Absceso periamigdalino bilateral. Reporte de un caso y revisión de las controversias en el diagnóstico y tratamiento / Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management

La presentación bilateral del absceso periamigdalino es poco frecuente. Su abordaje es controversial y se discute si realizar amigdalectomía en caliente versus diferida. Se presenta el caso de un paciente de sexo masculino, de 14 años, con odinofagia, trismo y fiebre. Presentaba hipertrofia amigdalina bilateral, pilares abombados y edema de paladar blando. Tomografía computada: hipertrofia amigdalina bilateral, con realce poscontraste, ambas con colección, edema con moderada estenosis faríngea. Se decidió internación para tratamiento endovenoso y amigdalectomía con drenaje bilateral. Resolución completa del cuadro con alta a las 48 horas. Ante la presencia de un absceso periamigdalino, debe considerarse la posibilidad de un absceso contralateral oculto. Debe ser diagnosticado y tratado adecuadamente para prevenir complicaciones. La amigdalectomía en caliente podría ser un tratamiento seguro y debería ser considerado en pacientes que serán sometidos a anestesia para drenaje. La decisión final debe ser determinada para cada caso en particular.

The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.

Experiencia clínica y manejo de los abscesos periamigdalinos en el Complejo Asistencial Dr. Sótero del Río / Clinical experience and management of peritonsillar abscesses at the Dr. Sótero del Río Health Center

RESUMEN Introducción: El absceso periamigdalino es una causa importante de consulta de urgencia en los servicios de otorrinolaringología. Su manejo incluye tratamientos antibióticos y drenaje del absceso. Objetivo: Describir y analizar las características clínicas, epidemiológicas y manejo de los abscesos periamigdalinos en el Complejo Asistencial Dr. Sótero del Río. Material y método: Estudio retrospectivo, descriptivo, incluyendo a todos los pacientes con un absceso periamigdalino entre los años 2013 y 2016. Se analizaron variables epidemiológicas, clínicas, uso de antibióticos, drenajes, y persistencia del cuadro. Resultados: La serie está constituida por 122 pacientes, con una edad promedio de 29 años. Diez y nueve coma seis por ciento corresponde a pacientes pediátricos. La clínica se caracterizó principalmente por odinofagia (62,7%), voz engolada (32%), fiebre (27%) y trismus (27%). Al examen físico, se observó abombamiento del pilar (67,2%), desplazamiento de la úvula (41,8%), trismus (26,2%), y placas blanquecinas sobre la amígdala (18,9%). Este último hallazgo fue más frecuente en la población pediátrica. El 46,2% de los pacientes recibió algún tratamiento antibiótico antes de consultar en el servicio de urgencia, y el 35,7% de los pacientes recibieron corticoides durante la consulta al servicio de urgencia. En la gran mayoría (92%), se realizó un drenaje del absceso, principalmente por incisión (81,7%). Sólo en el 13,1% de los pacientes se requirió un segundo drenaje. Conclusión: El absceso periamigdalino es una causa importante de consulta en los servicios de urgencia, siendo más frecuente en el adulto joven. El drenaje del absceso asociado a un tratamiento antibiótico endovenoso y/o vía oral presenta un excelente pronóstico.

ABSTRACT Introduction: Peritonsillar abscesses are an important cause of emergency consults in the otorhinolaryngology department. Its management includes use of antibiotics and drainage of the abscess. Aim: To describe and analyze the clinical characteristics, epidemiology, and management of peritonsillar abscesses at the Dr. Sótero del Río Health Center. Material and method: Retrospective and descriptive study of all patients presenting with a peritonsillar abscess between the years 2013 and 2016. Variables analyzed include demographics, signs and symptoms, use of antibiotics, drainage, and persistence of the disease. Results: This series includes 122 patients, with a mean age of 29 years; 19.6% are pediatric patients. Clinically, patients presented mainly with odynophagia (62.7%), muffled voice (32%), fever (27%), and trismus (27%). On physical examination, swelling of the tonsillar pillar (67.2%), uvula deviation (41.8%), trismus (26.2%), and white patches on tonsil (18.9%) were observed. The latter finding was more common in children. Forty-six percent of the patients received an antibiotic treatment previous to consulting at the emergency department, and 35.7% received steroids at the emergency department. The majority (92%) had the abscess drained, mainly by incision (81.7%). Only 13.1% of the patients required a second drainage. Conclusion: Peritonsillar abscess is a common presentation at the emergency department, seen primarily in young adults. The prognosis is excellent with drainage of the abscess associated with an intravenous and/or oral antibiotic treatment.

