Comparison of Medical Therapy Alone to Medical Therapy with Surgical Treatment of Peritonsillar Abscess

Abstract

Objective This study was performed to determine whether the efficacy and safety of medical management of uncomplicated peritonsillar abscess (PTA) presenting in the emergency department is equivalent to medical plus surgical therapy. Study Design Case series with chart review. Setting Southern California Permanente Medical Group (SCPMG). Subjects and Methods Upon successful completion of a prospective study comparing medical treatment (MT) to surgical treatment (ST) of PTA in 2008, MT was adopted by 12 SCPMG centers while 7 centers continued standard surgical drainage. Clinical outcomes are now reviewed on a random sampling of 211 patients with PTA treated with MT and 96 patients treated with ST between 2008 and 2013 at the respective medical centers. Patients were treated with intravenous (IV) fluids, weight-appropriate IV ceftriaxone, clindamycin, and dexamethasone, and then discharged on clindamycin × 10 days (MT). Patients in the ST group received MT but also surgical drainage. Primary end points were complication rates and failure rates. Results MT and ST resulted in no significant difference in treatment success or complications. However, patients in the MT group obtained significantly less liquid opioid prescriptions (MT, 30.8 ± 5.65; ST, 77.75 ± 13.41; P < .0001), reported fewer sore days (MT, 4.48 ± 0.27; ST, 5.77 ± 0.49; P = .0004), and required less days off from work (MT, 3.4 ± 0.44; ST, 4.9 ± 0.82; P = .044). Conclusions Compared to ST, MT appears to be equally safe and efficacious, with less pain, opioid use, and days off work, especially if patients with PTA present without trismus. MT for PTAs reduces the possibility of surgical complications, as well as the cost and inconvenience associated with ST.

Bilateral peritonsillar abscess: a case series

“…If medical treatment is proven to be effective even in bilateral PTA, it can improve the patients' comfort, save costs and reduce procedural risks. 14 In addition to intravenous antibiotics, a short course of glucocorticoids could also beneficial in reducing the edema of upper airway and relieving pain. However, the role and benefits of glucocorticoids in treating PTA remained controversial with conflicting evidence.…”

Approach to otolaryngology emergency in COVID-19 pandemic

“…Meanwhile, however, patients should be closely observed in terms of progression of infection and complications which may develop. [48] While abscess drainage is possible through the mouth in peritonsillar and retropharyngeal abscesses, incisions made from the outside to provide access to the area related and the abscess drainage is performed in other situations. For the interventions made through the neck, it is recommended to place the drain and ensure the drainage of the region in the following days.…”

Quinsy in Adult: Clinical Profile and Management Challenges in Two Tertiary Hospitals Northwest Nigeria

“…Quinsy an old term also known as Peritonsillar abscess (PTA) is an accumulation of pus in the potential space between the capsule of the tonsil and the pharyngeal constrictor muscle [1,2]. It is the most common deep neck space abscess and a common cause of ENT admissions worldwide, with significant morbidities and occasionally mortality [3][4][5].…”

“…Medical management, Needle aspiration (NA), Incision and drainage (I&D) and Quinsy tonsillectomy can all be employed in treating PTA [8,[21][22][23][24]. Over time the trend has moved from the more aggressive methods like quinsy tonsillectomy to more conservative methods such as treatment with medications alone [2,7]. Quinsy tonsillectomy is removal of the tonsils at the time of PTA [8,21].…”

“…Medical management with antibiotics, analgesics, hydration and steroids is now being favored by many authors [2]. They argue that less invasive methods still work, and antiinflammatory agents reduce the inflammatory process, leading to faster recovery.…”