm a significant predictor of need for surgical intervention. Any benefit of surgery does not appear to depend on intra-operative yield of pus.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Sujata De
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Madhankumar Krishnan
- Department of Otorhinolaryngology - Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
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Lau AS, Selwyn DM, Yang D, Swainbank L, Ridley P, Carmichael N, Metcalfe C, Watson G, Emerson H. The Liverpool Peritonsillar abscess Score: Development of a predictive score through a prospective multicentre observational study. Clin Otolaryngol 2019; 44:293-298. [PMID: 30663235 DOI: 10.1111/coa.13290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/17/2018] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non-specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non-specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals. DESIGN Prospective, multicentre observational study. SETTING Primary and secondary care. PARTICIPANTS Patients >16 years with symptoms of sore throat. DATA We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration-proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally. RESULTS 100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; and uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively. We validated the latest (third) iteration of the LPS internally (ie, on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85%; and negative predictive value 96%. The area under the receiver operating characteristics (AUROC) curve was 0.970. CONCLUSIONS We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non-specialist colleagues.
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Affiliation(s)
- Andrew S Lau
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Merseyside, UK
| | - David M Selwyn
- Mersey ENT Research Collaborative, Merseyside, UK.,Ainsdale Medical Centre, Southport, UK.,Ainsdale Village Surgery, Southport, UK
| | - Ding Yang
- Mersey ENT Research Collaborative, Merseyside, UK.,Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
| | - Liam Swainbank
- Mersey ENT Research Collaborative, Merseyside, UK.,St Hilary Group Practice, Wallasey, UK
| | - Paul Ridley
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Merseyside, UK
| | - Nicola Carmichael
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Merseyside, UK
| | - Christopher Metcalfe
- Mersey ENT Research Collaborative, Merseyside, UK.,Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
| | - George Watson
- Mersey ENT Research Collaborative, Merseyside, UK.,Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
| | - Hannah Emerson
- Mersey ENT Research Collaborative, Merseyside, UK.,Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
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Greydanus DE, Merrick J. Infectious mononucleosis: be aware of its lethality! Int J Adolesc Med Health 2019; 31:ijamh-2018-0284. [PMID: 30645196 DOI: 10.1515/ijamh-2018-0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Donald E Greydanus
- MD, DrHC (Athens), Founding Chair and Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Joav Merrick
- MD, MMedSci, DMSc, Professor of Pediatrics, Department of Pediatrics, Mt Scopus Campus, Hadassah Hebrew University Medical Center and Director, National Institute of Child Health and Human Development, Jerusalem, Israel
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Konieczny KM, Pitts-Tucker TN, Biggs TC, Pringle MB. A five-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy. Ann R Coll Surg Engl 2019; 101:40-43. [PMID: 30112941 PMCID: PMC6303835 DOI: 10.1308/rcsann.2018.0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The T-14 questionnaire is a validated outcome measurement tool to assess the value of paediatric tonsillectomy from a parent's perspective. There is a paucity of data regarding the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. Our previous study assessed T-14 scores up to year 2 postoperatively, with this study extending follow-up to 5 years. MATERIALS AND METHODS We undertook a prospective uncontrolled observational study examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children undergoing surgery were invited to complete a T-14 questionnaire preoperatively, as well as at 3 months, 6 months, 1 year, 2 years and now 5 years postoperatively. RESULTS In total, 44 of 54 patients completed questionnaires preoperatively and at all postoperative time points, with 46 being completed at 5 years. There was a highly significant (P < 0.001) difference between the preoperative scores and all other measured T-14 scores postoperatively. The mean score preoperatively was 33.3 compared with 1.0 at 5 years. CONCLUSIONS This is the first study to assess long-term quality of life following paediatric tonsillectomy using the T-14 questionnaire. The benefits of tonsillectomy on long-term quality of life further confirms its value within the paediatric population.
