Peritonsillar Complications of Acute Inflammations of Palatine Tonsils (a Retrospective Study)
Authors:
Jana Krtičková 1; J. Haviger 2; Lenka Ryšková 3; K. Smatanová 1; Viktor Chrobok 1; L. Školoudík 1
Authors‘ workplace:
Klinika ORL a chirurgie hlavy a krku, FN Hradec Králové, LF UK v Hradci Králové
; přednosta prof. MUDr. V. Chrobok, CSc., Ph. D.
1; Katedra informatiky a kvantitativních metod, Fakulta informatiky a managementu, Univerzita Hradec Králové, vedoucí katedry doc. RNDr. P. Pražák, Ph. D.
2; Ústav klinické mikrobiologie, Fakultní nemocnice Hradec Králové, přednosta doc. MUDr. H. Žemličková, Ph. D.
3
Published in:
Otorinolaryngol Foniatr, 65, 2016, No. 1, pp. 24-29.
Category:
Original Article
Overview
Introduction:
The authors present a group of patients hospitalized with peritonsillar complications over the period from 2003 to 2012. The aim of the study was to compare different types of treatment and to use the data for optimization of therapy.
Results:
A total of 587 patients were hospitalized during the study period for peritonsillar complications of tonsillitis; Children accounted for 29% of the group. Unilateral peritonsillar abscess was demonstrated in 67% of cases, while 32% of patients were treated for phlegmon, and 1% of the patients had confirmed bilateral peritonsillar abscess. Analysis of inflammatory markers revealed no statistical difference in the CRP (p=0.25) and Leu (p=0.88) values between the groups. When comparing children (0-18 years of age) and adults with peritonsillar complications, we found a statistically significant difference in the CRP values (p=0.0037), but not in Leu values (p=0.36). Patients with peritonsillar phlegmon received parenteral treatment as monotherapy, predominantly protected aminopenicillins (58%) and penicillin (26%). Peritonsillar abscess was treated parenterally, mainly by monotherapy with penicillin (60%) and protected aminopenicillins (30%). The first attack of peritonsillar phlegmon was managed conservatively (90% of cases) or by unilateral tonsillectomy (8%) or bilateral tonsillectomy (2%). The first attack of peritonsillar abscess was managed by unilateral tonsillectomy (34% of cases), bilateral tonsillectomy (32% of cases), abscess incision (31%), 3% of patients developed spontaneous perforation before receiving medical treatment, and aspiration of the abscess was performed in 0.3% of the patients. Of 118 patients who were treated by peritonsillar abscess incision, peritonsillar complications recurred in 14 (12%) patients. Of 165 patients who received surgical treatment for phlegmon, 13 patients (8%) were admitted for recurrence. Of 135 patients with unilateral tonsillectomy, 3 patients (2%) were admitted for recurrence. In the group of patients with recurrence of peritonsillar complications, tonsillectomy was performed in all children, and in 86% of adults. Bleeding after tonsillectomy was found in 22 (7%) adults who had received surgical treatment for peritonsillar complications.
Conclusion:
We prefer penicillin antibiotics for treatment of peritonsillar complications. When choosing the method of peritonsillar abscess drainage, we use an individualized approach considering the patient’s age, overall condition and wishes. The risk of recurrence of peritonsillar complications is about 8-12% for conservative therapy, while tonsillectomy gives a lower risk of disease recurrence, but prolongs hospitalization and carries the risk of postoperative bleeding (7%). We always recommend tonsillectomy in patients with the recurrence of peritonsillar complications.
Keywords:
peritonsillar abscess, peritonsillar phlegmona, quinsy, tonsillitis
Sources
1. Akin, R. C., Holst, R., Schousboe, L. P.: Risk factors for post-tonsillectomy haemorrhage. Acta Otolaryngol., 132, 2012, 7, s. 773-777.
2 Albertz, N., Nazar, G.: Peritonsillar abscess: treatment with immediate tonsillectomy - 10 years of experience. Acta Otolaryngol., 132, 2012, 10, s. 1102-1107.