Bacteriology of peritonsillar abscess: the changing trend and predisposing factors / Bacteriologia do abscesso peritonsilar: tendência de mudança e fatores predisponentes

Abstract Introduction: Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors. Objective: To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration. Methods: This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration. Results: A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p = 0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age > 65 years) with an odds ratio (OR) of 2.76 (p = 0.03), and decreased in the hot season (mean temperature > 26 °C) (OR = 0.49, p = 0.04). No specific microorganism was associated with prolonged hospital stay. Conclusion: The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.

Resumo Introdução: O Abscesso Peritonsilar é a infecção cervical profunda mais comum. O microrganismo infeccioso pode ser diferente de acordo com os fatores clínicos. Objetivo: Identificar o principal agente causador do abscesso peritonsilar e investigar a relação entre o patógeno causador, os fatores clínicos do hospedeiro e a duração da hospitalização. Método: Este estudo retrospectivo incluiu 415 pacientes hospitalizados diagnosticados com abscesso peritonsilar que foram internados em um centro médico terciário de junho de 1990 a junho de 2013. Coletamos dados através da análise dos arquivos médicos dos pacientes e analisamos variáveis como características demográficas, doença sistêmica subjacente, tabagismo, alcoolismo, hábito de mascar noz de betel, bacteriologia e duração da hospitalização. Resultados: Um total de 168 pacientes apresentaram resultados positivos para isolamento de patógenos. Streptococcus viridans (28,57%) e Klebsiella pneumoniae (23,21%) foram os microrganismos mais comuns identificados pela cultura da secreção. A taxa de isolamento de anaeróbios aumentou para 49,35% nos últimos 6 anos (p = 0,048). Os anaeróbios comuns foram Prevotella e Fusobacterium spp. A identificação de K. pneumoniae aumentou em pacientes idosos (idade > 65 anos) com razão de chances (Odds Ratio - OR) de 2,76 (p = 0,03) e diminuiu na estação do calor (temperatura média > 26 °C) (OR = 0,49, p = 0,04). Nenhum microrganismo específico foi associado à hospitalização prolongada. Conclusão: O patógeno mais comumente identificado através da cultura de secreção foi S. viridans, seguido por K. pneumoniae. A identificação de anaeróbios mostrou ter aumentado nos últimos anos. Os antibióticos selecionados inicialmente devem ser efetivos contra aeróbios e anaeróbios. A identificação bacteriana pode estar associada a fatores clínicos e fatores ambientais do hospedeiro.

Diagnosis and Treatment of Peritonsillar Abscess with Single Enhanced Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess. SUBJECTS AND METHOD: We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. RESULTS: There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen's kappa) was 0.825 (p<0.01). CONCLUSION: Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation.

Initial Factors Influencing Duration of Hospital Stay in Adult Patients With Peritonsillar Abscess

OBJECTIVES: To review cases of peritonsillar abscess and investigate the initial clinical factors that may influence the duration of hospitalization. To determine the predictive factors of prolonged hospital stay in adult patients with peritonsillar abscess. METHODS: Subjects were adults hospitalized with peritonsillar abscess. We retrospectively reviewed 377 medical records from 1990 to 2013 in a tertiary medical center in southern Taiwan. The association between clinical characteristics and the length of hospital stay was analyzed with independent t-test, univariate linear regression and multiple linear regression analysis. RESULTS: The mean duration of hospitalization was 6.2±6.0 days. With univariate linear regression, a prolonged hospital stay was associated with several variables, including female gender, older ages, nonsmoking status, diabetes mellitus, hypertension, band forms in white blood cell (WBC) counts, and lower hemoglobin levels. With multiple linear regression analysis, four independent predictors of hospital stay were noted: years of age (P<0.001), history of diabetes mellitus (P<0.001), ratio of band form WBC (P<0.001), and hemoglobin levels (P<0.001). CONCLUSION: In adult patients with peritonsillar abscess, older ages, history of diabetes mellitus, band forms in WBC counts and lower hemoglobin levels were independent predictors of longer hospitalization.

