Clinical Study of 162 Cases of Peritonsillar Abscess Diagnosed by Contrast-Enhanced Computed Tomography

Abstract

In this retrospective clinical study of peritonsillar abscesses, we reviewed the data of 162 patients (116 males and 46 females) with peritonsillar abscess aged 8 to 86 years (mean age, 37.0 years) who had been diagnosed by contrast-enhanced computed tomography (CT), hospitalized, and treated for the abscess between January 2017 and December 2022. The abscess occurred on the left side in 72 (44.4%) patients, on the right side in 80 (49.4%) patients, and bilaterally in 10 (6.2%) patients. The abscess was of the superior oval type on 85 (49.4%) sides, the superior cap type on 41 (23.8%) sides, the inferior oval type on 25 (14.5%) sides, and the inferior cap type on 21 (12.2%) sides. Among 111 patients, bacteriological examination of the abscess fluid for the causative bacteria yielded 78 causative strains, including 24 strains of aerobic bacteria, predominantly Streptococcus pyogenes (51.6%), and 47 strains of anaerobic bacteria; the remainder were mixed bacterial strains. Bacterial resistance rates to antibiotics were as follows: 5.8% for piperacillin, 3.4% for ceftriaxone, 2.6% for meropenem, 11.5% for clindamycin, 28.6% for levofloxacin, and 15.4% for minocycline. Of the 162 patients, 83 (48.3%) were treated by incision, 25 (14.5%) by puncture, 62 (36.0%) with antibiotics, and 2 (1.2%) via abscess tonsillectomy. The most frequently used antibiotics (87.2% cases) were ampicillin/sulbactam combined with clindamycin and/or dexamethasone. The peritonsillar abscess recurred in 14 (8.6%) patients, and the recurrence occurred within 3 months of the initial onset in 8 (57.1%) of these patients. In conclusion, contrast-enhanced CT should be performed to accurately diagnose the location, size, and shape of a peritonsillar abscess and select the optimal treatment.