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Affiliation(s)
- KM Konieczny
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
| | - TN Pitts-Tucker
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - TC Biggs
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - MB Pringle
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
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Balfour-Lynn IM, Wright M. Acute Infections That Produce Upper Airway Obstruction. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7152287 DOI: 10.1016/b978-0-323-44887-1.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This chapter discusses the common and potentially serious infective causes of acute upper airway obstruction in children. The laryngeal anatomy of young children makes them particularly susceptible to upper airway obstruction, and during acute infections this is exacerbated by inflammation and edema of the airway mucosa. The most common cause of infective upper airway obstruction in children is viral laryngotracheobronchitis, or croup, which is usually a mild and self-limiting illness, but management with corticosteroids may still be necessary. Bacterial causes of upper airway obstruction have fortunately become rare since the introduction of the Haemophilus influenzae B (HiB) immunization, but a few cases of epiglottitis do still occur due to nonimmunization, vaccine failure, and infection with non-HiB organisms. These cases constitute a medical emergency due to the risk of rapid progression to complete airway obstruction. Other rare conditions are discussed including bacterial tracheitis, diphtheria, retropharyngeal, and peritonsillar abscesses. Key learning points in this chapter include the main discriminating factors of the various causes of infective upper airway obstruction, the importance of a calm and minimally distressing approach to the child presenting with stridor, and the need for early anesthetic team involvement in cases with a suspected bacterial etiology or signs of impending airway obstruction.
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Simard RD, Socransky S, Chenkin J. Transoral Point-of-Care Ultrasound in the Diagnosis of Parapharyngeal Space Abscess. J Emerg Med 2018; 56:70-73. [PMID: 30391146 DOI: 10.1016/j.jemermed.2018.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs. CASE REPORT A woman presented to the Emergency Department (ED) with fever, sore throat, trismus, and unilateral tonsillar swelling from a walk-in clinic with a preliminary diagnosis of PTA for drainage. A POCUS performed by the emergency medicine resident in the ED demonstrated normal tonsils. However, it revealed evidence of a PPSA. A computed tomography scan was performed, which confirmed the diagnosis. The patient was admitted to the otolaryngology service for antibiotics and steroids, with subsequent improvement and discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the use of POCUS in the ED avoided an unnecessary invasive procedure, and facilitated the correct diagnosis of an uncommon condition.
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Affiliation(s)
| | - Steve Socransky
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jordan Chenkin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
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Douglas CM, Altmyer U, Cottom L, Young D, Redding P, Clark LJ. A 20-year observational cohort of a 5 million patient population-Tonsillectomy rates in the context of two national policy changes. Clin Otolaryngol 2018; 44:7-13. [DOI: 10.1111/coa.13233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Catriona M. Douglas
- Department of Otolaryngology - Head and Neck Surgery; Queen Elizabeth University Hospital; Glasgow UK
| | - Ursula Altmyer
- Department of Microbiology; Queen Elizabeth University Hospital; Glasgow UK
| | - Laura Cottom
- Department of Microbiology; Queen Elizabeth University Hospital; Glasgow UK
| | - David Young
- Department of Statistics; Strathclyde University; Glasgow UK
| | - Penelope Redding
- Department of Microbiology; Queen Elizabeth University Hospital; Glasgow UK
| | - Louise J. Clark
- Department of Otolaryngology - Head and Neck Surgery; Queen Elizabeth University Hospital; Glasgow UK
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Banigo A, Moinie A, Bleach N, Chand M, Chalker V, Lamagni T. Have reducing tonsillectomy rates in England led to increasing incidence of invasive Group AStreptococcusinfections in children? Clin Otolaryngol 2018; 43:912-919. [DOI: 10.1111/coa.13095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- A. Banigo
- ENT Department; Heatherwood and Wexham Park Hospitals NHS Trust; Slough UK
- ENT Department; Aberdeen Royal Infirmary; Aberdeen UK
| | - A. Moinie
- ENT Department; Aberdeen Royal Infirmary; Aberdeen UK
| | - N. Bleach
- ENT Department; Heatherwood and Wexham Park Hospitals NHS Trust; Slough UK
| | - M. Chand
- Public Health England; London UK