The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses / O papel do volume plaquetário médio e a relação neutrófilos/linfócitos em abscesso periamigdaliano

Abstract Introduction: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. Objective: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. Methods: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. Results: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p < 0.05), the platelet count was not significantly different among the patient and control groups (p > 0.05). Conclusion: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.

Resumo Introdução: O abscesso periamigdaliano (APA) é uma doença infecciosa grave do tecido tonsilar. O seu tratamento geralmente requer uma abordagem medicamentosa e cirúrgica para o alívio dos sintomas. Recentemente, além do acompanhamento clínico, alguns marcadores inflamatórios, como o volume plaquetário médio (VPM) e a relação neutrófilos/linfócitos (RN/L), foram considerados marcadores de monitoramento adicionais em doenças inflamatórias. Objetivo: O objetivo deste estudo foi descrever o papel os VPM e a RN/L em pacientes com APA. Método: Estudo retrospectivo realizado com 88 pacientes com ATP e 88 indivíduos saudáveis. Analisamos a contagem de leucócitos, neutrófilos, linfócitos, plaquetas, proteína C-reativa (PCR), VPM e RN/L e a comparamos os valores entre o grupo de pacientes e grupo controle. Resultados: Os níveis de VPM eram significativamente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de corte de 8,7 para o VPM foi considerado ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 75, 65,9, 68 e 72%, respectivamente. Os níveis da RN/L eram significantemente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de 3,08 para a RN/L foi o valor de corte ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 90,9, 90,9, 90,9 e 90,9%, respectivamente. Enquanto a contagem dos valores de leucócitos, neutrófilos, linfócitos e PCR foi significantemente diferente entre os grupos de pacientes e controle (p<0,05), a contagem de plaquetas não foi (p>0,05). Conclusão: Os valores de VPM e RN/L sugerem que estes são parâmetros inflamatórios de acompanhamento rápido, barato e confiável, e que podem ser facilmente integrados à prática diária para o tratamento de APA, exceto pela contagem de plaquetas.

Characteristics of Microbiology of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to review the characteristics of microbiology of peritonsillar abscess and to recommend adequate empirical antibiotics. SUBJECTS AND METHOD: Patients (437) who underwent surgical drainage for peritonsillar abscess were reviewed retrospectively. We analyzed correlations between age, gender, obesity and diabetes mellitus and cultured organisms with respect to susceptibility of antibiotics. RESULTS: The leading pathogens were α-hemolytic streptococcus (44.3%), Streptococcus viridians (12.3%), β-hemolytic streptococcus (8.2%) and Streptococcus pyogenes (6.8%). The rates of α-hemolytic streptococcus and Streptococcus pyogenes growth were p=0.002 and p=0.032, respectively; these values were significantly higher in patients under the age of 40 than those over the age of 40. Klebsiella pneumoniae infection was observed more frequently in the diabetic group than in the non-diabetic group. Antibiotics susceptibility test showed that four leading pathogens were susceptible to ampicillin/sulbactam. CONCLUSION: Only ampicillin/sulbactam was sufficient to treat peritonsillar abscess empirically. In conclusion, the use of third generation Cephalosporin or other antibiotics for anaerobes is not considered necessary for the empirical treatments of peritonsillar abscess.

The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis

Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.

Case report of emergent nursing care of peritonsillar abscess in an infant / 中国实用护理杂志

Objective To explore the emergent nursing care of peritonsillar abscess in an infant. Methods The process of observation, treatment and nursing care of an infant with peritonsillar abscess were reviewed, and the nursing experiences were summarized. Results Through close observation of the rate, rhythm and depth of the respiration, the early signs of airway obstruction, guide parents with children right, keep the children quiet, open the airway, at the same time to prepare relevant emergency use objects to be prepared for emergency surgery, we saved time for the operation. Postoperative management of the airway and observation for the signs of bleeding in the area of incision were provided. The infant recovered well and was discharged after the treatment and nursing. Conclusions This case reminds nurses to pay attention to the airway obstruction while caring for the infants with peritonsillar abscess. The key points of nursing are observation and management of the airway obstruction, emergent preoperative preparation, postoperative monitoring, management of the airway and observation for the bleeding of the incision area.

Distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess during ;2010-2014 in Wenzhou / 中华临床感染病杂志

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess .Methods Data on bacterial pathogens isolated from peritonsillar abscess in Wenzhou Central Hospital from January 2010 to December 2014 were retrospectively analyzed .Strains were identified with Vitek 32 identification system and the drug susceptibility test was performed with K-B method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains .Results A total of 2 864 bacterial strains were isolated in five years , in which 1 786 strains were Gram-negative bacilli (62.4%), and 1 078 (37.6%) strains were Gram-positive cocci. The positive rate of Gram-negative bacilli was on the rise during year 2010-2014 (χ2 =84.74, P<0.01), and the top three Gram-negative bacilli were Pseudomonas aeruginosa, Acinetobacter baumannii and Haemophilus influenzae, which accounted for 72.5%(1 295/1 786) of the total Gram-negative strains, and the positive rates of first two bacilli were on the rise (χ2 =83.75 and 24.74, P<0.01).Gram-positive cocci were mainly Staphylococcus aureus and Hemolytic streptococcus, which accounted for 83.2% ( 897/1 078) of the total Gram-positive strains.Resistance rates of Pseudomonas aeruginosa to ceftazidime, cefoperazone, piperacillin/tazobactam were on the rise (χ2 =16.17, 13.48 and 11.44, P<0.05), while resistance rates to gentamicin and amikacin were on the decline (χ2 =16.54 and 16.63, P <0.05). Resistance rates of Acinetobacter baumannii to ceftazidime, cefoperazone/sulbactam and piperacillin/tazobactam were on the rise (χ2 =12.52, 10.85 and 14.14, P<0.05).Resistance rates of Haemophilus influenzae to ampicillin were on the rise (χ2 =10.21, P<0.05), and the positive rate of β-lactamase producing strains was also on the rise (χ2 =10.38, P<0.05).Resistance rates of Staphylococcus aureus to cefazolin and methicillin were on the rise (χ2 =15.44 and 12.53, P<0.05), but no vancomycin resistant strain was found .Hemolytic streptococcus were sensitive to all commonly used antibiotics .Conclusions Peritonsillar abscess in Wenzhou Central Hospital is mainly induced by Gram-negative bacilli infection . Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus are the top three bacterial pathogens , and are highly resistant to most antibiotics .

Peritonsillar Abscess in Northern Nigeria: A 7 Years Review

Background: The aim of this study was to describe the clinico-epidemiologic profile of peritonsillar abscess (PA) seen in our center in northern Nigeria. Methods: This was a to retrospectively review of all patients with PA managed in our hospital over a 7-year period. Case notes were reviewed and information retrieved included biodata and clinical information were entered into an SPSS statistical software version 20.0 and analysed descriptively and result presented in table and figures. Results: A total of 25 patients were seen during the study period age ranged from 2–52 years with a mean age of 25.96 years; 14.1 (SD 2.8). Male to female ratio of ≈ 1.1:1.0. Right side was affected in 60%. The period of presentation of patients with PA varied between 4–12 days with a mean duration of 6.5 days. The presenting complaints in these patients varied from sore throat alone in 4 (16%), fever and sore throat in 17 (68%), others 16%. The duration of hospital stay varied from between 1 to 8 days with mean of 4.2 days; 3.32 days (SD 1.1). All the patients had incision and drainage with no recurrence of symptoms. Conclusion: PA is an Ear, Nose and Throat emergency that is commoner amongst the young adult males and the modality of treatment is still incision and drainage in our setting.

Peritonsillar Involvement in Pyoderma Gangrenosum associated with Ulcerative Colitis

Peritonsillar abscess is a common deep throat infection. Early diagnosis and prompt, appropriate management of a peritonsillar abscess prevents mortality. A 45-year-old woman on steroids for an ulcerative colitis (UC) exacerbation presented with sore throat and multiple skin ulcers on her left forearm and right foot. Computed tomography of the neck revealed a peritonsillar abscess. Gram staining and culture of the abscess were negative, and a skin biopsy suggested pyoderma gangrenosum (PG). The final diagnosis was peritonsillar involvement of steroid-refractory PG-associated UC. The patient showed a complete response to infliximab. Here, we report a case of successful infliximab treatment for peritonsillar involvement of steroid-refractory PG-associated UC.

