Peritonsillar abscesses in children

A follow-up retrospective study was performed on 41 children who presented with peritonsillar abscesses from 1970–1980. The ages ranged from 3 to 16 years, with the mean age of 10 years. There were 26 females and 15 males. The abscesses were predominantly left-sided (28 vs. 13 right-sided) and the mean duration of symptoms was 3 days. Of the patients, 39% had been treated with antibiotics prior to the abscess development. Only 15% of the patients had a documented past history of exudative tonsillitis. Of the 41, 1 patient was lost to follow-up, and 11 underwent tonsillectomy for the abscess. Thus, 29 patients were reviewed who received no surgical therapy for their peritonsillar abscess other than incision and drainage. These patients were contacted for an interval history with a period of follow-up ranging from 6 months to 10 years. Only 2 of the 29 patients (7%) had recurrent abscesses. Two other patients (7%) had further recurrent bouts of exudative tonsillitis but not abscesses. These 4 children were in an initial group of 6 who had a prior history of documented tonsillitis. The incidence of recurrent peritonsillar abscesses reported in the literature has ranged from 7.6 to 16% in series which were comprised mainly of adults. The low incidence of recurrent abscesses (7%) in this series would indicate a need to reevaluate the indication for tonsillectomy for peritonsillar abscess in the pediatric age group. The authors recommend that tonsillectomy be performed in those children who present with a pervious history of documented tonsillitis or suffer a complication at the time of the first abscess (neck abscess or airway compromise).     

扁桃体周围脓肿的治疗和病理观察

本文分析 153例扁桃体周围脓肿的临床治疗过程 ,治疗方法包括广谱抗生素 ,反复针穿刺排脓及扁桃体摘除术。 153例中经穿刺排脓治愈者 79例 (51.6 % ) ;最后行扁桃体摘除术者 72例(4 7.1% )。对 56例扁桃体周围脓肿的扁桃体进行病理观察 ,发现扁桃体周围脓肿的扁桃体中 Weber's腺普遍呈萎缩表现 ,提示扁桃体周围脓肿发病机理可能与 Weber's腺感染有一定关系。     

Abscess tonsillectomy for acute peritonsillar abscess

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

Peritonsillar infections: prospective study of 100 consecutive cases

IntroductionPeritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis.Material and methodsWe prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration.ResultsSeventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%.ConclusionsDue to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.     

Peritonsillar abscess in children and its indication for tonsillectomy

38 children aged 1-15 years treated for peritonsillar abscess (PTA) between 1976 and 1986 have been reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (T+) (10 patients = 26.3%) and those without such history (T-) (28 patients = 73.4%). 19 patients were surgically drained, 2 abscesses ruptured spontaneously, 2 patients were treated by repeated needle aspirations and 15 patients were treated by medication only. Neither the pre-PTA history (T+ versus T-) nor the mode of treatment during the acute event showed any significant differences in comparing the recurrency rate of PTA or tonsillitis. Therefore, it seems that a single event of PTA among pediatric population should not be considered an indication for tonsillectomy.     

Peritonsillar abscess: recurrence rate and the indication for tonsillectomy

Two hundred ninety patients treated for peritonsillar abscess (PTA) between 1970 and 1982 were reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%). The patients in the first group had four times more recurrences than those in the second group (40% versus 9.6%). Patients older than 40 years were found to have a lower incidence of throat infections than younger patients, and no PTA recurrences were observed. Neither subsequent tonsillitis nor recurrent PTA was observed among 72 patients (25%) who underwent tonsillectomy 6 to 12 weeks after PTA. The pre-PTA history was found to be a dominant factor in determining the need for tonsillectomy. In patients who suffered from recurrent tonsillitis prior to PTA, tonsillectomy is recommended. In those with a single episode of PTA and no history of tonsillitis, tonsillectomy is not indicated.     

Peritonsillar abscess: the rationale for interval tonsillectomy

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

Management of peritonsillitis/peritonsillar

Peritonsillitis and peritonsillar abscess (quinsy) are commonly encountered emergencies in day to day ENT practice. However the value of a tonsillectomy as well as its timing in these cases is debatable amongst Otolaryngologists. A postal survey performed amongst practising ENT surgeons in the U.K. revealed that 475 out of 571 ENT surgeons (83%) prefer to "wait and observe" for a single isolated attack of peritonsillitis/peritonsillar abscess while 86 surgeons (15%) would routinely advocate interval tonsillectomy after an attack of peritonsillitis/quinsy. In patients without a background history of tonsillitis, 432 of the 475 ENT surgeons (90.9%) would advise a tonsillectomy after the second attack of peritonsillitis/quinsy whereas 30 surgeons (6.3%) would do so only after a third attack. A retrospective study of 207 patients was performed to evaluate the safety of a "wait and observe" policy. One hundred and four of the 129 adults (88.3%) and 5 out of the 6 children (83.2%) who did not undergo a tonsillectomy remained asymptomatic after the single isolated attack of peritonsillitis/quinsy. Four adults (3.1%) and 1 child (16.6%) required a tonsillectomy eventually for recurring attacks of tonsillitis. Recurrence of peritonsillitis/peritonsillar abscess was observed in 11 patients (8.5%). These results suggest that a "wait and observe" policy is safe for most patients presenting with a single attack of peritonsillitis/peritonsillar abscess without a background history of tonsillitis.     