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Infections of the Upper and Middle Airways. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152082 DOI: 10.1016/b978-0-323-40181-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Hurley RH, Douglas CM, Montgomery J, Clark LJ. The hidden cost of deep neck space infections. Ann R Coll Surg Engl 2017; 100:129-134. [PMID: 29046089 DOI: 10.1308/rcsann.2017.0193] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The incidence of deep neck space infection (DNSI) is rising and appears to be related to falling rates of tonsillectomy. The purpose of this study was to assess demographics of patients presenting with DNSI and the financial burden to the National Health Service (NHS). Methods Data were collected retrospectively on patients aged over 16 years admitted to NHS Greater Glasgow and Clyde with DNSI between 2012 and 2016. Demographics, aetiology and use of hospital resources were reviewed. The cost of hospital admissions was calculated using data from NHS Scotland's Information Services Division, the local diagnostics division and the British National Formulary. Results Seventy-four patients were admitted with DNSI during the study period. Forty (54%) were male. The mean age was 44.0 years (range: 16-86 years). The most frequent source of infection was the tonsil (n=30, 40.5%). The most common infective organism was Streptococcus constellatus (n=9, 12.2%). The mean length of stay was 11 days. Fifty-five patients (74.3%) required operative intervention. The mean cost of admission per patient was £5,700 (range: £332-£46,700). Conclusions This study highlights the high cost burden of DNSI to the NHS. The incidence of DNSI in Glasgow has risen over the study period; contributing factors may include the reduced tonsillectomy rate and a reduction in antibiotic prescribing. As the incidence of DNSI continues to rise, there will be an increase in cost to the NHS, which must be planned for.
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Juul ML, Rasmussen ER, Rasmussen SHR, Sørensen CH, Howitz MF. A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991-2012. Clin Otolaryngol 2017; 43:274-284. [DOI: 10.1111/coa.12959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Louise Juul
- Department of Otorhinolaryngology; Head & Neck Surgery and Audiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Eva Rye Rasmussen
- Department of Otorhinolaryngology; Head & Neck Surgery and Audiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | | | - Christian Hjort Sørensen
- Department of Otorhinolaryngology; Head & Neck Surgery and Audiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Michael Frantz Howitz
- Department of Otorhinolaryngology; University Hospital Hillerød; Dyrehavevej Denmark
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Douglas CM, Lang K, Whitmer WM, Wilson JA, Mackenzie K. The effect of tonsillectomy on the morbidity from recurrent tonsillitis. Clin Otolaryngol 2017; 42:1206-1210. [PMID: 28199053 DOI: 10.1111/coa.12850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year.1 Recurrent tonsillitis results in significant morbidity and impacts on individuals' quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. OBJECTIVES To describe disease-specific and global quality of life for adults with recurrent tonsillitis 6 months after tonsillectomy, using two instruments: the health impact of throat problems (HITP) and EuroQol-visual analogue scale questionnaire. To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory (GBI). To assess potential predictors of tonsillectomy benefit. DESIGN A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy.2 SETTING: Secondary care, teaching hospital. PARTICIPANTS Seventy patients (57 female), median age 20 years (range 13-41). RESULTS Median preoperative HITP was 47 (range 15-67), compared to 4 (0-72), (P<.001) 6 months following surgery. Median HITP difference was 39.5 (range -20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (-3 to 100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before "achieving" tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years. CONCLUSIONS Recurrent tonsillitis causes a poor disease-specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease-specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue delay.
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Affiliation(s)
- C M Douglas
- Department of Otolaryngology - Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - K Lang
- Department of Otolaryngology - Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - W M Whitmer
- MRC/CSO Institute of Hearing Research - Scottish Section, Glasgow Royal Infirmary, Glasgow, UK
| | - J A Wilson
- Department of Otolaryngology - Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - K Mackenzie
- Department of Otolaryngology - Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK
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Borgström A, Nerfeldt P, Friberg D, Sunnergren O, Stalfors J. Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study. BMJ Open 2017; 7:e013346. [PMID: 28087550 PMCID: PMC5253564 DOI: 10.1136/bmjopen-2016-013346] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/14/2016] [Accepted: 12/06/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions. SETTING A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden. PARTICIPANTS All Swedish children 1-<18 years registered in the NPR with a tonsil surgery procedure 1987-2013. RESULTS 167 894 tonsil surgeries were registered in the NPR 1987-2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1-3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs. CONCLUSIONS There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1-3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.