A Case of Lemierre's Syndrome in Young Patient with Acute Peritonsillar Abscess

Lemierre's syndrome is very rare and is characterized by previous oropharyngeal infections, such as pharyngitis or peritonsillar abscess, leading to high fever, internal jugular venous thrombosis, and metastatic infections to multiple internal organs. Prompt and accurate diagnosis followed by early treatment with antibiotics is very important because its mortality is high if treatment is delayed. We report on the case of a 23-year-old female who was transferred to our hospital with a left peritonsillar abscess combined with left jugular venous thrombosis, complaining of a sore throat and left submandibular swelling, and diagnosed as Lemierre's syndrome. Finally, she was treated successfully without anticoagulants.

Interval Tonsillectomy: 27 Cases of Peritonsillar Abscesses Managed in Medical College Hospital.

Background and objectives: Peritonsillar abscess (quinsy) is the most common deep infection of the head and neck. The surgical treatment whether abscess tonsillectomy or interval tonsillectomy should be done is a subject of controversy, which still remains unresolved. Setting: Dept. of ENT, Head and Neck Surgery, KVG Medical College, Sullia, Karnataka. Material and methods: This was a comparative case series analysis study done in our department during the study period of 54 months from January 2007 to June 2011. Twenty-seven patients with clinical features of peritonsillar abscess who underwent medical line of treatment with incision and drainage and later interval tonsillectomy were included in the study. Results: The mean age was 30.4 years, mean hospital stay during incision and drainage was 3.51 days. The patient turned up for surgery within a mean duration of 9.4 months. The mean blood loss during the procedure was 100.5 ml and the mean visual analog scale (VAS) scores after interval tonsillectomy were 4.78. Mild-to-moderate difficulty was seen during the dissection of the abscess scarred tonsillar bed. Conclusion: Interval tonsillectomy is the standard treatment for managing peritonsillar abscess in many institutions. We recommend interval method of tonsillectomy done after a minimum of six weeks after incision and drainage of the peritonsillar abscess.

Atypical presentation of peritonsillar abscess.

Peritonsillar abscess is a known complication of tonsillitis.The patient usually present with typical symptoms of odynophagia, fever and difficulty in mouth opening. The diagnosis is established by clinical examination that commonly revealed unilateral peritonsillar swelling. Aspiration of pus will confirm the diagnosis. We report an atypical presentation of peritonsillar abscess case which presented with dysphagia without fever, odynophagia and trismus.

Experiencia de amigdalectomía en la Fundación Hospital de La Misericordia durante los últimos diez años / Tonsillectomy experience in the Foundation Hospital de la Misericordia Bogotá during the past ten years

Antecedentes: La amigdalectomía es un procedimiento frecuente en otorrinolaringología pediátrica. Actualmente se indica en hipertrofia amigdalina que obstruya la vía aérea, amigdalitis aguda bacteriana recurrente, asimetría amigdalina y absceso periamigdalino. Es un procedimiento efectivo y con poca morbimortalidad. Las complicaciones más frecuentes son dolor, sangrado, intolerancia a la vía oral e insuficiencia velofaríngea. Objetivo. Revisar la experiencia en amigdalectomía durante los últimos diez años, en la Fundación Hospital de La Misericordia.Materiales y métodos. Estudio retrospectivo, serie de casos, de pacientes llevados a amigdalectomía desde mayo de 2000 a febrero de 2009 en la Fundación Hospital de La Misericordia. Los resultados fueron analizados con el programa SPSS16.0. Resultados. Se incluyeron 149 pacientes. Las indicaciones de amigdalectomía fueron hipertrofia amigdalina con obstrucción de vía aérea en 45 por ciento, amigdalitis a repetición e hipertrofia en 27,5 por ciento, amigdalitis a repetición en 11,4 por ciento, y asimetría amigdalina 6,7 por ciento. La técnica quirúrgica utilizada en todos los pacientes fue extracapsular, de éstas el 97 por ciento con electrocauterio monopolar y 3 por ciento con técnica fría. Dentro de las complicaciones postquirúrgicas más frecuentes estuvieron: dolor en 41 por ciento, otalgia 12,7 por ciento y sangrado postoperatorio un 4 por ciento. El estudio histopatológico reportó en la mayoría hiperplasia folicular reactiva y un solo caso de linfoma de Burkitt cuya indicación fue asimetría amigdalina. Se encontró mejoría clínica en 96 por ciento de los pacientes. Conclusión. La amigdalectomía además de ser un procedimiento costo efectivo, es seguro y con escasas complicaciones. Realizada bajo las indicaciones descritas, proporciona un beneficio indiscutible en la calidad de vida y evolución clínica del paciente.

