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.

Complicaciones ORL severas por mononucleosis infecciosa en adolescentes sanos: 2 casos clínicos y revisión de la literatura / ENT severe complications of infectious mononucleosis in healthy adolescents: report of two cases and literature review

Resumen La mononucleosis infecciosa (MI) es un cuadro clínico generalmente benigno y autolimitado en la infancia y adolescencia debido a la primoinfección del virus de Epstein-Barr caracterizado por la triada de faringitis, fiebre y adenopatías. El riesgo de complicaciones aumenta con la edad y la inmunosupresión, siendo las complicaciones letales más frecuentes las asociadas a rotura esplénica, alteraciones neurológicas y obstrucción de la vía aérea por el aumento del tamaño amigdalar. Los abscesos cervicales asociados a MI son poco frecuentes, siendo mayoritariamente periamigdalinos e intraamigdalares. Presentamos dos casos quirúrgicos de abscesos cervicales profundos de gran tamaño con afectación retrofaríngea y parafaríngea en adolescentes sanos de corta edad (14 y 15 años), sin ningún tipo de inmunosupresión o factores de riesgo, uno de ellos asociado además, a una relevante hemorragia amigdalar espontanea, condición no descrita previamente en la literatura en relación a MI en un paciente tan joven.

Abstract Infectious mononucleosis (MI) is a generally benign and self-limited condition in childhood and adolescence due to the primary EBV infection characterized by the triad of pharyngitis, fever, and lymphadenopathies. The risk of complications increases with age and immunosuppression. The most frequent fatal complications are those associated with splenic rupture, neurological alterations, and airway obstruction due to increased tonsillar size. Cervical abscesses associated with MI are rare, being mostly peritonsillar and intra-tonsil. We present two surgical cases of big deep cervical abscesses with retropharyngeal and parapharyngeal involvement in healthy very young adolescents (14 and 15 years old), without any type of immunosuppression or risk factors, one of them associated with a clinically relevant spontaneous tonsillar bleeding, which had not been described in the literature associated with MI in such young patient.

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.

Peritonsillar and deep neck infections: a review of 330 cases / Infecções peritonsilares e cervicais profundas: revisão de 330 casos

Abstract Introduction: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. Objective: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. Methods: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. Results: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). Conclusion: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Resumo Introdução: Infecções cervicais profundas são definidas como processos infecciosos supurativos dos espaços viscerais profundos do pescoço. Objetivo: Analisar diferentes fatores que podem influenciar as infecções peritonsilares e cervicais profundas que podem desempenhar um papel como preditores de mau prognóstico. Método: Apresentamos um estudo retrospectivo de 330 pacientes portadores de infecções cervicais profundas e de infecções peritonsilares admitidos entre janeiro de 2005 e dezembro de 2015 em um hospital terciário de referência. A análise estatística de comorbidades, aspectos diagnósticos e terapêuticos foi realizada utilizando-se os programas Excel e o SPSS. Resultados: Houve um aumento na incidência de infecções peritonsilares e infecções cervicais profundas. Comorbidades sistêmicas como diabetes ou doença hepática são fatores de mau prognóstico. O patógeno mais comum foi S. viridans (32,1% das culturas positivas). 100% dos pacientes receberam antibióticos e corticosteroides, e 74,24% necessitaram de tratamento cirúrgico. As complicações mais comuns foram mediastinite (1,2%) e obstrução das vias aéreas (0,9%). Conclusão: Comorbidades sistêmicas são preditores de mau prognóstico. Atualmente, a mortalidade diminuiu graças ao cuidado multidisciplinar e melhorias no diagnóstico e tratamento.

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.

Clinical Characteristics of Acute Pediatric Neck Infection and Predictive Factors of Abscess Formation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Abscess of neck is a life-threatening disease in children. Detection of abscess is important because it is essential for the determination of surgical drainage. However, clinical diagnosis is difficult, because children are seldom able to verbalize their symptoms or cooperate with physical examination. This study aims to review the clinical characteristics of 157 pediatric patients with neck inflammation and investigate the relative risk factors for abscess. SUBJECTS AND METHOD: Pediatric patients who were admitted to Dongguk University Hospital from January 2005 to July 2014 with acute neck inflammation were reviewed. All 157 pediatric patients were divided into two groups, based on radiologic findings with and without neck abscess. RESULTS: Of 157 patients, 53 children were diagnosed with neck abscess, and peritonsillar abscess was the most common type of neck abscess followed by submandibular abscess, retro·parapharyngeal abscess and posterior triangle & other abscess. The dominant pathogens, staphylococcal infection (≤2 yr) and streptococcal infection (>3 yr), was different for the different age group. The abscess group except for peritonsillar abscess was characterized by younger age, higher heart rate and WBC count, and longer hospital days than those without abscess (p=0.026, 0.026, <0.001, 0.007 respectively). Multivariate analysis revealed younger age (≤24 mo) and higher heart rate were independent predictors for abscess formation (odds ratio: 3.022, 2.923). CONCLUSION: Pediatric patients with high heart rate & younger age are at risk for abscess formation; meticulous care and early imaging work up are required in younger children with deep neck infection, and especially with higher heart rate.