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Affiliation(s)
- Anna Borgström
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, StockholmSweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, StockholmSweden
| | - Danielle Friberg
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, StockholmSweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden
| | - Joacim Stalfors
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
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Yap D, Harris AS, Clarke J. Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis. Ann R Coll Surg Engl 2017; 99:31-36. [PMID: 27513803 PMCID: PMC5392795 DOI: 10.1308/rcsann.2016.0261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Sore throat and tonsillitis place a significant burden on the National Health Service. National guideline criteria for gauging the severity of sore throat and tonsillitis have reduced the number of tonsillectomies performed, which is thought to have increased the rate of tonsil-related infections. METHODS Data was extracted from the prospective Patient Episode Database of Wales and analysed to determine the annual number of tonsillectomies for recurrent tonsillitis, adjusted for population changes. Admissions to acute hospitals for tonsillitis, peritonsillar abscess and deep neck space abscesses were also examined. RESULTS Between 1999 and 2014, hospital admissions for tonsillitis rose three-fold (r=0.968), while admissions for peritonsillar abscess rose by 48% (r=0.857) and retro or parapharyngeal abscess admissions also increased (r=0.709). In contrast, the number of tonsillectomies per 100,000 population gradually decreased (r=-0.16). There was a positive correlation between the incidence of tonsillitis and admissions for peritonsillar abscess (adjusted r2 0.631; p=0.015) and retropharyngeal abscess (adjusted r2 0.442; p=0.00254). There was a statistically significant negative correlation between the incidence of tonsillitis and the number of tonsillectomies performed (adjusted r2=-0.07; p=0.0235). CONCLUSIONS The significant rise in tonsillitis in Wales raises the question as to whether we should revisit the criteria for tonsillectomy. The perceived cost saving from limiting certain procedures should not prevent healthcare policymakers from considering all other evidence. The rise in peritonsillar, retropharyngeal and parapharyngeal abscess is alarming, as they are associated with significant morbidity and mortality.
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Affiliation(s)
- D Yap
- Royal Gwent Hospital, Aneurin Bevan University Health Board , Newport , Wales
| | - A S Harris
- Royal Gwent Hospital, Aneurin Bevan University Health Board , Newport , Wales
| | - J Clarke
- Royal Gwent Hospital, Aneurin Bevan University Health Board , Newport , Wales
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Mcleod R, Brahmabhatt P, Owens D. Tonsillectomy is not a procedure of limited value - the unseen costs of tonsillitis and quinsy on hospital bed consumption. Clin Otolaryngol 2016; 42:573-577. [PMID: 27754588 DOI: 10.1111/coa.12773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of the introduction of the SIGN Clinical guidelines in 1999 and subsequent revision in 2005 on tonsillectomy, hospital admission with tonsillitis and peritonsillar abscess rates in four countries. METHODS Retrospective analysis using English, Welsh, Australian and New Zealand National healthcare hospital admission databases between 2000 and 2013. Primary outcomes measures included tonsillectomy rates and hospital admission rates for tonsillitis and peritonsillar abscess. Secondary outcome measures included bed-day usage in England and Wales. Linear forecasting was used to identify the potential impact of any trends. RESULTS Following guideline introduction for tonsillectomy, a significant decline in tonsillectomy rates in England (P < 0.01) and Wales (P < 0.05) was seen. Hospital admissions for acute tonsil infections increased in England (P < 0.01) and Wales (P < 0.01). In Australia and New Zealand, tonsillectomy and admission for tonsillitis rates both increased (P < 0.01). During this time, the increased rate of admission for tonsillitis in England and Wales was significantly greater than Australasia (P < 0.01). CONCLUSIONS Following the introduction of these Clinical guidelines, there was a decrease in the rate of tonsillectomy in England and Wales and a presumed associated increase in admissions with tonsillitis. This did not occur in Australasia where tonsillectomy rates rose over time. If these trends continue, it is likely that they will have a significant deleterious impact on healthcare spending in the future.