Background: Tonsillectomy is a common procedure in Pediatric Otorhinolaryngology. This procedure is indicated for hypertrophied tonsils that causes airway obstruction, recurrent acute bacterial tonsillitis, asymmetric tonsils and peritonsillar abscess. It is an effective procedure and with little morbimorbidity. The most common complications are pain, bleeding, delay oral intake and velopharyngeal insufficiency. Objetive. To revise the experience during the last 10 years of tonsillectomy in Fundacion Hospital de La Misericordia. Materials and methods. Retrospective study, serie of cases, includes all patients who had tonsillectomy from May 2000 to February of 2009 in Fundacion Hospital de La Misericordia. The results were analyzed with the program SPSS16.0. Results. 149 patients were included in the analysis. Tonsillectomy was indicated for hypertrophied tonsils that causes airway obstruction in 45 percent of patients, recurrent tonsillitis and hypetrophied tonsils in 27,5 percent, recurrent tonsillitis in 11,4 percent, and asymmetric tonsils 6,7 percent. The technique performed in all patients was extracapsular tonsillectomy, using monopolar electrocautery in 97 percent and cold knife in 3 percent. The most common complications were pain in 41 percent, followed by otalgy 12,7 percent and bleeding 4 percent of the patients. The histological examination reported in most of them reactive follicular hyperplasia, except a case of Burkitt lymphoma whose indication was significant tonsillar asymmetry. Clinical improvement was seen in 96 percent of the patients. Conclusions. Tonsillectomy is a cost-effective and safe procedure. Under certain indications referred in this paper, tonsillectomy improves quality of life and good clinical course.

Faringotonsilites em crianças: visão de uma amostra de pediatras e otorrinolaringologistas / Pharyngotonsillitis in children: view from a sample of pediatricians and otorhinolaryngologists

As faringotonsilites agudas são infecções das vias aéreas superiores comuns na infância. Objetivo: Analisar opiniões e condutas de pediatras e otorrinolaringologistas do Estado de São Paulo em relação ao diagnóstico, tratamento e prevenção das faringotonsilites e suas complicações em crianças. Material e Métodos: Selecionamos aleatoriamente 1370 pediatras e 1000 otorrinolaringologistas do Estado de São Paulo. Aos especialistas foi enviado questionário por correio. Desenho do Estudo: Estudo transversal. Resultados: 95,8% dos pediatras e 91,5% dos otorrinos não solicitam rotineiramente exames para diagnóstico laboratorial das faringotonsilites agudas na criança. Os antimicrobianos mais prescritos pelos pediatras nas faringotonsilites bacterianas foram: penicilina por via oral durante 10 dias (33,6%) e penicilina benzatina em dose única (19,7%). Os antimicrobianos mais prescritos pelos otorrinos para tratamento foram: penicilina por via oral durante 10 dias (35,4%) e penicilina por via oral durante 7 dias (25,7%). A medida de prevenção das faringotonsilites bacterianas considerada muito eficaz por mais da metade dos pediatras e otorrinos foi a cirurgia de tonsilectomia. A faringotonsilite de repetição foi o principal motivo para os otorrinos indicarem cirurgia de tonsilectomia aos escolares e adolescentes (49,3% e 53,4%, respectivamente). Conclusões:É necessário uniformizar condutas de pediatras e otorrinos para diagnóstico e tratamento das faringotonsilites em crianças.