3. Beneš, J.: Infekční lékařství. Praha, Galén, 2009, ISBN 978-80-7262-64-1, s. 492-500.
4. Costales-Marcos, M. et al.: Infecciones periamigdalina: estuido prospectivo de 100 casos consecutivos, (Peritonsillar infections: prospective study of 100 consecutive cases). Acta Otorinolaringol. Esp., 63, 2012, s. 212-217.
5. Fryčková, A., Máchalová, M., Šlapák, I.: Krvácení po tonzilektomii a tonzilotomii u dětí. Otorinolaryng. a Foniat. /Prague/, 61, 2012, 1, s. 29-33.
6. Gavriel, H., Golna, Y., Lazarovitch, T., Eviatar, E.: Bakteriology of peritonsillar abscess in patiens over 40 years-a neglected age group. Eur. Arch. Otorinoloaryngol., 272, 2015, 4, s. 981-984.
7. Giger, R., Landis, B. N., Dulguerov, P.: Hemorrhage risk after quinsy tonsillectomy. Otolaryngol. Head Neck Surg., 133, 2005, 5, s. 729-734.
8. Janušková, V., Komínek, P., Mainerová D., Lenert, R., Vantuch, P. Aspirační punkce v léčbě peritonzilárního abscesu II (První zkušenosti). Otorinolaryng. a Foniat. /Prague/, 1999, 3, s. 175-178.
9. Khayr,W., Taepke J.: Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy. Am. J. Ther., 12, 2005, 4, s. 344-350.
10. Komínek, P. a kol., Záněty hltanu, Tobiáš, 2005, ISBN 80-7311-064-4.
11. Komínek, P., Chrobok, V., Pellant, A., Kraus, J., Černý, V., Betka, J.: Krvácení po tonzilektomii – literární přehled (epidemiologie, rizikové faktory, život ohrožující krvácení). Otorinolaryng. a Foniat. /Prague/, 63, 2014, 1, s. 41-49.
12. Komínek, P., Janušková, V., Vantuch, P., Lenert, R., Mainerová, D.: Aspirační punkce v léčbě peritonzilárního abscesu I (Obecná část). Otorinolaryng. a Foniat. /Prague/, 48, 1999, 3, s. 172-174.
13. Marom, T., Cinamon, U., Itskoviz, D., Roth, Y.: Changing trends of peritonsillar abscess. Am. J. Otolaryngol., 31, 2010, 3, s. 162-167.
14. Ono, K., Hirayama, C., Ishii, K., Okamoto, Y., Hidaka, H.: Emergency airway management of patients with peritonsillar abscess. J. Anesth., 18, 2004, 1, s. 55-58
15. Powell, J., Wilson, J. A.: An evidence-based review of peritonsillar abscess. Clin. Otolaryngol., 37, 2012, 2, s. 136-145.
16. Schraff, S., McGinn, J. D., Derkay, C. S.: Peritonsillar abscess in children: a 10-year review of diagnosis and management. Int. J. Pediatr. Otorhinolaryngol., 57, 2001, 3, s. 213-218.
17. Sowerby, L. J., Hussain, Z., Husein, M.: The epidemiology, antibiotic resistance and post-discharge course of peritonsillar abscesses in London, Ontario. J. Otolaryngol. Head Neck Surg., 42, 2013, 1, s. 5.
18. Školoudík, L., Dufek, Z., Vokurka, J., Čelakovský, P.: Krvácení po tonzilektomii. Otorinolaryng. a Foniat. /Prague/, 54, 2005, 1, s. 42-46.
19. Školoudík, L., Dufek, Z., Vokurka, J., Čelakovský, P.: Redukuje harmonický skalpel riziko pooperačního krvácení po tonzilektomii ? Choroby hlavy a krku, 14, 15, 3-4/2005, 1/2006, s. 20-25.
20. Wikstén, J., Hytönen, M., Pitkäranta, A., Blomgren, K.: Who ends up having tonsillectomy after peritonsillar infection? Eur. Arch. Otorhinolaryngol., 269, 2012, 4, s. 1281-1284.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
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