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Affiliation(s)
- R Mcleod
- University Hospital of Wales, Cardiff, UK
| | | | - D Owens
- University Hospital of Wales, Cardiff, UK
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Collis DH, Sanu A. Zygomatic haematoma in an 11-month-old helps diagnose retropharyngeal abscess, with concurrent tonsillitis and subsequent infant tonsillectomy. BMJ Case Rep 2016; 2016:bcr-2016-215135. [PMID: 27651403 DOI: 10.1136/bcr-2016-215135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 11-month-old boy presented with a 2-day history of non-specific symptoms and a zygomatic haematoma. With aetiology uncertain after admission clerking and blood tests, a CT head scan was arranged for suspected traumatic injury and revealed a retropharyngeal abscess (RPA) with significant airway narrowing in the transverse plane. The patient received urgent intraoral abscess drainage and bilateral tonsillectomy in theatre. This case highlights the need for a high index of suspicion regarding RPAs. These abscesses have potentially fatal sequelae and are difficult to diagnose in the infant paediatric population.
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Affiliation(s)
- David H Collis
- Department of Otolaryngology, Morriston Hospital, Swansea, UK
| | - Ameeth Sanu
- Department of Otolaryngology, Morriston Hospital, Swansea, UK
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Gahleitner C, Hofauer B, Stark T, Knopf A. Predisposing factors and management of complications in acute tonsillitis. Acta Otolaryngol 2016; 136:964-8. [PMID: 27109151 DOI: 10.3109/00016489.2016.1170202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION RPA and NF was diagnosed with a sensitivity/specificity of 100%/94% in patients with acute tonsillitis and without suspicion for disease complication after ENT examination, but an age >35 years and serum CRP >15.5mg/dl. BACKGROUND Acute tonsillitis represents a frequent disease in the otorhinolaryngology. Some patients exhibit disease aggravations resulting in (descending) peritonsillar abscess (PTA, dPTA), para-/retropharyngeal abscess (PPA, RPA), or necrotising fasciitis (NF). The study analyses the underlying predisposing factors. METHODS The retrospective cohort study includes a total of 1636 patients comprising 852 outpatients with acute bacterial tonsillitis, 279 in-patients with acute bacterial tonsillitis, 452 patients with PTA, 31 patients with dPTA/PPA, 12 patients with RPA, and 10 patients with NF. Patients were analysed for disease-related data. RESULTS While leucocytes do not distinguish the sub-groups, C-reactive protein demonstrated a significant increase resulting in the highest level for RPA and NF (p < 0.0001). PTA and RPA are usually caused by streptococcus, dPTA/PPA by anaerobic bacterias, and NF mixed infections (p < 0.0001). Patients with PTA were younger than dPTA/PPA (p = 0.002) or RPA/NF (p < 0.0001). Subsequently, the rate of internistic comorbidities was significantly increased in RPA/NF (p < 0.0001). ROC-analysis identified cut-offs for age <36 years and CRP <15.5mg/dl to distinguish acute bacterial tonsillitis from RPA.