Acute pharyngotonsillitis is a common upper airway infection in children. Aim: To analyze opinions and practices of pediatricians and otorhinolaryngologists from Sao Paulo State, Brazil, concerning diagnosis, treatment and prevention of pharyngotonsillitis and their complications in children. Methods: We randomly selected 1,370 pediatricians and 1,000 otolaryngologists from Sao Paulo State, Brazil. A questionnaire was mailed to the specialists. Study design: Cross-sectional. Results: 95.8% of the pediatricians and 91.5% of the otolaryngologists do not perform routine laboratory diagnosis for acute pharyngotonsillitis in children. The antimicrobials more commonly prescribed by pediatricians for treatment of bacterial pharyngotonsillitis were: oral penicillin for 10 days (33.6%) and s single injection of benzathine penicillin G (19.7%). The antimicrobials prescribed more often by otorhinolaryngologists for treatment were: oral penicillin for 10 days (35.4%) and oral penicillin for 7 days (25.7%). Tonsillectomy was considered the most effective measure for prevention of bacterial pharyngotonsillitis by more than half of pediatricians and otolaryngologists. Repeated pharyngotonsillitis was the main reason for otolaryngologists to indicate tonsillectomy for school-aged children and adolescents (49.3% and 53.4% respectively). Conclusions: It is necessary to standardize the practices of pediatricians and otolaryngologists regarding diagnosis and treatment of pharyngotonsillitis in children.

Two Cases of Peritonsillar Abscess Following Tonsillectomy / 대한이비인후과학회지

Peritonsillar abscess occurs commonly and is well known as a result of infection of the peritonsillar space. Peritonsillar abscess rarely occurrs following perfectely performed tonsillectomy. Instead, the most likely causes are due to the retained tonsillar tissue remnants, to the persistence of Weber's gland, and to the second branchial cleft fistula disruption secondary to tonsillectomy. There are no case reports or reviews existing in the Korean medical literature. We present two cases of peritonsillar abscess that occurred after tonsillectomy with a review of the international literatures.

A Clinical Analysis of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is the most common deep neck infection that occurs in adults, but until now there are so many controversies about the treatment modalities. The purpose of this study is to investigate the clinical course according to the treatment modalities for peritonsillar abscess and to evaluate the efficacy of tonsillectomy. SUBJECTS AND METHOD: Two hundred twenty-six patients with peritonsillar abscess admitted from January 1999 to October 2006. Among them, a retrospective review of medical records and additional telephone interview were performed on 151 cases. RESULTS: Among 151 cases, incision and drainage (I&D) was performed in 132 cases: 7 cases were done by aspiration and others were treated by antibiotics only. There was no significant difference in the dutarion of hospitalization between I&D, aspiration and antibiotics only (p>0.05). The incidence of recurrent PTA was only 6.6% (10/151). Tonsillectomy in PTA patients significantly reduced duration, frequency and severity of sore throat in long term follow up (p<0.05). CONCLUSION: The duration of hospitalization in PTA patients did not depend on treatment modalities. We conclude that tonsillectomy is not always necessary due to low incidence of recurrent PTA even though it improves satisfaction of PTA patients.

Clinical Usefulness of Neck Ultrasonography in Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Clinical differentiation of peritonsillar abscess (PTA) from peritonsillar cellulitis is sometimes difficult and physicians often rely on blind needle aspiration to locate abscess formation. According to previous studies, intraoral ultrasound is a useful, simple, and noninvasive technique that candifferentiate PTA from cellulitis in clinically equivocal cases, although it may cause some discomfort. The objective of this study was to establish a neck ultrasonographic technique that candifferentiate PTA from cellulitis in borderline cases and thereby to avoid unnecessary needle aspiraton. SUBJECTS AND METHOD: The study population included 44 patients (32 males and 12 females; age range 13 to 59 years) with clinically suspected PTA. These patientsunderwent neck ultrasonography examination before needle aspiration of abscess. RESULTS: On the basis of neck ultrasonography, 38 patients were considered as PTA and 6 as cellulitis. Neck ultrasonography was able to detect peritonsillar abscess in 94.7 per cent of the cases (sensitivity). The specificity of the test was 83.3 per cent, and accuracy was 79.1 per cent. CONCLUSION: Neck ultrasonography is a useful, simple, well-tolerated non-invasive technique that can be used to differentiate PTA from cellulitis in clinically equivocal cases.