Variations in the microbiology of peritonsillar abscess

Microbiologic studies are routinely performed in the assessment of peritonsillar abscess (PTA). Though the bacterial growth rates of PTA are expected to be uniform due to high accessibility and reasonable sterility, they demonstrate a vast range of results, which is partially explained by the differing culturing methods and incubation times. Our aim was to retrospectively examine the changing features identified in the occurrence of PTA bacterial growth rates over a period of seven years. A retrospective study was undertaken on all cases of PTA admitted from January 1996 to December 2002. Details regarding sex, age and country of birth were obtained. Population data and the maximum residue level (MRL) of antibiotics in food were collected. Bacteriologic studies were analysed for gram stain, aerobic and anaerobic culture results, and also antibiotic sensitivities, if obtained. Four hundred and fifty-seven consecutive hospitalisations due to PTA were identified; 281 patients who had 310 hospitalisations with known results of the microbiologic studies were included. The most common pathogens were Streptococcus pyogenes and Prevotella. A statistically significant escalation was seen in the anaerobic growth rate from 6.8% of cases in 1996 to 37% in 1999. A similar change, though not significant, was noticed with the polymicrobial growth rate. None of the parameters investigated showed any statistically significant influence on this tendency. These results may clarify the immense range of bacterial study results reported, suggest a change in the biologic behaviour of the studied bacteria and direct further research.     

Clinical parameters predicting tonsillar malignancy

European Archives of Oto-Rhino-Laryngology - Tonsillectomy is indicated in unilateral tonsillar enlargement (UTE) to rule out malignancy, which eventually is found in about 1.4% of the patients....     

Evaluation of Wound Healing Following Surgical Extractions Using the IPR Scale

ObjectiveTo monitor wound healing following surgical extraction of wisdom teeth using the novel Inflammatory Proliferative Remodeling (IPR) Scale.MethodsA prospective study design was used. Participants included 94 otherwise healthy adult patients undergoing surgical extraction of a wisdom tooth at a tertiary medical centre from June 2018 to June 2019. The IPR Scale was completed by two resident surgeons in oral and maxillofacial surgery at three time points after the procedure, corresponding to the three phases of wound healing. Mean subscale and total scores were calculated. Patients graded their preoperative anxiety, intraoperative pain, and pain during follow-up on a 10 cm visual analog scale, and the findings were correlated with the IPR Scale scores.ResultsMean IPR total score (range 0–16) was excellent (14.43 ± 1.45). Mean scores by healing phase were as follows: inflammatory 6.35 ± 1.34 (range 0–8); proliferation, 4.56 ± 0.8 (range 0–5); remodeling, 2.83 ± 0.51 (range 0–3). There was a positive correlation between mean preoperative anxiety level (5.9 ± 3.6) and intraoperative pain perception (2.4 ± 2.4; P = 0.65) and a negative correlation between mean preoperative anxiety level and IPR Scale scores for each healing phase. Two cases were complicated by abscesses which resolved with treatment.ConclusionThe IPR Scale is a promising tool for the effective evaluation of the wound healing process following wisdom tooth extractions. Relaxation methods and behavioural adaptation might help to lower patient anxiety and thereby improve oral wound healing.     

The electrodiagnostic examination of psychogenic swallowing disorders

The article discusses the usefulness and technique of investigation of suspected psychogenic dysphagia by surface electromyography (sEMG) of deglutition. Thirty-two patients with suspected psychogenic dysphagia (Group 1) and 40 healthy individuals (Group 2) were involved in the study. The timing, amplitude and graphic patterns of activity of the masseter, submental, infrahyoid and trapezius muscles were examined during voluntary single water swallows (“normal”), and continuous drinking of 100 cc of water. The muscle activity in oral, pharyngeal and initial oesophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. Globus hystericus was found in only 14 patients of the Group 1 (43.75%). The main sEMG pattern of psychogenic dysphagia is a lack of any pathologic changes of timing, voltage and graphic patterns of deglutition. In 28% of cases tension of skeletal muscles not involved in deglutition was observed during single swallowing (vs. 0% in controls). Psychogenic/hysteria-conversion dysphagia has no pathologic sEMG patterns associated with deglutition. Skeletal muscle tension during deglutition, being observed in some cases has no connection with the act of swallowing itself. Surface EMG, being non-invasive and non-radiographic, can be used for screening purposes for patients with dysphagia thus avoiding expensive and time-consuming investigation.