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Affiliation(s)
- Constanze Gahleitner
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Benedikt Hofauer
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Thomas Stark
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Andreas Knopf
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
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Wei L, MacDonald T, Shimi S. Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study. Fertil Steril 2016; 106:1150-1156. [PMID: 27393836 DOI: 10.1016/j.fertnstert.2016.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To study pregnancy rates after appendectomy and/or tonsillectomy. DESIGN Population-based cohort study using the United Kingdom (U.K.) primary health care-based Clinical Practice Research Datalink (CPRD). SETTING Not applicable. PATIENT(S) Female patients who underwent appendectomy, tonsillectomy, or both from 1987 to 2012 and appropriate comparators. INTERVENTION(S) Timed follow-up until first pregnancy after surgery. The association between prior surgery and subsequent pregnancy was determined with the use of Cox regression models. MAIN OUTCOME MEASURE(S) Pregnancy rate and time to first pregnancy after surgery. RESULT(S) The analyses included 54,675 appendectomy-only patients, 112,607 tonsillectomy-only patients, 10,340 patients who had both appendectomy and tonsillectomy, and 355,244 comparators matched for exact age and practice from the rest of female patients in the database. There were 29,732 (54.4%), 60,078 (53.4%), and 6,169 (59.7%) pregnancies in the appendectomy-only, tonsillectomy-only, and both appendectomy tonsillectomy cohorts, respectively versus 155,079 (43.7%) in the comparator cohort during a mean follow-up of 14.7 ± 9.7 years. Adjusted hazard ratios (HRs) for subsequent birth rates were 1.34 (95% confidence interval [CI] 1.32-1.35), 1.49 (95% CI 1.48-1.51), and 1.43 (95% CI 1.39-1.47), respectively. Time to pregnancy was shortest after both appendectomy and tonsillectomy followed by appendectomy only and then tonsillectomy only compared with the rest of the population. CONCLUSION(S) Appendectomy and/or tonsillectomy was associated with increased subsequent pregnancy rates and shorter time to pregnancy. The effect of the surgical procedures on the pregnancy outcome was cumulative.
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Affiliation(s)
- Li Wei
- Department of Practice and Policy, School of Pharmacy, University College London, London
| | - Thomas MacDonald
- Medicines Monitoring Unit, Medical Research Institute, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Sami Shimi
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
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Thong G, Davies K, Murphy E, Keogh I. Significant improvements in quality of life following paediatric tonsillectomy: a prospective cohort study. Ir J Med Sci 2016; 186:419-425. [PMID: 26782690 DOI: 10.1007/s11845-016-1398-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical efficacy of adenotonsillectomy is under debate with falling tonsillectomy rates in the UK and Ireland. In 2010, an NHS commissioned randomised controlled trial recommended medical management, leading to some Primary Care Trusts refusing to commission any tonsillectomies at all. With the HSE cutting Hospital Spending by €200 million euro in 2014, data supporting the benefit of adenotonsillectomy in the Irish population are sorely lacking. AIMS We aimed to evaluate the symptomatic benefit reported by parents of children undergoing adenotonsillectomy/tonsillectomy in the Irish population. METHODS We utilised the T14 Paediatric Throat disorders Outcome Test, a disease-specific, validated questionnaire which assesses patient reported outcome measures (PROMs). We administered pre and post-operative questionnaires to parents of children ages 3-16 years undergoing tonsillectomy. Symptomatic children on our tonsillectomy waiting list were also simultaneously recruited. RESULT Eighty-six children were recruited. A total of 55 parents of children undergoing tonsillectomy filled questionnaires. These were well matched in age and gender with 31 children on the waiting list. An independent samples t test was conducted to compare the improvement scores for tonsillectomy and control groups. There was a significant difference in scores for the tonsillectomy group, with pre-operative scores of (M = 39.8, SD = 9.7) and at post-operative follow-up of (M = 1.6, SD = 7.3) t (61) = -18, p ≤ 0.0001 (two tailed). This correlated with a significant difference in the mean between the two periods (mean difference = 38.3, 95 % CI: 42.3-34.1). CONCLUSION This study provides clear evidence that tonsillectomy provides significant improvement in PROMs vs. watchful waiting. We consider tonsillectomy to be a procedure of considerable clinical benefit and a worthwhile allocation of HSE expenditure.