Otolaryngology Consultation for Peritonsillar Abscess in the Pediatric Population

Objective To assess clinical outcomes of children seen in consultation for peritonsillar abscess treated without the routine use of computed tomography or needle aspiration. Study Design Retrospective review of patients evaluated in the emergency department for possible peritonsillar abscess. Patient outcomes are reviewed with a statistical analysis of children grouped according to age. Methods A series of 102 patients, ages 8 months to 19 years, who were evaluated by the emergency department with otolaryngology consultation for possible peritonsillar abscess. All patients were admitted and given intravenous fluid replacement, antibiotics, and analgesia. Patients who responded to 24 hours of medical treatment were discharged, whereas patients who did not respond underwent elective tonsillectomy. Main Outcome Measure Outcome of patients evaluated for peritonsillar abscess treated without immediate surgery, needle aspiration, or computed tomography. Outcomes are correlated with age and clinical findings. Results Fifty‐two patients were discharged after initial medical therapy. Fifty patients underwent elective tonsillectomy; 40 of these patients were found to have abscesses at the time of surgery. When analyzed according to age, patients ages 8 months to 6 years were more likely to respond to medical treatment than children ages 7 to 12 and 12 to 19 (P = .023). Significant differences in the mean age of children requiring surgery (11.0 y) compared with those who responded to medical treatment (7.9 y) were observed (P = .003). Younger children who underwent tonsillectomy had a lower incidence of surgically confirmed abscess. Conclusions A significant number of children presenting with odynophagia, malaise, pharyngotonsillar bulge, and decreased oral intake respond to medical therapy without radiological evaluation or surgical intervention. Additionally, younger children (1–6 y) are more likely to respond to medical treatment than older children. Pertinent clinical data, as well as advantages and disadvantages of this approach, are discussed.     

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

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

Routine abscess tonsillectomy: late results.

The late results of abscess tonsillectomy as a routine treatment of peritonsillar abscess were investigated. The material comprises 113 patients. Follow-up was performed two to five years after the operation (bilateral dissection tonsillectomy under general anesthesia). Symptoms of pharyngitis, recurrent or chronic, were present in 17 percent of the patients, in most cases without major objective changes in the throat. The incidence of these symptoms was highest--70 percent--in patients past middle age without any history of trouble from the throat before the peritonsillar abscess. Tonsil remnants were seen in 28 percent, but only 6 percent of the patients had new episodes of febrile throat infections. The results are discussed. A reserved attitude to abscess tonsillectomy (and to interval tonsillectomy) is recommended for peritonsillar abscess in elderly patients without previous trouble from the throat.     

Management of peritonsillar abscess

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

A randomized trial for outpatient management of peritonsillar abscess

In order to compare the efficacy of permucosal needle drainage with that of incision and drainage in the outpatient management of peritonsillar abscess, 52 patients with aspiration-proven peritonsillar abscess were entered into a randomized, prospective protocol. A symptomatic scale scoring system was employed to evaluate treatment results. In the needle drainage group, 92% (22/24) were cured with a single aspiration. Ninety-three percent (26/28) of the patients in the incision and drainage group were cured on the initial attempt. The remainder of the patients in both groups were cured with a single retreatment. Only one patient required hospitalization, and no patients required tonsillectomy to resolve the abscess. These data indicate that outpatient permucosal needle drainage of peritonsillar abscess is an acceptable, inexpensive treatment comparing favorably with incision and drainage.     

Peritonsillar abscess. A prospective evaluation of outpatient management by needle aspiration

Outpatient management of peritonsillar abscess by needle aspiration and oral antibiotic therapy was evaluated for its effectiveness in providing rapid symptom relief and cure and in preventing recurrence. Between 1984 and 1987, 124 patients with peritonsillar infection were treated in our department, and 115 were included in this prospective study. Needle aspiration was not carried out in 11 patients because of young age, noncooperation, or severe trismus. The other 104 patients underwent permucosal aspiration and were followed up for periods of four months to three years. Of these, findings of aspiration were positive in 75 (72%). Only nine (12%) of the 75 patients with positive aspirates had to be hospitalized. In 64 (85%) of the 75 patients, the abscess resolved without further therapy. Aspiration of pus, along with oral administration of antibiotics, thus appears to be a reasonable alternative to incision and drainage or "hot" tonsillectomy in patients with peritonsillar abscess. This conservative approach obviates the need for hospital admission in most patients, thus enabling a significant cost reduction.     

