Peritonsillar abscess – critical analysis of abscess tonsillectomy
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.
- SourceAvailable from: laeger.dk
- [Show abstract] [Hide abstract]
ABSTRACT: 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%.Conclusions Due 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.Acta Otorrinolaringológica Española 05/2012; 63(3):212–217.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. Patients and methods A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration,and therapeutic approach. Results Twenty-nine children were admitted, with a mean age of 7.4 _ 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8% had an upper respiratory infection and 65% were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillinclavulanate acid with clindamycin, including corticosteroids.Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6% of confirmed abscesses. The mean length of hospital stay was 5.6 _ 1.6 days. Delayed tonsillectomy was performed in 31%, except in one patient who developed a parapharyngeal abscess. Currently, 18.9% of all peritonsillar infections occur in the pediatric population. Conclusions The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of _-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed,is only indicated in patients with recurrent tonsillitis.Anales de Pediatría 07/2006; 65(1):37-43. · 0.72 Impact Factor