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Affiliation(s)
- G Thong
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland.
| | - K Davies
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - E Murphy
- Department of Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - I Keogh
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
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Konieczny KM, Biggs TC, Pringle MB. A two-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy. Ann R Coll Surg Engl 2015; 97:382-5. [PMID: 26264092 DOI: 10.1308/003588415x14181254790248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The T-14 questionnaire is a validated patient reported outcome measure used to assess the value of paediatric tonsillectomy from the patient's perspective. There are currently limited data revealing the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. A previously published study was therefore extended to provide additional data at 12 and 24 months following surgery. METHODS A prospective uncontrolled observational study was undertaken examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children having surgery were invited to complete a T-14 questionnaire preoperatively as well as at 3, 6 (previously published), 12 and 24 months postoperatively. RESULTS The questionnaire was completed for 50 of the 54 patients preoperatively as well as at 3, 6 and 12 months postoperatively, with 44 being completed at 24 months. The mean difference between the preoperative T-14 scores and the scores at 3, 6, 12 and 24 months following surgery were highly statistically significant (p<0.001). CONCLUSIONS This is the first study published in the literature to assess the T-14 questionnaire at 12 and 24 months following paediatric tonsillectomy, providing evidence of the ongoing benefit of patient reported outcome measures. This further confirms the value of tonsillectomy in the paediatric population and demonstrates its ongoing positive effects on quality of life.
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Affiliation(s)
- K M Konieczny
- University Hospital Southampton NHS Foundation Trust , UK
| | - T C Biggs
- University Hospital Southampton NHS Foundation Trust , UK
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Multicentre prospective clinical application of the T14 paediatric outcome tool. The Journal of Laryngology & Otology 2015; 129:980-5. [PMID: 26259840 DOI: 10.1017/s0022215115000924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to measure changes in disease-specific quality of life in children following tonsillectomy or adenotonsillectomy. METHODS A multicentre prospective cohort study was performed involving seven ENT departments in England. A total of 276 children entered the study over a 2-month period: 107 underwent tonsillectomy and 128 adenotonsillectomy. Forty-one children referred with throat problems initially managed by watchful waiting were also recruited. The follow-up period was 12 months. Outcome measures were the T14, parental impressions of their child's quality of life and the number of days absent from school. RESULTS One-year follow-up data were obtained from 150 patients (52 per cent). The mean baseline T14 score in the non-surgical group was significantly lower (T14 = 23) than in the tonsillectomy group (T14 = 31) or the adenotonsillectomy group (T14 = 35; p < 0.001). There was a significant improvement in the T14 scores of responders in all groups at follow up. The effect size was 1.3 standard deviations (SD) for the non-surgical group, 2.1 SD for the tonsillectomy group and 1.9 SD for the adenotonsillectomy group. Between-group differences did not reach statistical significance. A third of children in the non-surgical group underwent surgery during the follow-up period. CONCLUSION Children who underwent surgical intervention achieved a significant improvement in disease-specific quality of life. Less severely affected children were managed conservatively and also improved over 12 months, but 1 in 3 crossed over to surgical intervention.
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Qureshi H, Ference E, Novis S, Pritchett CV, Smith SS, Schroeder JW. Trends in the management of pediatric peritonsillar abscess infections in the U.S., 2000-2009. Int J Pediatr Otorhinolaryngol 2015; 79:527-31. [PMID: 25708703 DOI: 10.1016/j.ijporl.2015.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To analyze temporal trends in the incidence and surgical management of children with peritonsillar abscesses (PTAs), and to examine whether there has been concurrent changes in hospital charges or length of stay. METHODS The Kids' Inpatient Database (KID) from 2000 to 2009 was examined for children less than 18 years old with ICD-9-CM diagnostic codes for PTA (475). Survey weighted frequency and regression analyses were performed across the entire study period on variables of interest in order to determine estimates of national incidence, demographics and outcomes. RESULTS A total of 20,546 weighted cases of PTA were identified during the study period. There was no significant change in the incidence of pediatric PTA across the study period (p=0.63) or in the rate of nonsurgical management (p=0.85). There was a significant increase in the rates of I&D from 26.4% to 33.7% (p<0.001) and a significant decrease in the rate of tonsillectomy from 13.0% to 7.8% (p<0.001). Mean inflation-adjusted charges significantly increased from approximately $8400 in 2000 to $13,300 in 2009 (p<0.001), and average length of stay was 2.15 days with no significant change during the study period (p=0.164). Mean inflation-adjusted charges for patients undergoing tonsillectomy alone were approximately $1800 greater than mean charges for those undergoing I&D alone (p=0.003) and length of stay was also significantly longer for tonsillectomy patients versus I&D patients [I&D 1.99 days versus tonsillectomy 2.23 days (p<0.001)]. CONCLUSIONS There was no change in the incidence of pediatric PTAs from 2000 to 2009 but there was a change in surgical management, with a significant decrease in the rate of tonsillectomy and significant increase in the rate of incision and drainage procedures. Hospital charges during this period increased nearly 60% despite no change in rates of CT imaging, surgical intervention or length of stay.