Peritonsillar abscess in children: a 10-year review of diagnosis and management

OBJECTIVE: peritonsillar abscess is the most common deep neck infection in adults and children. However, pediatric patients with their smaller anatomy and often inability to cooperate with exam and treatment, provide a challenge. This study reviews the experience over the last 10 years at a children's hospital in the diagnosis and treatment of pediatric peritonsillar abscess. METHODS: a retrospective chart review of 83 children diagnosed with a peritonsillar abscess by the Otolaryngology service over a 10-year period (March 1989-February 1999) were reviewed. Presenting signs and symptoms, physical findings, age, season of presentation, prior pharyngitis history, and prior treatment was collected from the charts. Additionally, diagnostic studies (if any), treatment performed, bacteriology, and outcome/complications were noted. RESULTS: due to either an inability to cooperate fully for examination and treatment, or because of an earlier history of significant recurrent pharyngitis or obstructive tonsillar hypertrophy, half of the children required treatment in the operating room. Twenty-six out of 83 (31%) underwent a quinsy tonsillectomy. Length of stay was relatively short (0.9 days). There were no recurrent PTAs in our series, although four children initially treated with incision and drainage required tonsillectomy for persistent symptoms or residual abscess. Ten of those not treated with tonsillectomy (19%) required interval tonsillectomy for recurrent pharyngitis. CONCLUSION: limited by the ability to cooperate with treatment, children often require different treatment plans. We offer a treatment algorithm for managing children with PTAs that takes into account their age, level of cooperativeness, co-morbidities and prior history of pharyngitis, PTA or obstructive sleep disorder.     

Peritonsillar abscess in children in the southern district of Israel

Objective

Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in the pediatric population. This study reviews our experience over the years 2004-2007 at the Soroka University Medical Center in the southern district of Israel in treating children with peritonsillar abscess. We compared our results with data regarding peritonsillar abscess in adults.

Methods

We performed a retrospective chart review of 126 children diagnosed and proved to have a peritonsillar abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected from the medical charts of the patients.

Results

The average age of children with peritonsillar abscess was 12.8 years. 92 patients (73%) were above 10 years of age. We did not find an increase in the number of children with peritonsillar abscess per year over the time period of the study. The number of patients with peritonsillar abscess was significantly higher in the autumn and spring, 79 (62.6%) patients did not have prior history of tonsillar infections and 64 (67.4%) children were treated with antibiotics prior to the diagnosis of an abscess. In 95 (75.4%) patients the drainage method was needle aspiration, in 30 (28.3%) patients incision and drainage was performed and only one patient underwent bilateral quinsy tonsillectomy (0.8%). The bacterial culture was negative in 37 (36.7%) patients. In 29 patients (45% of positive cultures) the causative organism was Streptococcus group A. Mixed culture was present in 10 (15.6%) patients, nine cultures (14%) were positive for anaerobes, alone or in combination with other pathogens. Eighty-one patients (64.2%) were treated with amoxicillin-clavulanate potassium, 24 (19%) received cefuroxime and 17 (13.5%) were treated with cefuroxime+ metronidazole. The average hospital stay was 3 days.

Conclusion

Peritonsillar abscess, a potentially life threatening infection, is similar in presentation and bacteriology in the pediatric and the adult population. Based on our review we conclude that peritonsillar abscess in children can be effectively treated by the same methods used in the adult population.     

The contemporary approach to diagnosis and management of peritonsillar abscess

PURPOSE OF REVIEW: Peritonsillar abscess is a common problem, but some aspects of diagnosis and management remain controversial. We review the recent literature on peritonsillar abscess. RECENT FINDINGS: Intraoral ultrasound can be a helpful diagnostic tool for peritonsillar abscess. For management, needle aspiration, incision and drainage, and quinsy tonsillectomy all yield successful results. Recent reviews have still not established that one treatment is consistently preferred. A randomized, placebo-controlled trail found that the use of intravenous steroids seems to reduce many symptoms, when used along with abscess drainage. SUMMARY: The use of steroids may be beneficial in the treatment of peritonsillar abscess, and different techniques for abscess drainage are still used around the world, with consistently good results.     

Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations

The medical records of 1150 tonsillectomized patients were retrospectively reviewed for registration of the frequency of post-tonsillectomy haemorrhage in relation to sex and age of the patients, the indications for tonsillectomy, and the operative experience of the surgeon. The number of post-operative bleeds requiring surgery was 32 (2.8%) and occurred most frequently in young men and in patients with a history of previous peritonsillar abscess undergoing cold tonsillectomy. The frequency of haemorrhage in abscess tonsillectomy was not higher than expected. As previous studies have demonstrated that abscess tonsillectomy is associated with a minimal risk of spreading the infection or other serious complications, it is suggested that abscess tonsillectomy should be the preferable treatment of peritonsillar abscess.     

Bilateral peritonsillar abscess revisited

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

Peritonsillar infections

The preferred antibiotic treatment for tonsillar and peritonsillar infections remains high dosages of penicillin. Peritonsillar swelling can be probed by needle aspiration. Where necessary, immediate incision and drainage of an abscess can be achieved. Quinsy tonsillectomy may be carried out for the best abscess exposure. Interval tonsillectomy is advised for those patients who give histories of previous tonsillar infections.