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.

Interval tonsillectomies; comparison of per and post operative complications in patients undergoing early and delayed after peritonsillar abscess

Peritonsillar abscess is a common clinical problem faced by otorhinolaryngologist all over the world. There are different schools of thoughts regarding tonsillectomy after peritonsillar abscess due to its expected complications. This comparative study was conducted to know about frequency of complications in each of the techniques. To compare per and post operative complications in patients undergoing early and delayed interval tonsillectomy after peritonsillar abscess. This was randomized control trial. Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. From Jan 2012 to Dec 2013. After taking detailed history, thorough examination, relevant investigations and informed written consent peritonsillar abscess was drained and then interval tonsillectomy was performed. The complications were noted on predesigned proforma. Chi square test was used to compare the complications in both the groups while keeping P < 0.05 as significant. Out of 60 patients males were 38 and females were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SD with a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SD with a range of 13-46 years. Findings of per-operative and post operative hemorrhage showed that there was insignificant difference in both the groups [P=0.601]. However pain and hospital stay in both the groups was significantly different with P value of 0.004 and 0.000 respectively. Early interval tonsillectomy is an easy and safe procedure for peritonsillar abscess

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.

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.

Application of enhanced CT in the differential diagnosis of peritonsillar abscess and intratonsillar abscess / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the application of enhanced CT in the differential diagnosis and treatment of peritonsillar abscess (PTA) and intratonsillar abscess (ITA).</p><p><b>METHODS</b>Thirty-eight in-patients with clinically suspected PTA from June 2011 to June 2013 were included in this study. All these patients underwent enhanced CT scan for the throat region. According to CT results, the location of abscess was determined, and the thickness of the posterior wall of abscess as well as its distance with the internal carotid artery was calculated.Incision and drainage were then guided with this information.</p><p><b>RESULTS</b>Twenty-six of the 38 patients (68.4%) met the diagnosis of PTA, demonstrating a hypodense collection with rim enhancement in the peritonsillar space, including 4 cases with multilocular abscess. Ten cases (26.3%) should actually be diagnosed as ITA, with a abscess collection located in the palatine tonsil tissue. Two cases(5.3%) were diagnosed as peritonsillar cellulitis (PTC), showing diffuse isodense lesion around the peritonsillar space. The 26 cases of PTA and 10 cases of ITA patients were all cured using incision and drainage under the precise guidance of CT, while the 2 cases of PTC only treated with medicine. The mean distance between the posterior wall of abscess and the carotid artery (X(-) ± s) were (0.76 ± 0.34) cm and (0.90 ± 0.37) cm for the two entities respectively, with no significant difference (P > 0.05).</p><p><b>CONCLUSIONS</b>Enhanced CT scan can clearly demonstrate the characters of PTA and ITA, and make identification. Moreover, it is helpful for the determination of therapy, improving the success rate of drainage and reducing the potential risk of large artery injury.</p>

A case of Kawasaki disease with coexistence of a parapharyngeal abscess requiring incision and drainage / 소아과

Kawasaki disease (KD) causes multisystemic vasculitis but infrequently manifests with deep neck infections, such as a peritonsillar abscess, peritonsillar or deep neck cellulitis, suppurative parapharyngeal infection, or retropharyngeal abscess. As its etiology is still unknown, the diagnosis is usually made based on typical symptoms. The differential diagnosis between KD and deep neck infections is important, considering the variable head and neck manifestations of KD. There are several reports on KD patients who were initially diagnosed with retropharyngeal abscess on on computed tomography scans (CT). However, the previously reported cases did not have abscess or fluid collection on retropharyngeal aspiration. Therefore, false-positive neck CT scans have been obtained, until recently. In this case, suspected neck abscess in patients with KD unresponsive to intravenous immunoglobulin could signal the possible coexistence of suppurative cervical lymphadenitis.

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.

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.