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Affiliation(s)
- Hannan Qureshi
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elisabeth Ference
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Sarah Novis
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Cedric V Pritchett
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, United States
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James W Schroeder
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, United States
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Shelton F, Biggs TC, Henderson A, Patel NN. Procedures of limited clinical value in ENT: what effect has there been on operating numbers? Clin Otolaryngol 2015; 40:396-9. [PMID: 25711626 DOI: 10.1111/coa.12401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- F Shelton
- Department of ENT Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T C Biggs
- Department of ENT Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Henderson
- Department of ENT Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N N Patel
- Department of ENT Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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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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Ruben R. One size does not fit all! Int J Pediatr Otorhinolaryngol 2015; 79:1. [PMID: 25433375 DOI: 10.1016/j.ijporl.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robert Ruben
- Department of Otolaryngology, Montefiore Medical Center, New York, USA.
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Science M, Bitnun A, McIsaac W. Identifying and treating group A streptococcal pharyngitis in children. CMAJ 2014; 187:13. [PMID: 25512654 DOI: 10.1503/cmaj.141532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics (Science, Bitnun), The Hospital for Sick Children; Granovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine (McIsaac), Mount Sinai Hospital, University of Toronto; Department of Community and Family Medicine (McIsaac), University of Toronto, Toronto, Ont.
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics (Science, Bitnun), The Hospital for Sick Children; Granovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine (McIsaac), Mount Sinai Hospital, University of Toronto; Department of Community and Family Medicine (McIsaac), University of Toronto, Toronto, Ont
| | - Warren McIsaac
- Division of Infectious Diseases, Department of Paediatrics (Science, Bitnun), The Hospital for Sick Children; Granovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine (McIsaac), Mount Sinai Hospital, University of Toronto; Department of Community and Family Medicine (McIsaac), University of Toronto, Toronto, Ont
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Van Brusselen D, Vlieghe E, Schelstraete P, De Meulder F, Vandeputte C, Garmyn K, Laffut W, Van de Voorde P. Streptococcal pharyngitis in children: to treat or not to treat? Eur J Pediatr 2014; 173:1275-83. [PMID: 25113742 DOI: 10.1007/s00431-014-2395-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Controversy remains about the need for antibiotic therapy of group A streptococcal (GAS) pharyngitis in high-resource settings. Guidelines on the management of GAS pharyngitis differ considerably, especially in children. We performed a literature search on the diagnosis and treatment of GAS pharyngitis in children and compared different guidelines with current epidemiology and the available evidence on management. Some European guidelines only recommend antibiotic treatment in certain high-risk patients, while many other, including all American, still advise antimicrobial treatment for all children with GAS pharyngitis, given the severity and re-emerging incidence of complications. Empirical antimicrobial treatment in children with sore throat and a high clinical suspicion of GAS pharyngitis will still result in significant overtreatment of nonstreptococcal pharyngitis. This is costly and leads to emerging antibiotic resistance. Early differential diagnosis between viral and GAS pharyngitis, by means of a 'rapid antigen detection test' (RADT) and/or a throat culture, is therefore needed if 'pro treatment' guidelines are used. CONCLUSION Large scale randomized controlled trials are necessary to assess the value of antibiotics for GAS pharyngitis in high-resource countries, in order to achieve uniform and evidence-based guidelines. The severity and the possibly increasing incidence of complications in school-aged children suggests that testing and treating proven GAS pharyngitis can still be beneficial.
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Affiliation(s)
- Daan Van Brusselen
- Department of Pediatrics, University of Leuven, Herestraat 49, 3000, Leuven, Belgium,
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