Article

Peritonsillar abscess - Critical analysis of abscess tonsillectomy

Department of Otorhinolaryngology, Head and Neck Surgery, Philipps University of Marburg, Germany
Clinical Otolaryngology (Impact Factor: 2.39). 09/2003; 28(5):420 - 424. DOI: 10.1046/j.1365-2273.2003.00736.x

ABSTRACT 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.

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    ABSTRACT: HintergrundPeritonsillarabszesse (PTA) sind eine häufige, aber schwere Komplikation der aktuen exsudativen Tonsillitis. Es wurde untersucht, ob Antibiotika nach chirurgischer Sanierung des PTA erforderlich sind. Patienten und MethodeIn die epidemiologische Beobachtungsstudie wurden 283 Patienten mit einem PTA eingeschlossen (98 w., 185 m., Alter: 2–72 Jahre). Für eine prospektiv randomisierte multizentrische Studie wurden 105 Patienten in 2Gruppen mit oder ohne postoperative Antibiotikagabe nach Abszesstonsillektomie eingeteilt. Es wurden CRP, Leukozyten, Antistreptolysintiter und Blutkulturen sowie Angaben zu Schmerzen, Schluckproblemen und Wohlbefinden erfasst. ErgebnisseDer PTA trat überwiegend bei Männern in der 2.–4. Lebensdekade auf, am häufigsten im Sommer. Bei den Patienten beider Gruppen ergaben sich keine statistisch signifikanten Unterschiede bezüglich der subjektiven Angaben sowie bei den Laborwerten. Eine Bakteriämie wurde in keinem Fall festgestellt. SchlussfolgerungDie sofortige chirurgische Sanierung ist wirksam und sicher zur Therapie eines PTA, auch ohne begleitende Antibiotikatherapie fand sich keine erhöhte Komplikationsrate. Aufgrund der geringen Fallzahl der Studie können die Ergebnisse nur als Tendenz, jedoch nicht als generelle Empfehlung gewertet werden. BackgroundPeritonsillar abscess (PTA) is a common and serious complication of acute exudative tonsillitis. We wanted to answer the following question: Are postoperative antibiotics mandatory after abscess tonsillectomy? Patients and methodsIn an epidemiological observational study, 283 patients (98females and 185 males, age range 2–72years) were treated with abscess tonsillectomy for PTA. For a prospective randomized multicenter study, 105 patients were divided into two groups; one groupwas treated postoperatively with benzylpenicillin, and antibiotics were omitted in the control group. We evaluated postoperative pain scores, swallowing disorders, and well-being. Additionally, laboratory parameters such as C-reactive protein, leukocytes, and antistreptolysin titer were measured, and blood cultures were collected. ResultsMale patients in the 2nd–4th decades of life were predominantly affected, mostly in the summer. For the patients in the two groups, we assessed no significant differences in either the subjective or the laboratory parameters. The blood cultures showed no evidence of bacteremia. ConclusionsWe conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for PTA. No higher complication rate was found when additional antibiotic treatment was not used. Because of the small number of cases, the results can be regarded only as a tendency, not as a general recommendation.
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