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1.
Objective: Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients. Methods: A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using χ2-test, the age distribution was compared by Mann-Whitney U-test. Results: Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson χ2-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance (P<0.001) in elder patients after immediate tonsillectomy. Conclusions: We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.  相似文献   

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The risk of secondary haemorrhage following abscess tonsillectomy is reported in the literature with differing rates. A retro- and prospective analysis of complication rates following abscess tonsillectomy was conducted in 142 patients (54 females, 88 males; mean age: 35 years). In 22% of patients, a secondary haemorrhage occurred. In half of these (11% of total), the haemorrhage had to be treated surgically. Secondary haemorrhage occurred most commonly on the 6th and 8th postoperative days. Reports in the literature are not in unison about the risk of secondary haemorrhage following abscess tonsillectomy and therefore allow no final judgement about an objective risk of this complication. This report strengthens the results of the 'Comparative Audit Service' analysis from 1997, which did show a high risk of secondary haemorrhage following tonsillectomy, as well as following abscess tonsillectomy.  相似文献   

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《Auris, nasus, larynx》2020,47(4):697-701
Parapharyngeal abscess (PPA) may cause life-threatening complications and peritonsillar abscess (PTA) and tonsillitis frequently precede PPA. The optimal management of PPA caused by PTA has been the subject of debate with respect to the surgical approach. We present three cases of PPA concomitant with PTA in elderly patients. In two cases, the abscesses in parapharyngeal space were drained by abscess tonsillectomy followed by intraoral incision of the tonsillar bed. On the other hand, the third case did not undergo abscess tonsillectomy because of his refusal of surgery and needed extraoral drainage after the aggravation of PPA. Based on the experience of those three cases, it was suggested that abscess tonsillectomy followed by intraoral incision of the tonsillar bed might be a useful surgical approach for the drainage of PPA concomitant with PTA, especially in elderly patients.  相似文献   

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《Acta oto-laryngologica》2012,132(12):1312-1317
Conclusion. There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. Objective. There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. Material and methods. All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3–88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2–83 years). Results. In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1–4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2–8.6%) in the age- and gender-matched group of “selected” elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.  相似文献   

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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.  相似文献   

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The admission of patients with peri‐tonsillar abscess to a general ENT ward and its influence on secondary post‐tonsillectomy haemorrhage Patients with peri‐tonsillar abscess require hospitalization. The aim of this prospective study was to determine whether the admission of patients with peri‐tonsillar abscess to the same ward as those undergoing tonsillectomy influences the incidence of secondary post‐tonsillectomy haemorrhage. We included all adult patients undergoing in‐patient tonsillectomy (n = 183) and all patients with proven peri‐tonsillar abscess (n = 46) over a 1‐year period. Both patient groups were nursed in the same general otolaryngology ward. The operation dates of those patients who developed secondary post‐tonsillectomy haemorrhage were matched to the dates when patients with peri‐tonsillar abscess were admitted. Out of the 71 patients who had tonsillectomy on days when patients with peri‐tonsillar abscess were admitted, 10 developed secondary haemorrhage. Out of the 112 patients who had tonsillectomy on days when no one in the ward had peri‐tonsillar abscess, 16 developed secondary haemorrhage. No difference was demonstrated (χ2 = 0.0014, P > 0.05). In this study, admission of patients with peri‐tonsillar abscess to a general otolaryngology ward does not influence the incidence of secondary post‐tonsillectomy haemorrhage in patients undergoing elective surgery.  相似文献   

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Assessment of secondary haemorrhage rates following adult tonsillectomy – a telephone survey and literature review Many previous studies have considered patient re‐admission rates alone as the true rate of secondary haemorrhage following adult tonsillectomy. We aimed to determine the true rate of secondary haemorrhage following tonsillectomy in adults by performing a telephone interview with 60 consecutive patients. Whilst 40% (n = 24) of our patients reported a significant episode of bleeding (blood actively flowing from their mouth for more than 1 min) following discharge, only 8% (n = 5) were re‐admitted and only 3% (n = 2) required return to theatre. Review of the current literature suggests that return‐to‐theatre rates are more consistent than hospital re‐admission rates in large studies. We would suggest that although secondary haemorrhage can occasionally be very serious, the majority is minor, and it would therefore be more useful when comparing different techniques for tonsillectomy to consider numbers of patients returning to theatre rather than re‐admission rates.  相似文献   

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Sorin A  Bent JP  April MM  Ward RF 《The Laryngoscope》2004,114(2):297-300
OBJECTIVES: To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective chart review and long-term follow-up in office or by telephone interview. METHODS: We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms. RESULTS: All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had self-limited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission. CONCLUSIONS: Microdebrider-assisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow-up may define higher complication rates.  相似文献   

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The aim of this prospective study was to determine the suitability of ‘direct listing’ of patients for tonsillectomy by their General Practitioner. All General Practitioners were issued guidelines outlining the indications and contraindications for direct listing. One hundred consecutive patients, referred over a6-month period, were screened by an otolaryngologist. Thirty-three of these patients were referred inappropriately. The high rate of inappropriate referrals would suggest that this is an unacceptable practice.  相似文献   

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Tonsillectomy, adenoidectomy and adenotonsillectomy are among the commonest surgical procedures undertaken in children. The notes of 413 consecutive children having tonsillectomy, adenoidectomy or adenotonsillectomy were analysed retrospectively to determine complication rates. Of the total number of children, 5.6% had at least one complication, the most common of which was haemorrhage occurring as a first complication in 3.9% (16 children). Three children with bleeding required active treatment (0.7%), one requiring transfusion and two requiring a return to theatre, all within 3 1/2 hours of operation. The incidence of reactionary bleeding was not associated with the grade or seniority of the surgeon. Six children (1.5%) developed a fever post-operatively, of which one required antibiotic treatment. On the basis of these results it is feasible for such procedures to be carried out on a day-care basis.  相似文献   

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Tonsillectomy is one of the most common surgical procedures performed in children. Day case tonsillectomy is common in many parts of the USA but remains controversial in the UK. Day case tonsillectomy in children has been performed in a dedicated paediatric day care unit at the Mayday Hospital since 1994. The results for the years 1995–1997 were reviewed. In these years 928 true day case tonsillectomies were performed. Reactionary haemorrhage occurred in 0.97% (nine children) but only three children required a return to theatre. All bleeding occurred within the standard observation period. There were no deaths. The overall effective day case rate was 95.7%, only 31 children needing unplanned admission, mainly for postoperative vomiting. The results suggest that day case tonsillectomy can be safely and successfully performed, with a dedicated paediatric day case unit and a favourable population geography.  相似文献   

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